Maydey Acosta
Miami,FL
Summary
Resourceful Specialist offering expertise in problem-solving, data analysis and customer service. Adept at quickly learning new technologies and processes for driving success. Proven track record of successfully managing multiple projects and developing innovative solutions.
Overview
19
19
years of professional experience
Work History
HIM Specialist
Ensemble Health Partners (Nicklaus Health Client)
03.2023 - Current
- Recruited and hired top-performing individuals bringing undeniable experience and wealth of skills to organization.
- Collaborated closely with physicians and nursing staff to improve quality of patient records documentation.
- Participated in committees to discuss electronic health records and methods to improve overall workflows.
- Retrieved medical data for physicians and patients.
- Secured confidential patient information from unauthorized access.
- Upheld HIPAA regulations and standards for protecting patient information.
- Generated medical reports on patient admissions, treatment and discharge for disbursement to various departments.
- Coded and abstracted medical records according to ICD-10-CM and CPT coding guidelines.
- Performed regular quality and validation assessments on patient data to verify accuracy.
- Used strong analytical and problem-solving skills to develop effective solutions for challenging situations.
- Identified issues, analyzed information and provided solutions to problems.
- Managed time efficiently in order to complete all tasks within deadlines.
- Catalogued patient data in clinical databases and registries according to regulatory practices.
Charge Capture Specialist
Nicklaus Children's Hospital
07.2018 - 03.2023
- Verified correct revenue and productivity action notations for billing.
- Reviewed billing sheets to obtain daily service charges.
- Worked with clinical departments to maintain complete, accurate and compliant charge capture functions.
- Collaborated closely with physicians and nursing staff to improve quality of patient records documentation.
- Retrieved medical data for physicians and patients.
- Performed regular quality and validation assessments on patient data to verify accuracy.
- Catalogued patient data in clinical databases and registries according to regulatory practices.
- Generated medical reports on patient admissions, treatment and discharge for disbursement to various departments.
- Managed time efficiently in order to complete all tasks within deadlines.
Senior Medical Biller
Miami Jewish Health System
05.2015 - 05.2018
- Delivered timely and accurate charge submissions.
- Kept vendor files accurate and up-to-date to expedite payment processing.
- Created improved filing system to maintain secure client data.
- Adhered to established standards to safeguard patients' health information.
- Audited and corrected billing and posting documents for accuracy.
- Prepared billing statements for patients and verified correct diagnostic coding.
- Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
- Filed and updated patient information and medical records.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
- Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
Senior Medical Collector
University of Miami Miller School of Medicine
11.2012 - 04.2015
- Responsible for the daily operations of follow-up, appeals, and denials of transplants work queues
- Maintains all collection activities for government payers and manage care
- Obtain payments by contacting insurance carriers regarding accounts not paid within a predetermined time
- Understand reimbursement methodologies involving multiple procedure guidelines, add on codes, Surgery modifier and fee schedule reimbursement.
- Responsible for reviewing and understanding all EOB’s denials codes received from the insurance companies and taking appropriate actions (appeals, underpaid accounts, adjustments, or refunds), submission of medical records upon insurance request.
- Researched billing errors and discrepancies to initiate corrective action.
- Logged charges and payments within Excel .
- Corrected, completed and processed claims for multiple payer codes
- Responded to customer inquiries and provided detailed account information
- Established relationships with customers to encourage payment of delinquent accounts
- Located customers with overdue accounts and solicited payment in compliance with fair debt collection practices
Collections Coordinator
Miami Children’s Hospital
02.2011 - 09.2012
- Contacts guarantors to motivate them to provide additional information required for payment
- Contacts responsible parties to request payment
- Demonstrates knowledge of managed care contract language, governmental regulations, and the contract reimbursement matrix when resolving issues on accounts
- Collection activity specialist for Medicaid patients
- Documents all collection activities immediately following contact, concisely, completely, and accurately in the hospital system
- Maintains and makes collection efforts on 1200-1400 patient accounts per month
- Pursues payment until account is resolved
- Resolves complex payment issues in a timely manner
- Generated revenue for the hospital by making payment arrangements, collecting accounts, and monitoring and pursuing delinquent accounts
- Identified interdepartmental process flow problems and makes suggestions for efficiencies.
Charge Poster
Miami Children’s Hospital
04.2010 - 02.2011
- Complies with HIPAA (Health Information Portability and Accountability Act of 1996) concerning all aspects of maintaining strict confidentiality of every patient, medical record, or report
- Maintains production standards according to set targets
- Makes all adjustments and/or corrections to claims from reviewing journals, pre-edits, errors or unprocessed billing reports
- Matches and collates all manual CMS-1500 forms
- Reviews all manual CMS-1500 forms for complete and accurate information
- Attaches all pertinent information to manual bills prior to forwarding to the payor
- Bills patient accounts electronically as required by third party payor
- Posts co-payments, deductibles, or any other payments received by the physician offices to the appropriate accounts and encounters
- Processes, in a timely and accurate way, charge tickets and any billing of all patient accounts for medical services to the correct account
- Reconciles charges and payments received from office
- Reviews each bill for complete and accurate data for both new and established patients
- If bill is incomplete, requests information needed to complete
- Once data is received, completes that data
- Verifies benefits and obtains authorizations, as required
- Complies with all third party payor requirements for verifications and authorizations and methods of applying the requirements.
- Communicated with supervisors on insurance issues, trends and reimbursement setbacks affecting cash flow by monitoring insurance accounts.
- Supported month-end close activities and processes.
- Presented audit findings to accounting manager after reviewing results and paperwork.
- Prepared and generated claims by completing data entry of correct information.
- Identified and corrected billing errors and obtained missing information for smooth claims payment.
- Reviewed and followed up on outstanding insurance claims.
Financial Representative III
Mercy Hospital
07.2008 - 09.2009
- Collected for government payers – Medicare and Medicaid as a secondary
- Adjusted accounts to ensure accuracy with contracts using PMMC
- Checked patient’s status on the DDE and followed-up on accounts
- Balanced charges and payments
- Handled customer service for self-paid patients and insurance telephone inquiries
- Analyzed accounts to determine patients’ true responsibility
- Worked with patients on establishing payment plans, discounts, and agreements.
Financial Representative I
Mercy Hospital
10.2007 - 07.2008
- Prepared daily deposit
- Generated DCR to be sent to management
- Processed billing and submitted daily releases
- Ran the DEP to electronically transmit claims.
Medical Billing / Coder – Front Desk
Financial Health Network Inc
12.2006 - 09.2007
- Processed and handled claims using NDC Lytec
- Submitted claims electronically via ENS Clearinghouse
- Handled billing & coding of pediatric, cardiology, general medicine, and radiology accounts.
- Ensured HIPAA compliance through strict confidentiality.
- Contacted insurance companies and handled demographics/data entry
- Reviewed medical records documentation and accurately coded all diagnoses and procedures using.
- ICD and CPT coding conventions
- Assigned appropriate medical codes with 80 percent accuracy rate.
Education
Associate of Arts - Medical Billing And Coding
Keiser University
Pembroke Pines, FL06-2025
Skills
- Project management
- Quality assurance monitoring
- Medical terminology proficiency
- Information security protocols
- Electronic health records management
- Conflict resolution techniques
- Health records review
- Effective communication
- Proficient in Office 365
- Quality improvement
- Clinical documentation
- HIPAA and HITECH requirements
- Trained in Cerner, Power Chart, Epic
- Accurate documentation
- Health information systems
- Medical coding
Languages
Spanish
Native or Bilingual
English
Full Professional
Timeline
HIM Specialist
Ensemble Health Partners (Nicklaus Health Client)
03.2023 - Current
Charge Capture Specialist
Nicklaus Children's Hospital
07.2018 - 03.2023
Senior Medical Biller
Miami Jewish Health System
05.2015 - 05.2018
Senior Medical Collector
University of Miami Miller School of Medicine
11.2012 - 04.2015
Collections Coordinator
Miami Children’s Hospital
02.2011 - 09.2012
Charge Poster
Miami Children’s Hospital
04.2010 - 02.2011
Financial Representative III
Mercy Hospital
07.2008 - 09.2009
Financial Representative I
Mercy Hospital
10.2007 - 07.2008
Medical Billing / Coder – Front Desk
Financial Health Network Inc
12.2006 - 09.2007
Associate of Arts - Medical Billing And Coding
Keiser University
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