Mary Ramos

Assisted in Tribal billing, followed specific guidelines and procedures for healthcare services provided to American Indian and Alaska Native populations, particularly through IHS Tribal Program's, under Washington Apple Health billing procedures. Billed Mental Health, Opid Treatment Program (OTP) and (MAT) Medication-assisted Treatment, billed for Substance Use Disorder (SUD) billed for group & individual counseling sessions.

Process refunds to patients, process letters from Insurances requesting a refund . Access to payer websites to pull EOB backup for refunds/ Apply AR Codes . Work closely with AP Dept . Maintain & work spreadsheets as needed. Maintain relationship with insurance vendors/ clients, for clear concise communication on refunds. Submit any disputes or invalid deductions/adjustment/ credits on accounts. Assist in auditing and any special projects as needed.

Follow up on accounting activity to resolve account balance. Correct payment per insurance contract make any adjustment and post any payments, verify if referral/auth is needed, and obtain. Take member calls and research accounts. Bill claims/resubmit corrected claim when needed. Follow up on all commercial plans/Medicare/Medicaid. Bill all MVA/Crime Victims/Work Comp, work all AR for timely billing.

• Call center environment, managed patient phone calls for billing inquiries, ensuring timely resolution of account discrepancies.
• Facilitated insurance verification processes to confirm eligibility and coverage details. assist in financial assistance application process.
• Processed patient payments efficiently, maintaining accurate financial records.
• Collaborated with healthcare providers to resolve billing issues and improve patient satisfaction.

Work claim edits in EMR/ Epic. bill claims electronically through Epremis software, hold any claims that require authorization. Billed Commercial payers/Government Payers. Familiar with provider portals OHP/Availity/Noridian/ Medicare CWF/-Ability.

Register and schedule new intakes. Verify insurance benefits for SLP/OT/ PT. Obtain authorization. Bill insurance claims/follow on claims/post payments. Balance batch/prepare bank deposit. Counsel patients on payment plans as needed.

Evaluated patient financial situations to determine eligibility for assistance programs.

Educated patients on financial options, insurance coverage, and payment plans.

Collaborated with healthcare providers to resolve billing discrepancies and enhance patient experience.

Billed HB/PB on UB-04 /HCFA 1500 claim form.

Billed electronically through Epremis software, research & update insurance payers. Mailed paper claims to appropriate payers.

Worked failed claims report, Corrected claim errors and resubmitted claims. Worked special billing projects assigned, managed work queues assigned.