Mariano Nieves
Seminole
Summary
Experienced billing technician with 7 years of experience in claims, billing, processing and payor coordination. Eager to to expand expertise in patient accounts for claim analysis, patient billing, and effective reimbursement strategies to excel and contribute towards the revenue of Indian Health Service. Committed to ensuring HIPAA standards are in all work presented.
Overview
8
8
years of professional experience
Work History
Billing -Patient Financial Rep II
BayCare
08.2023 - Current
- Improved billing quality by applying increased attention to detail when processing and submitting and timely claims to Medicaid, commercial and third party payors.
- Demonstrated strong problem-solving skills by auditing accuracy of medical coding and resolving complex billing issues.
- Developed a comprehensive understanding of various payer requirements and policies, resulting in fewer denied claims due to insufficient documentation or coding errors.
- Protected the integrity of deadlines by monitoring daily work tasks to be delegated accordingly.
Appeals-Non Contracted Patient Financial Rep II
BayCare
11.2022 - 08.2023
- Achieved successful appeal outcomes by meticulously reviewing and analyzing claim denials, identifying errors, and presenting persuasive arguments.
- Implemented effective time management strategies, consistently meeting deadlines for claim submission and follow-up activities.
Appeals-Contracted Plans Patient Financial Rep II
BayCare
04.2021 - 11.2022
- Reduced claim denial rates with thorough pre-appeal reviews, identifying potential issues before submission.
- Developed strong relationships with healthcare providers, insurance companies, and regulatory agencies to facilitate successful outcomes in the appeals process.
Concentrator Technician
Quality Biomedical
05.2020 - 04.2021
- Enhanced equipment performance by conducting regular maintenance and troubleshooting tasks.
- Increased customer satisfaction with prompt and knowledgeable support for various technical issues.
Appeals Specialist
Parallon Business Performance Group
01.2017 - 05.2020
- Expedited resolution times for appeals cases by efficiently managing workload and prioritizing urgent matters.
- Reduced claim denial rates with thorough pre-appeal reviews, identifying potential issues before submission.
Education
Associates - Computer Electronics
Remington College
Tampa, FL01.2007
High School Diploma -
Seminole High School
Seminole, FL05.1999
Skills
- Fully bilingual in Spanish and English
- Billing System proficiency (eg, Soarian, Cerner, SSI)
- Technical issue analysis
- Customer Service & Technical Support
- Auditing & Claims Adjustment
- Insurance Verification & Reimbursement
- Third-Party Billing & Claims Management
- Strong analytical skills
- HIPAA Compliance & Privacy Regulations Knowledge
- Organizational & Time Management Skills
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
References
- Luis Lugo, Power Plant Supervisor, 17 years, (813)-368-9989
- Theodore Hasenstaub, Engineer Contractor, 10 years, (727)-214-4553
Timeline
Billing -Patient Financial Rep II
BayCare
08.2023 - Current
Appeals-Non Contracted Patient Financial Rep II
BayCare
11.2022 - 08.2023
Appeals-Contracted Plans Patient Financial Rep II
BayCare
04.2021 - 11.2022
Concentrator Technician
Quality Biomedical
05.2020 - 04.2021
Appeals Specialist
Parallon Business Performance Group
01.2017 - 05.2020
Associates - Computer Electronics
Remington College
High School Diploma -
Seminole High School
Similar Profiles
Brooke KashtanBrooke Kashtan
Nurse Apprentice at BayCareNurse Apprentice at BayCare
Erika Jones RT(R)Erika Jones RT(R)
Cardiovascular Technologist at BaycareCardiovascular Technologist at Baycare
Jasmine WashingtonJasmine Washington
Registered Nurse, Medical-Surgical Unit at BayCareRegistered Nurse, Medical-Surgical Unit at BayCare