MARILU TORRES
Chicago,Illinois
Summary
Dedicated Reimbursement Specialist with 27 years of extensive experience in processing, managing, and resolving healthcare insurance claims. Proven track record in delivering accurate and efficient reimbursement services while prioritizing customer satisfaction. Expertise includes navigating complex claim issues, understanding diverse insurance policies, and ensuring timely resolution of payment discrepancies. Recognized for exceptional organizational skills and strong problem-solving abilities, complemented by a deep understanding of healthcare billing codes and regulations.
Overview
28
28
years of professional experience
Work History
Physician Reimbursement Specialist
Associates in Nephrology
03.1997 - 01.2025
- Insurance Verification and Prior Authorization: Verified insurance benefits and obtained prior authorization for procedures and services as required by payers, ensuring compliance with payer-specific guidelines and timely reimbursement.
- Payment Processing: Managed patient payments over the phone, processed payments efficiently, and provided clear explanations regarding patient balances and insurance coverage.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Posted payments to accounts and maintained records.
- Utilized electronic health record systems to maintain accurate patient documentation and improve information accessibility.
- Knowledgeable with following healthcare systems: Acumen Epic, Acumen Rounder, WPS, Cerner (AmitaHealth), Braintree, Availity and Outsource and well familiar with Popular health insurance (Blue Cross Blue Shield, Humana, Cigna, Aetna and many others.) MS Word and MS EXCEL.
Medical Biller
Associates in Nephrology
03.1997 - 01.2025
- Vascular, MCP and Hospital Billing: Extensive experience with MCP billing for outpatient and inpatient services, utilizing the EPIC system to accurately code, submit, and follow up on claims, ensuring maximum reimbursement.
- System Access and Integration: Set up and maintained access to various hospital systems (Advocate Hospital, Northwest Community, and Amita Hospitals), ensuring smooth and secure user access for staff.
Electronic Medical Record Specialist
Associates in Nephrology
09.2005 - 09.2012
- Medical Records Request Management: Processed medical records requests from insurance companies and third-party medical record companies, ensuring timely and accurate delivery in accordance with HIPAA regulations..
- Led initiatives to streamline electronic documentation processes, reducing administrative burdens.
- Maintained accuracy, completeness, and security for medical records and health information.
- Followed up with medical staff regarding missing information in patient records.
- Utilized electronic medical record systems to store, retrieve and process patient data.
- Scanned and uploaded medical records into electronic medical records system.
- Reviewed medical records for completeness and filed records in alphabetic and numeric order.
- Tracked and monitored requests for medical records release.
Medical Billing Supervisor
Associates in Nephrology
09.2003 - 09.2010
- Supervised daily operations of medical billing team, ensuring compliance with regulations and standards.
- Developed training programs for new staff, enhancing knowledge of billing procedures and software systems.
- Implemented process improvements that increased efficiency in claims submissions and follow-ups.
- Conducted regular audits of billing practices, identifying discrepancies and ensuring accurate revenue capture.
- Goal to educate staff to helping improve accuracy and reduce claim rejections.
- Analyzed billing reports to identify trends, providing strategic insights for operational enhancements.
Education
High School Diploma -
Curie High School
BA -
DEVRY University
Skills
- ICD-10 Coding
- CPT Coding
- HIPAA Compliance
- Revenue Cycle Management
- Medical Terminology
- Electronic Health Records
- Claim Denial Resolution
- Insurance Verification
Languages
English
Spanish
Timeline
Electronic Medical Record Specialist
Associates in Nephrology
09.2005 - 09.2012
Medical Billing Supervisor
Associates in Nephrology
09.2003 - 09.2010
Physician Reimbursement Specialist
Associates in Nephrology
03.1997 - 01.2025
Medical Biller
Associates in Nephrology
03.1997 - 01.2025
High School Diploma -
Curie High School
BA -
DEVRY University
Availability
- Worked Remote/Hybrid