Marisela Calzada
Fort Worth,Texas
Summary
- Experienced revenue cycle management professional with extensive experience in administration, accounts receivable, and customer service. Surpasses metrics established in department. Skill set include but not limited; - Extensive knowledge of revenue cycle operations: collections, billing, payment processing, reconciliation, and appeals. - Time management and facilitation. - Professional Appearance - Ability to prioritize to work in an effective and organized manner to meet deadlines without jeopardizing customer service. - Referrals: outgoing and incoming - Experience in coordinating events, presentations, and meeting facilitating. - Variance report review to determine plan discrepancies and identify payor trends. - Flexibility to transition into different roles depending on business need of busy medical centralized billing facility. - Experience with Medicaid, Medicare, and all commercial payers. - Scheduling of staff as well as assisting with payroll to account for correct department billing. - Detail oriented to avoid any delays or errors when communicating between clinical staff and business staff for coordination of patient care. - Demonstrates Business Acumen - Qualified Spanish Interpreter
- - certified through THR. - Certified Medical Interpreter- TIN
Overview
17
17
years of professional experience
Work History
Reimbursement Analyst
Cook Children's Physician Network
Fort Worth, Texas
01.2024 - Current
- Responsible for payment variance activities related to the incorrect processing of claims
- Validating underpayment variances and taking appropriate resolution steps, tracking underpayment recoveries, trending underpayments by payer and issue and successfully recovering underpaid amounts as efficiently as possible
- Working under the direction of the Reimbursement Manager, to assist in troubleshooting system proration problems, payer issues and contract-related discrepancies
- Collaborative communication with payor relations to track any trends with denials, underpayments, or any other issues so that all problems can be resolved, and reimbursement optimized
- Review adjustments requested by central billing staff as well as clinic management to approve if correct, or decline if more review is required.
Freelance Spanish Interpreter
Translation and Interpretation
08.2023 - Current
- Accept/Decline assignments based on availability
- Translate Spanish to English and English to Spanish INP, virtually, and over the phone
- Manage invoicing, accounts payable, receivable
- Provide excellent customer service to patients, providers, clients, and support staff.
Freelance Spanish Interpreter
MasterWord
06.2023 - Current
- Accept/Decline assignments based on availability
- Translate Spanish to English and English to Spanish INP, virtually, and over the phone
- Manage invoicing, accounts payable, receivable
- Provide excellent customer service to patients, providers, clients, and support staff.
Community Health Billing Coordinator
Texas Health Resources
12.2021 - 08.2023
- Review daily charges to ensure accuracy: payer, billing, coding
- Work directly with program director in all administrative asst
- Duties
- Ensure all services provided meet strict grant guidelines: cite location, services provider, provider servicing restrictions
- Revenue integrity: provide accurate fee schedules for departments based of CMS/TMHP contractual rates
- Review patient demographics and income verifications to confirm grant eligibility
- Monthly itemization review to ensure validity
- Review time off request to approve or decline depending on staff availability and to ensure PTO is tracked accurately with payroll as well as to ensure all being billed to correct cost center
- Review and verify invoices received from various vendors to ensure prompt payment
- Coordinate with vendors for any contract updates/changes
- Maintain real-time balances for all grants
- Update Mobile Sharepoint with recent data and upcoming events
- Assist with patient access duties in case of staff changes: data entry, registration, benefits verifications, confirmations calls, end of day reconciliation
- Implement and train for new workflow with new grants: privately funded as well as state funded
- Member of QM committee for BCCS grant for which I assist and facilitate external and internal audits
- Vendor contract renewal and contract re-negotiations
- Qualified Bilingual Interpreter: Spanish to English/ English to Spanish as of June 2022.
Patient Accounts Rep II
Texas Health Resources
10.2019 - 12.2021
- Reviewing Queues on a daily basis: Charge Entry, Claim Edits, Credits, Follow Up, Retro Review, and Router Review to guarantee revenue
- Implementation of new process: SB1264 Mediations: Work hand in hand with CBO director, management, and Texas Department of Insurance
- Train team on new process and provide them with new updated workflows and policies to ensure maximum productivity
- Verifying eligibility and benefits
- Reviewing claims if there seems to be an overpayment and if required forwarding to be refunded or requesting needed adjustments
- Answering questions from CS department pertaining to patient billing
- Coordinating with patient to guarantee we are billing correct payer
- Initiating the mediation process with Texas Department of Insurance for claims that were underpaid
- Coordinating with mediators to guarantee prompt payment for their services
- Reviewing all accounts to make sure they are mapped to correct department: contracted, non-contracted, refunds
- Continuing education on Epic to make sure claims are resolved correctly.
HPTN Coordinator / Front Office Supervisor
Baylor Scott & White Health/HTPN
Dallas, Texas
05.2018 - 10.2019
- Reviewing Queues on a daily basis: Charge Entry, Claim Edits, Credits, Follow Up, Retro Review, and Router Review to guarantee revenue
- Training front desk staff to improve workflow
- Coordinating scheduling for providers with hospital staff, referring clinics, and our partnering organizations
- Daily end of day deposits: making sure all money matches our collection log, deposit slips, entering into corporate database, and prepping for weekly pick-up deposits
- Accounts payable: requesting payments for all clinic expenses from corporate
- Verifying insurance prior to patient appointment
- Re-bill any rejected claims to avoid non-payments or denials for timely filing per payer guidelines
- Appeal wrongfully denied claims with supporting documentation
- Verify referrals and authorizations are up to date, in systems, and attached to claims
- Obtaining retro authorizations/certifications and notify corresponding physician staff to make sure one is obtained for future visits
- Review time off request to approve or decline depending on staff availability and to ensure PTO is tracked accurately with payroll
- Charge entry: to ensure the month end is updated with all visits entered, billed and cleared for processing
- Maintain communication with patient access for proper patient billing: charity pending
- Follow account aging guidelines to forward to external collection agency
- Review accounts for credits: distribute money or request refunds if applicable
- Make outgoing/receive outgoing calls to have patients update any demographics as well as answer any questions in regards to statements/account activity
- Adhere to SLA guidelines to meet goals per department
- Coordinate with practice administration and multi-specialty billing to resolve all issues in a timely and efficient manner to avoid revenue losses.
Care Team Associate
Wellmed- United Health Group
12.2017 - 05.2018
- Review incoming faxes from the server to forward to the correct department while meeting productivity guidelines
- Initiate authorization and forward to management for final approval
- Daily census reports of inpatient stays, skilled nursing stays, rehabilitation stays: called corresponding facilities to update the report to send back to management
- Communication between case management and facilities to secure clear and concise information for a better flow of patient care and payer practices
- Forward correspondence to facilities via mail, fax, and verbal for approvals and denials to guarantee speedy notification to avoid delay in patient care
- When reviewing the fax server making sure all incoming faxes were uploaded to the correct member chart while following correct HIPAA guidelines.
Patient Financial Counselor II
Texas Oncology
Dallas, Texas
09.2014 - 11.2017
- Greet and meet with every new patient as well as at initiation/change to any treatment: infusion, chemotherapy, and radiation
- Review benefits with the patient and set up insurance correctly to avoid delays in authorization, treatment, and reimbursement
- Assist patients with MASH, in-house assistance/charity, foundation assistance, and indigent status
- Work Hold Report for claims that have not been paid or unable to be sent out by clearing house
- Data entry: physician billing for hospital patients
- Coordinate referrals for patients when required by insurance plan
- Make sure all chemotherapy regimens and radiation therapy are approved by the insurance company with any pre-certifications/pre-authorizations obtained prior to the initiation of treatment
- Enter all paperwork into various systems making sure all HIPAA laws and standard protocols are followed
- Review cost estimates for each new treatment to avoid any surprise billing for patients and set up payment plans if needed or assist patients by finding other methods of payment for high-cost treatments
- Meet with benefit reps from the pharmaceutical companies to stay updated on the assistance available to patients based on needs and insurance guidelines.
Business Office Supervisor
Andrew Burke DO
Dallas, Texas
07.2013 - 09.2014
- Payment posting both electronically and manually for all major insurance companies as well as patient payments
- Follow up on non-payments
- Re-bill any rejected claims to avoid non-payments or denials for timely filing
- Appeal wrongfully denied claims
- Referral
- Obtained authorizations from insurance companies for procedures/testing that require it
- Front desk management.
Insurance Specialist
Urology Associates of North Texas
Arlington, Texas
10.2012 - 06.2013
- Review A/R for 12 physicians
- Follow up on denial report and appeal claims in accordance with billing guidelines
- Follow up with office managers by monitoring claims that were denied based on errors of reception staff
- Communication with biller to prevent a spike in denials
- Correct any claims for rebilling.
Medicaid Billing and Collections Representative
Dallas Life Support Systems
North Richland Hills, Texas
11.2011 - 10.2012
- Submit claims on TMHP.com for an immediate response on secondary claims
- Scrub claims on a daily basis to make sure claims billed correctly from the get-go
- Work directly with Medicaid biller to prevent denials based on authorizations
- Follow up with any denials and correct for proper and prompt payment
- Review title XIX for correct authorizations on supplies.
Business Office Representative
Texas Pulmonary and Critical Care Consultants
Arlington, Texas
08.2007 - 11.2010
- Manage patient collections: set up payment plans, charity, or sent to collections
- Appeal claims in a proper and prompt manner in accordance with contract guidelines
- Followed up on all EOB including filing
- Process and post patient payments
- Manage patient collections: set up payment plans, charity, or sent to collections
- Enter patient demographics from hospital patients to bill for physician services
- Filled in for receptionist at two office locations
- Attend collection seminars.
Education
Associate of the Arts -
Tarrant County College
12.2018
Diploma in Medical Insurance Billing and Coding -
Everest College
Fort Worth, TX06.2007
Skills
- Appeals Handling
- HIPAA Compliance
- Healthcare Reimbursement
- Claims Processing
- Microsoft Excel proficiency
- Insurance Verification
- Denial Management
- Medicare knowledge
- Medicaid Expertise
- Revenue Cycle Management
- Medical Billing
- Payment posting
- Microsoft Office
- Client Service
- Data Recording
- Medicaid knowledge
- Clerical writing
- Bookkeeping
- Copay Collection
- Eligibility Verification
- Administrative writing
- Teamwork and Collaboration
- Customer Service
- Problem-Solving
- Time Management
- Attention to Detail
- Problem-solving abilities
- Multitasking
- Multitasking Abilities
- Organizing and Prioritizing Work
- Reliability
- Excellent Communication
- Critical Thinking
- Organizational Skills
- Team Collaboration
- Effective Communication
- Adaptability and Flexibility
- Relationship Building
- Decision-Making
- Documentation skills
- Data Entry
- Claims adjustment
- Reporting skills
- Task Prioritization
- Excellent administrative abilities
- Medical Terminology
- Interpersonal Skills
- Analytical Thinking
- Prior authorization processing
- Documentation abilities
- Insurance Claim Forms Review
- Policy Review
- Coverage Determination
- Documentation processing
- Insurance Coverage Verification
- Continuous Improvement
- Written Communication
- Understanding of medical terms
- Denied claims identification
- Eligibility Determination
- Claim Amount Calculations
- Application Review
- Collaborative relationships
- Financial Transactions
- Professional Demeanor
- Problem-solving aptitude
- Data Entry Software
- Data Integrity
- Patient Rapport
- Information Verification
- Billing Software
- Account Management
- Payment and Investigation Escalations
- Regulatory Compliance Adherence
- Patient contact
Languages
Spanish
Native or Bilingual
Timeline
Reimbursement Analyst
Cook Children's Physician Network
01.2024 - Current
Freelance Spanish Interpreter
Translation and Interpretation
08.2023 - Current
Freelance Spanish Interpreter
MasterWord
06.2023 - Current
Community Health Billing Coordinator
Texas Health Resources
12.2021 - 08.2023
Patient Accounts Rep II
Texas Health Resources
10.2019 - 12.2021
HPTN Coordinator / Front Office Supervisor
Baylor Scott & White Health/HTPN
05.2018 - 10.2019
Care Team Associate
Wellmed- United Health Group
12.2017 - 05.2018
Patient Financial Counselor II
Texas Oncology
09.2014 - 11.2017
Business Office Supervisor
Andrew Burke DO
07.2013 - 09.2014
Insurance Specialist
Urology Associates of North Texas
10.2012 - 06.2013
Medicaid Billing and Collections Representative
Dallas Life Support Systems
11.2011 - 10.2012
Business Office Representative
Texas Pulmonary and Critical Care Consultants
08.2007 - 11.2010
Associate of the Arts -
Tarrant County College
Diploma in Medical Insurance Billing and Coding -
Everest College