Maria Cantu
Corpus Christi,Texas
Summary
Brings proven track record of success in determining eligibility and resolving complex cases. Works professionally with clients to develop and implement successful strategies for maximizing services and benefits. Skilled in problem-solving and identifying solutions meeting clients' needs. Supportive Eligibility Specialist with extensive application engagement and dedicated service skills. Bilingual professional with skill to maintain accurate records, schedule appointments and handle various administrative responsibilities.
Overview
22
22
years of professional experience
Work History
Authorization Specialist II
Randstad / Superior Health Plan/ Centene Corp
10.2022 - Current
- Improved patient satisfaction by streamlining authorization processes and ensuring timely responses to inquiries.
- Enhanced departmental efficiency with thorough knowledge of insurance guidelines and medical terminology.
- Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
- Reduced processing times by effectively managing a high volume of authorizations, referrals.
- Initiate authorization requests for outpatients services in accordance with the prior authorization list
- Route to appropriate staff when needed.
- Verify eligibility and benefits.
- Process faxes within established standards, follows up outbound calls.
- Data enters authorizations into the system.
- Reach out to Provider for necessary information.
- Assist with CCR department when needed which is attaching clinical's to inpatient hospitals authorization's and sending out task to the owners of that authorization.
Medical Coder /Medical Coding and Billing Specialist
Rapid Radiology
02.2019 - 09.2021
- Increased coding accuracy by diligently reviewing medical documentation and applying appropriate codes.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Maintained a high level of productivity while consistently meeting deadlines for claim submissions.
- Promoted teamwork within the department through effective communication and collaboration on complex cases.
- Collaborated with physicians to obtain necessary documentation, improving claim approval rates.
- Assist patients with statements and understand balances on accounts. Understanding their explanation of benefits.
- collect balances over the phone.
- Post Patients, Facility, or insurance payments.
Medical Biller and Coder
Abdominal Specialist Of South Texas
08.2017 - 11.2018
- Correctly coded and billed medical claims for inpatients offices and colonoscopy and endoscopy
- Reduced claim denials through meticulous verification of patient eligibility and coverage benefits prior to claim submission.
- Worked closely with physicians to accurately assign ICD-10 diagnostic codes for optimal reimbursement rates from insurance companies.
- Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.
- Post Insurance payments paper or EFT and patients payments
- Send out statement to patients.
- Verify benefits fo colonoscopy and endoscopy with all medical, medicaid and medicare benefits and phone patients with their responsibility and collect payments.
- Work on aging reports with insurance appeals.
- Assist with prior authorizations and referral
Medical Office Coordinator
Dr. Roger Sifuentes
05.2011 - 12.2016
- Enhanced patient satisfaction by streamlining appointment scheduling and managing office communications.
- Reduced wait times for patients by implementing efficient check-in and check-out procedures.
- Improved medical team collaboration by coordinating schedules, meetings, and conferences.
- Increased office efficiency with effective management of medical records and documentation.
- Ensured compliance with regulatory standards by maintaining up-to-date knowledge on healthcare policies and procedures.
- Coordinated referral processes smoothly, facilitating seamless transitions between primary care providers and specialists when needed.
- Stayed current on latest industry trends and advancements allowing for proactive adaptation of best practices within the medical office.
- Supported billing staff by making corrections to invoices and insurance submissions.
- Maintained updated list of employee credentials and notified staff when professional licenses and certifications approached expiration.
- Processed new office referrals to correct agencies within 24 hours of receiving notice.
- Maintained patient databases and updated information in alignment with HIPAA protocols.
- Received, recorded and filed medical payments by check, cash, and credit card.
- Verified benefits and worked with insurance companies to obtain payments.
- Coordinated luncheons with Pharmaceutical Representatives.
- Pulled charts and prepared for nurse and doctor assessment.
- Improved customer satisfaction scores through application of superior conflict resolution and problem-solving skills.
- Responsible for all medical billing and coding in the medical office.
- Post all insurance pavements paper or eft's and patients payments daily.
- Daily close reports and making daily bank deposit's.
Insurance Specialist
ABC Pediatrics
05.2007 - 06.2010
- Enhanced customer satisfaction by addressing insurance-related inquiries and resolving issues promptly.
- Processed eligibility and benefits verification and authorization requests.
- Followed up on denials, late payments, extensions and other special circumstances.
- Tracked pending authorizations to resolve discrepancies and avoid revenue loss.
- Reduced claims processing time by effectively collaborating with adjusters, claimants, and internal departments.
- Improved operational efficiency by developing procedures for processing claims, payments, and endorsements.
- Trained new hires on company policies and procedures, ensuring a seamless transition into the Insurance Specialist role.
- Responded to customer calls swiftly to resolve issues and answer questions.
Medical Collections Specialist
Corpus Christi Women's Clinic
05.2002 - 05.2007
- Established clear expectations for payment arrangements, minimizing misunderstandings between patients and the practice.
- Negotiated payment plans with patients, ensuring timely payments and reducing financial strain on the practice.
- Improved patient satisfaction by promptly addressing and resolving medical billing disputes.
- Assisted patients with understanding their financial responsibilities, easing concerns about complex medical bills.
- Reduced errors in billing documentation by implementing a rigorous quality control system.
- Collaborated with insurance companies to expedite claims processing and secure timely reimbursements.
- Updated patient records accurately to ensure seamless coordination between departments and minimize delays in treatment or billing.
- Reviewed aging reports regularly to prioritize collection efforts strategically based on account status and risk level.
- Corrected, completed and processed claims for multiple payer codes.
- Maintained accurate records of customer accounts, payments and payment plans.
- Worked with customer to create debt repayment plan based on current financial condition.
Education
Medical Insurance - Medical Office Computer Specialist
Southern Careers Institute Inc
Corpus Christi, TX03.2002
GED -
Del Mar College
Corpus Christi, TX05.1989
Skills
- Claims Management
- Medical terminology expertise
- Medical coding knowledge
- Insurance Verification
- Data entry proficiency
- Prior authorization processing
- Appointment Scheduling
- Microsoft Office
- Verbal Communication
- Data Entry
- Medicaid knowledge
- Telephone Etiquette
- Authorizations understanding
Timeline
Authorization Specialist II
Randstad / Superior Health Plan/ Centene Corp
10.2022 - Current
Medical Coder /Medical Coding and Billing Specialist
Rapid Radiology
02.2019 - 09.2021
Medical Biller and Coder
Abdominal Specialist Of South Texas
08.2017 - 11.2018
Medical Office Coordinator
Dr. Roger Sifuentes
05.2011 - 12.2016
Insurance Specialist
ABC Pediatrics
05.2007 - 06.2010
Medical Collections Specialist
Corpus Christi Women's Clinic
05.2002 - 05.2007
Medical Insurance - Medical Office Computer Specialist
Southern Careers Institute Inc
GED -
Del Mar College
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