Maria Vanegas
Irving,Texas
Summary
To establish myself in a reputable company where able to turn a job into a career and through training and experience become an asset to myself and the company. Resourceful Specialist offering expertise in problem-solving, data analysis and customer service. Adept at quickly learning new technologies and processes for driving success. Proven track record of successfully managing multiple projects and developing innovative solutions. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
21
21
years of professional experience
Work History
Remittance Specialist, Charge Specialist and Appeals Coordinator
McEwen & Associates
08.2015 - Current
- Review clinical notes, diagnostic results, and other patient documentation to determine appropriate ICD-10, CPT, and HCPCS codes for billing
- Ensure timely and accurate submission of medical claims to insurance companies
- Handle denials, rejections, and appeals in a timely manner to maximize revenue
- Stay updated with the latest changes in coding guidelines, payer policies, and industry standards
- Review and analyze medical records to ensure accurate coding and billing
- Assign appropriate ICD-10, DRG, and other coding classifications to medical procedures and diagnoses
- Verify patient insurance coverage and process claims for reimbursement
- Follow up on unpaid claims and resolve billing discrepancies
- Maintain patient confidentiality and adhere to HIPAA regulations
- Collaborate with healthcare providers to obtain necessary documentation for billing purposes
- Stay updated on changes in coding guidelines and regulations
- Collaborate with the clinical team to obtain necessary documentation for accurate coding
- Post all payments and adjustments for multiple providers daily via lock box, incoming mail, and EFT downloads.
Eligibility Benefits Coordinator
Macarthur Medical Center
04.2013 - 01.2015
- Verification of insurance benefits for Gynecology calculation of patient liability estimates, notate accounts and notify patients of estimated amount due at time of service
- Verification of facilitation of authorizations when required
- Verification of insurance benefits for Obstetrics calculation of patient liability estimates to then generate payment plan breakdown of maternity fees with deductible as well as percentages
- ECI cases, Complete and submit forms for emergency medical certification for ER drop in follow up on case status.
- Explained benefits to plan participants in easy-to-understand terms in order to educate each on available options.
- Managed leave administration process, including FMLA requests, ensuring proper documentation and communication with employees.
- Streamlined benefits enrollment process for improved accuracy and reduced administrative workload.
Quality Control, Customer Service
Production Resource Group
06.2006 - 01.2013
- Perform routine clerical and data entry functions within Sales operations or Servicing departments
- Processes paperwork, gathers and verifies data and transfers data into a standard format
- Generates correspondence and routine reports, answers incoming telephone calls, responds to routine customer inquiries, and performs a variety of clerical duties.
- Managed a high volume of customer inquiries, demonstrating excellent problem-solving skills to resolve concerns quickly.
- Responded to all customer inquiries thoroughly and professionally.
- Supported continuous improvement initiatives by participating in internal meetings aimed at identifying areas for growth or optimization.
Data Entry Processor and Sales
A&W Distributors
05.2003 - 02.2006
- Performs a variety of duties associated with preparation and entry of data into the computer system, including charges, payments, refunds.
- Managed documents by organizing forms, making photocopies, filing records, preparing correspondence, and creating reports.
- Improved overall efficiency by suggesting updates to existing data entry procedures and adopting new technologies where applicable.
Education
High School Diploma -
High School (9th – 12th)
Dallas, TX05.2001
Associate of Arts - Medical Billing & Coding
Everest College
Dallas12.2005
Skills
- Customer Relations
- Expert Problem Solving
- Documentation Management
- Quality Assurance
- Data Analysis
Timeline
Remittance Specialist, Charge Specialist and Appeals Coordinator
McEwen & Associates
08.2015 - Current
Eligibility Benefits Coordinator
Macarthur Medical Center
04.2013 - 01.2015
Quality Control, Customer Service
Production Resource Group
06.2006 - 01.2013
Data Entry Processor and Sales
A&W Distributors
05.2003 - 02.2006
High School Diploma -
High School (9th – 12th)
Associate of Arts - Medical Billing & Coding
Everest College
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