MARIA RAMIREZ
Garland,TX
Summary
Experienced Reimbursement Specialist dedicated to ensuring clients receive due compensation for insurance claims. Proficient in use of Epic and Excel for client information input and billing. Confident and competent in negotiations and policy analysis.
Overview
8
8
years of professional experience
Work History
Reimbursement Analyst
RCM Technologies
04.2024 - Current
- Coordinates the maintenance and updates of all computer software tables and programs related to Reimbursement and variances
- Managed high volume caseloads effectively while maintaining strict deadlines for submission of claims or appeals documentation.
- Streamlined claims processing for increased efficiency and accuracy in reimbursements.
- Supported team members by sharing expertise in reimbursement methodologies and payer contracts analysis.
- Performs periodic reimbursement audits to determine if the system is being used to its full potential and to ensure contract compliance
- Complete written report of audit findings utilizing standard report formats
- Performs self-review of audit reports for tone, content, grammatical and technical accuracy, and completeness in accordance with department reporting standards
- Coordinates the preparation of reports in a timely and accurate manner
- Maintains up-to-date knowledge of current and emerging information regarding our payer contracts, Medicare legislation, regulations, market activity and industry trends and provides timely and effective communication of same to insurance leaders
- Researches and analyzes issues using tools such as the Internet, Medicare bulletins, CMS Web site and coding guides
- Provides training to the team on system usage and upgrades and outcomes of payment variance reporting.
- Maintains independence and objectivity related to assignments
- Boosted financial performance by identifying trends and recommending improvements to reimbursement procedures.
- Managed 45 accounts daily with minimum of 95% QA score
- Other duties as assigned
Accounts Receivable Assistant
National Partners In Healthcare
11.2022 - 04.2024
- Assists the A/R team with daily tasks to ensure claims and appeals are filed promptly with all required information.
- Mailed out paper claims with anesthesia records and/or associated EOBs.
- Received and completed requests for medical records and load them onto payor portals for payment.
- Managed legal inquires, completion of affidavits, and invoicing related to requests on patient accounts.
- Prepared and sent out mailings and packages.
- Answered and directed phone calls as needed.
- Used PHI and PPM billing systems daily.
- Maintained good work habits while exercised effective decision -making skills to accomplish goals and problem solve issues.
- Worked over 60 accounts daily.
Hospital Accounts Receivable Specialist
Steward Health Care
10.2021 - 10.2022
- Worked to facilitate resolution of past due patient accounts by working with insurance companies, government agencies and patients for payment for services that have been already provided.
- Ability to properly research account issues, resulting in account resolution.
- Established and maintained relationships with individual payer provider relations representatives to resolve collections issues with patient accounts.
- Prioritized and worked assigned accounts to obtain prompt payment from payer.
- Demonstrated accounts receivable claims problem solving.
- Demonstrated ability to escalate problem accounts to management as required by circumstances.
- Recorded information about financial status of customers and status of collection efforts.
- Demonstrated ability to communicate effectively on phone, in writing and via email.
- Demonstrated ability to interpret policies and procedures and communicate effectively, adapt to fast-paced environment and learned and retained new or evolving information and procedures.
- Submitted appeals to payer by using established guidelines to resolve claim denials and followed up on appeals in timely manner.
- Worked well under stress and pressure and respond to inquiries with tact, diplomacy and patience.
- Demonstrated knowledge of medical terminology, insurance billing and reimbursement, and coding.
- Ability to navigate through different patient accounting systems and billing/claim submission software.
- Managed over 45 patient accounts per day while maintaining accuracy of over 95%
Program Coordinator
Superior Health Plan Inc
01.2021 - 06.2021
- Conducted 50 daily outbound call requirement to members to completed Health Risk Assessment, Emergency Disaster plan and COVID 19 Screening.
- Assist in activities related to medical and psychosocial coordination care.
- Initiate authorization requests for output or input services.
- Research claims for alternative numbers for members.
- Perform tasks such as scheduling appointments for members, mail out educational materials and CM letters.
- Screen for eligibility. Identifying members without PCP and referred them to Member Services. Screened members by priority for case management assessment.
- Made outbound calls to member's PCP, power of attorney and other medical providers for information pertaining to member.
- Data entered assessments and authorizations into system for case manager review.
Patient Contact Assistant
Schumacher Clinical Partners, TSG Resources, Inc
01.2018 - 01.2021
- Provide billing ledgers to attorneys upon request.
- Update patient registration demographics and medical insurance.
- Bill insurance and adjust hospital balances.
- Preformed bankruptcy and hospital charity write offs.
- Signed certification of billing records and subpoenas.
- Answered phone calls regarding billing issues and attorney concerns.
- Prepared and scanned all processed credit cards, electronics, inter-office correspondence, and mail received.
- Exceeded in completing daily production requirements.
- Managed over 45 accounts per day.
Data Entry Clerk
Medix
11.2016 - 12.2017
- Entered numerical data into databases in timely and accurate manner.
- Obtained scanned records and uploaded them into database.
- Reviewed medical records for completeness and filed record s in alphabetic and numeric order.
- Added new material to file records and created new records.
- Reviewed and updated client correspondence files and scheduling database.
- Assisted with receptionist duties, file organization and research and development.
- Managed over 50 accounts per day.
Education
Associate of Science -
Richland Community College
Dallas, TX2020
Associate - Medical Assisting
Concorde Career College
Dallas, TX2016
Skills
- Bilingual
- Independent worker
- Problem Solving
- Time Management
- Verbal and Written Communication
- Denial Management
- Revenue Cycle Management
- Financial Calculation and Analysis
- Healthcare Reimbursement
- HIPAA Compliance
- Appeals Handling
- Microsoft Excel proficiency
- Root Cause Analysis
Timeline
Reimbursement Analyst
RCM Technologies
04.2024 - Current
Accounts Receivable Assistant
National Partners In Healthcare
11.2022 - 04.2024
Hospital Accounts Receivable Specialist
Steward Health Care
10.2021 - 10.2022
Program Coordinator
Superior Health Plan Inc
01.2021 - 06.2021
Patient Contact Assistant
Schumacher Clinical Partners, TSG Resources, Inc
01.2018 - 01.2021
Data Entry Clerk
Medix
11.2016 - 12.2017
Associate of Science -
Richland Community College
Associate - Medical Assisting
Concorde Career College
Similar Profiles
Hope SatsumaHope Satsuma
Pediatric Registered Nurse at RCM TechnologiesPediatric Registered Nurse at RCM Technologies
SARAH TWUMSARAH TWUM
Direct Support Professional Caregiver at RCM TechnologiesDirect Support Professional Caregiver at RCM Technologies
Niyah MaugeNiyah Mauge
Paraprofessional at RCM TechnologiesParaprofessional at RCM Technologies