Mariedet Leano
West Covina,CA
Summary
Highly experienced and detail-oriented medical biller with over 10 years of expertise in the medical field. Possessing a deep understanding of medical insurance practices, proficient in ICD-10 and CPT coding. Exceptional communication skills enable effective collaboration with patients, healthcare providers, and insurance companies. Strong organizational abilities and problem-solving acumen to navigate the intricacies of medical billing for seamless execution of billing processes with utmost precision and efficiency. Thrives in collaborative environments as a team player, capable of working independently to meet deadlines and achieve goals.
Overview
8
8
years of professional experience
Work History
Medical Billing Liaison and Billing Manager
M3 Physical Therapy
10.2018 - 08.2024
- Gained extensive experience at different sites for M3 Physical Therapy, including the West LA and West Hills Clinic, spanning from 2018 to 2024.
- Coordinated communication among insurance companies and insured patients to address co-payment, co-insurance, deductible, out-of-pocket expenses, and approval information.
- Managed and organized audits, RX. prior authorizations, and diverse medical documentation like Super Bill, doctor's notes, medical records, and subpoena requests for patients, clinics, court orders, and lawyers.
- Trained and mentored staff on procedures, compliance requirements, and collections techniques.
- Managed and oversaw all aspects of out-of-network claims, including coding, billing, filing, and follow-ups on claims and appeals/denials.
- Managed communication with patients regarding outstanding balances.
- Implemented effective measures by transferring delinquent patients to collections when previous attempts at payment collection were unsuccessful.
- Ensured accurate financial tracking by verifying the origin of money for all electronic and paper checks received at the West Hills and LA clinics.
- Maintained clinic's compliance with APTN, Optum, ASH,C AQH and Medicare standards for all insurances
- Managed patient refunds in compliance with Medicare, state programs, and PPO plans' regulations and guidelines for deductibles and out-of-pocket maximums.
- Addressed and resolved billing issues, enhancing patient satisfaction.
Front Desk Receptionist and Medical Biller
South Baylo University
01.2018 - 06.2018
- Managed insurance patients by communicating with various insurance companies to obtain co-pay and approval details. Also responsible for handling Super Bill, doctor's notes, medical records, and subpoena requests from patients, clinics, court orders, and lawyers.
- Managed monthly reporting process for clinic finances by tracking individual patient payments, pharmacy expenditures, daily patient count, and diagnosis information.
- Communicated with patients regarding insurance, appointments, physicians' schedules, and clinic details.
- Managed monthly reporting process for clinic finances by tracking individual patient payments, pharmacy expenditures, daily patient count, and diagnosis information.
- Managed efficient patient flow by greeting and registering 50-100 walk-in and appointment patients daily, ensuring timely filling out of paperwork.
- Managed monthly reporting process for clinic finances by tracking individual patient payments, pharmacy expenditures, daily patient count, and diagnosis information.
- Handled cash transactions as a cashier for patient copays, pharmacy purchases, and outstanding payments.
- Managed monthly reporting process for clinic finances by tracking individual patient payments, pharmacy expenditures, daily patient count, and diagnosis information.
- Managed monthly reporting process for clinic finances by tracking individual patient payments, pharmacy expenditures, daily patient count, and diagnosis information.
Medical Biller and Pharmacy Tech
Uptown Drug & Gift Shop
01.2017 - 01.2018
- Handled the submission of claims to various insurance companies and payers, including Medicare and Medicaid.
- Ensured accurate determination of eligibility and benefits for a range of medications.
- Ensured timely follow-up on unpaid claims within billing cycle timeframe
- Prepared, reviewed, and transmitted claims using billing software for both electronic and paper claim processing.
- Ensured accuracy and contract discount adherence for each insurance payment
- Managed and effectively addressed patient or insurance telephone inquiries using computer software system
- Monitored and ensured timely processing of pending insurance payments from various providers
- Efficiently addressed inquiries from diverse healthcare professionals and individuals requiring prescriptions
- Determined suitable medications and accurately measured dosages for fulfilling prescriptions
- Processed prescriptions electronically to ensure completeness and accuracy of information.
- Assisted healthcare providers and patients in-person and over the phone, addressing inquiries, requests, and providing referrals to the pharmacist.
- Managed record-keeping system by ensuring documentation of physicians' orders and prescriptions.
- Managed and updated prescription information in the computer system Rx30
- Maintained adherence to regulations and guidelines established by Medicare, state programs, and PPO plans.
Education
Other - Medical Billing and Coding
American Career College
Los Angeles, CA12.2018
Other - Pharmacy Tech
American Career College
Los Angeles, CA12.2006
High School Diploma -
Harvest Christian Academy
Los Angeles06.2003
Skills
- Medical Billing Management
- Billing System Expertise
- Billing and Collections
- ICD-10 and CPT
- Full Cycle Paper and Electronic Claims
- QuickBooks
- Auditing
- Microsoft Excel
- Microsoft Word
- Administrative Skills
- Computer skills
Timeline
Medical Billing Liaison and Billing Manager
M3 Physical Therapy
10.2018 - 08.2024
Front Desk Receptionist and Medical Biller
South Baylo University
01.2018 - 06.2018
Medical Biller and Pharmacy Tech
Uptown Drug & Gift Shop
01.2017 - 01.2018
Other - Medical Billing and Coding
American Career College
Other - Pharmacy Tech
American Career College
High School Diploma -
Harvest Christian Academy
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