Maria Garcia
Woodburn,OR
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented with over 20 years of medical billing and coding experience. Certified in medical auditing.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Medical Audit Specialist II
SAIF Corporation
2022.04 - Current
- Audit complex bills.
- Process out-of-state hospital bills to ensure proper payment is applied. Calculate out-of-state fee schedules.
- Manage target audits and system updates.
- Complete DME request authorization letters.
- Process L-Cost bills.
- Assist with auditor staffings.
- Provide assistance to Senior Medical Auditor.
- Participation on manual committee/updates.
- Assist auditors with audit and inquiries.
- Process pharmacy transactions.
- Point person for IS issues impacting MARS, web component emails, provider portal/BOL inquiries.
- Handle provider calls/inquiries.
- Request refunds.
Medical Auditor II
SAIF Corporation
2016.02 - 2022.03
- Audit level 1 bills.
- Assisted Senior Medical Auditor with new staff training and mentoring auditors.
- Performed QC on auditors and auto-reviewed system bills, also provided feedback.
- Identified billing/coding errors by providers.
Office Administrator
Woodburn Vision Source
1997.06 - 2016.01
- Reconciled accounts/bills and produced monthly reports.
- Managed billing and coding to ensure insurance payments.
- Trained new front desk hires.
- Assisted in preparation and processing of payroll.
- Managed and properly accounted for daily petty cash, payments, and deposits.
- HIPAA compliance officer.
- Managed the doctors' credentialing and insurance contracts.
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
- Established team priorities, maintained schedules and monitored performance.
Education
High School Diploma -
Woodburn High School
Woodburn, OR06.1995
Skills
- Training and mentoring
- Medical auditing
- Medical billing/coding
- Knowledge with DCBS and OAR's
- Team leader
Certification
CPMA and Insurance Claims Adjuster certifications.
Timeline
Medical Audit Specialist II
SAIF Corporation
2022.04 - Current
Medical Auditor II
SAIF Corporation
2016.02 - 2022.03
Office Administrator
Woodburn Vision Source
1997.06 - 2016.01
High School Diploma -
Woodburn High School
CPMA and Insurance Claims Adjuster certifications.
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