Summary
Overview
Work History
Education
Skills
Timeline
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Maximina (Maxine) Hernandez

Franklin Park,IL

Summary

Detail conscious, thorough, resourceful, self-motivated, quick learner, who adapts easily to new and changing professional situations Seasoned Medical Reimbursement Specialist with more than 6 years of experience in fast-paced billing and collecting environment. Excellent communication skills both oral and written; strong interpersonal and organizational abilities. Track record of achieving exceptional results in Commercial and Governmental insurance reimbursements and patient satisfaction.

Overview

7
7
years of professional experience
1
1
Language

Work History

Patient Account Representative, dba

DuPage Medical Group, Midwest Physicians Administrative Services
Downers Grove, IL
07.2014 - 03.2016
  • Properly and effectively review, monitor and follow-up on all outstanding medical insurance balances including filing of appeals on a timely manner for all
  • Commercial, Managed Care, Liability and Government payers as well as constant review of all payer policies and procedures for the purpose of proper billing and obtaining maximum reimbursement
  • Daily follow-up of accounts pending resolution /payment from medical insurance carriers including using methods such as calling, mailing or on-line submissions of supporting documentation and appeal whenever applicable and always abiding by HIPPA law
  • Constant monitoring of incoming monies from insurance carriers for the purpose of identifying necessary money transfers between accounts and/or refunding insurance over-payments
  • Clearly documenting in the Epic system any action taken before completely closing any balance
  • Daily communication with the Customer Service Representatives regarding patient complaints when it refers to patient balance disputes so as to resolve the complaint in a timely manner and thus maximize patient satisfaction
  • Work closely and in constant communication with clinical and Coding personnel in an effort to reduce billing errors.

dba

ELMHURST MEMORIAL HEALTHCARE, Elmhurst Clinic
Elmhurst, IL
03.2012 - 07.2014
  • Accurately and timely “scrubbing” and filing of Commercial, Managed Care and State of IL claims as well as collecting monies on the same including any patient balances thus maximizing reimbursements
  • Accurately and timely process claim according to policy and payer regulatory insurance guidelines
  • Work closely and in constant communication with clinical and Coding personnel in an effort to reduce billing errors
  • Responsible for documenting all billing and collection activity on accounts in a clear and concise manner
  • Submit commercial, managed care and governmental claim appeals within the timely filing periods to ensure maximum reimbursements
  • Daily follow-up of accounts pending resolution thru NextGen tasking system for both patient and insurance issues
  • Identify and prepare refund request for patients as well as insurance payers
  • Maintain constant communication with patients regarding insurance verification, patient demographic information and collection of outstanding patient balances
  • Apply internal and external adjustments, moving of insurance / customer monies whenever applicable so as to correct and close any human error discrepancies.

dba

ELMHURST MEMORIAL HEALTHCARE, Elmhurst Clinic
Elmhurst, IL
01.2009 - 02.2012
  • Analyze and research patient and insurance credits to properly maintain accurate account payment information
  • Thoroughly review and analyze insurance and patient credits using NextGen and Refund Manager; make necessary corrections and reallocate monies to outstanding balances if necessary
  • Research of supporting insurance documentation for the purpose of verifying accurate payment entries
  • Manually populate information on check format using QuickBooks, print checks, prepare for mailing and electronically transmit file to the bank
  • Import and export patient refund information between NextGen and
  • Quickbooks to then balance amounts between the two systems and notify the Accounting Department of results in report format
  • Responsible for maintaining blank check stock used for issuing refunds
  • Maintain good communication with the Accounting Department when it refers to voided checks, stop payments, unable to find forwarding mailing address and refund reports
  • Document unsolicited as well as solicited refund information in the BlueCross BlueShield Electronic Refund Management system and weekly monitoring of the same
  • File appeals and contact insurance companies regarding recoupment for the purpose of collecting outstanding balances on accounts
  • Back-up to the Cash Management Department
  • Contact patients for the purpose of verifying demographics and insurance verification.

Billing and Collections Specialist

Refunds Representative

Education

High School Diploma -

Proviso East High School

Skills

  • Epic
  • Next Gen Refund Manager Excel

Timeline

Patient Account Representative, dba

DuPage Medical Group, Midwest Physicians Administrative Services
07.2014 - 03.2016

dba

ELMHURST MEMORIAL HEALTHCARE, Elmhurst Clinic
03.2012 - 07.2014

dba

ELMHURST MEMORIAL HEALTHCARE, Elmhurst Clinic
01.2009 - 02.2012

Billing and Collections Specialist

Refunds Representative

High School Diploma -

Proviso East High School

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Maximina (Maxine) Hernandez