MARTA SANTIAGO
East Orange,NJ
Summary
Medical Billing and Coding Specialist with 20 years of providing administrative and patient support in hospital and medical office settings. Advanced knowledge of private and commercial insurance processes and codes. Adhere to data confidentiality and privacy rules in all workflows and promote dynamic interpersonal skills. Knowledgeable medical office professional talented at correcting and resubmitting claims, preparing patient charts, and reviewing health records to identify proper diagnosis codes for billing. Offers background in reviewing, analyzing, and managing medical record information to obtain prior authorizations from insurance companies and ensure payment. Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
17
17
years of professional experience
Work History
Medical Receptionist
New Edge Orthopedics
09.2024 - Current
- Verified Insurance Information, Eligibility and Benefits
- Check if CPT codes are Valid and Billable
- Verified Out Of Network and In Network Benefits
- Contributed to a positive work environment by collaborating effectively with colleagues and supporting team initiatives.
- Checked patient insurance, demographic, and health history to keep information current.
- Assisted healthcare providers with administrative tasks, enabling them to focus on quality patient care.
- Coordinated patient scheduling, check-in, check-out and payments for billing
- Conducted patient intake interviews, recording and documenting relevant information.
- Performed various administrative tasks by filing, copying and faxing documents.
- Greeted and interacted with patients to provide information, answer questions and assist with appointment scheduling.
- Obtained payments from patients and scanned identification and insurance cards.
- Facilitated smooth check-in process, ensuring all necessary paperwork was completed promptly.
- Maintained strict confidentiality of patient records in compliance with HIPAA regulations.
- Reduced no-shows by implementing appointment reminder system through phone calls or text messages.
- Handled billing procedures accurately, ensuring prompt payment from both patients and insurance providers.
- Assisted with medical coding and billing tasks.
- Processed medical insurance claims and payments.
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
Patient Financial Services Representative
Stone Center Of New Jersey
10.2023 - 04.2024
- Assisted patients in understanding their financial responsibilities, guiding them through available payment options and resources.
- Improved patient satisfaction by providing timely and accurate financial information.
- Reduced errors in billing, conducting thorough audits of patient accounts and identifying discrepancies.
- Maintained up-to-date knowledge of insurance regulations, ensuring compliance and minimizing risk of claim denials.
- Contributed to team success by sharing knowledge of best practices in medical billing and coding procedures.
- Developed strong relationships with insurance providers, fostering effective communication to facilitate prompt payment processing.
- Negotiated payment arrangements with self-pay patients, offering flexible solutions that aligned with their financial capabilities.
- Supported transition to electronic billing, ensuring seamless changeover that maintained billing accuracy and timeliness.
- Improved patient trust and confidence, resolving financial disputes and negotiating payment plans tailored to individual needs.
- Maintained accurate records of customer accounts, payments and payment plans.
- Responded to customer inquiries and provided detailed account information.
- Processed debtor payments and updated accounts to reflect new balance.
BILINGUAL SERVICE AGENT
HEALTH FIRST HEALTHPLAN
06.2022 - 05.2023
- Interacting by phone with providers and members in response to inquiries, concerns, and insurance coverage and products Follow-up on inquiries and complaints
- Provide information in response to inquiries, and complaints that require resolution
- Perform research on billing and claims inquiries
- Processed payments and copays function as a liaison between patients and providers
- Manage Inbound and Outbound calls
- Increasing customer retention, monitoring satisfaction levels
- Follow-up on appeals, and denials
- Authorizations, DME products SPH Analytics surveys, Medicare, Medicaid, collect payments, post, co-pays, deductibles, premium
- Daily reports generated in Excel
- Multitasking between programs and completing required data entry of client demographics or client look up systems
- Perform research on billing inquiries and claims to provide payments and refunds
- Research payment and refund issues, other duties as assigned by the management team related to job functions sort incoming faxes, correspondence, fax transportation forms
- Membership, handling dis-enrollments, and escalating issues that require further intervention
- Function as a liaison between various departments to address concerns
CLERICAL ASSOCIATE Level III
BELLVUE HOSPITAL
10.2017 - 04.2022
- EPIC data entry, Patient Registration, Payment processing, Scheduled Follow-up appointments, referrals, Productivity reports daily, and Insurance Verification
- Obtain signatures for general consent forms, HIPAA, and health care proxy and referrals
- Responsible clerical work in maintaining and checking various kinds of records clerical support in health care setting patient care units; as directed by medical staff, prepares, compiles, maintains, files, and/or retrieves patient medical records, requisitions, answers telephones and relays messages to patients and medical staff
- Collect Copays, Pending balances, post in epic
- Daily reports generated in Excel
- Schedule follow-up appointments
- Referrals, Pre-Authorizations
- Medical Records
- Liaison between Physician and patient submitting call in for prescription in EPIC
HOSPITAL CARE INVESTIGATOR
BELLVUE HOSPITAL
01.2008 - 06.2017
- Interview patients to determine their eligibility for medical assistance programs, authorizations
- Review paper and electronic claims for proper and timely submission, follow up with insurance carriers, receive and post payments, and process denials and appeals
- Maximize the hospital Care facility's revenue
- Obtain signatures for HIPAA, consent forms, proxy forms, fee scales, and authorizations for advanced approval to qualify for payment
- Determine the eligibility of applicants for medical assistance payment programs, and responsible relatives to pay for hospital or health care charges take necessary actions to bill and collect for these services; explore alternative sources for payment, hospital or health care services rendered verify, modify, and code demographic and insurance data
- Interviewed applicants and explained the scope of different available benefits.
- Reviewed applications for different aid programs and determined which qualification criteria for individuals.
Education
MEDICAL BILLER AND CODER - Medical Billing And Coding
DEVRY UNIVERSITY
New York, NY12.2022
HIGHSCHOOL DIPLOMA -
CONTINENTAL ACADEMY
MIRAMAR, FL07.2007
Skills
- Microsoft Word Office
Excel
- EPIC
- Medicaid
- Medicare
- Pre-Authorizations
- Time Management
- Critical Analyst
- Detailed Oriented
- Insurance verifications
- Co-payment collection
- Billing Support
- Patient Registration
- Electronic Health Records
- Patient intake procedures
- Billing procedures
- Schedule patients
- Health insurance processing
Accomplishments
- PowerPoint
- Epic System
- Epaces
- Salesforce
- Medical Billing and Coding
- HIPAA
- Insurance Verification Specialist
- Fluent in English and Spanish Verbally, Written
Awards
BRAVO - NYC Health Hospital Excellence Service
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Timeline
Medical Receptionist
New Edge Orthopedics
09.2024 - Current
Patient Financial Services Representative
Stone Center Of New Jersey
10.2023 - 04.2024
BILINGUAL SERVICE AGENT
HEALTH FIRST HEALTHPLAN
06.2022 - 05.2023
CLERICAL ASSOCIATE Level III
BELLVUE HOSPITAL
10.2017 - 04.2022
HOSPITAL CARE INVESTIGATOR
BELLVUE HOSPITAL
01.2008 - 06.2017
HIGHSCHOOL DIPLOMA -
CONTINENTAL ACADEMY
MEDICAL BILLER AND CODER - Medical Billing And Coding
DEVRY UNIVERSITY
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