Maydey Acosta
Miami,FL
Summary
Reliable business professional with experience in project management, process improvement and financial analysis. Proven track record of successfully streamlining business operations and reducing costs. Adept at analyzing data to identify trends and developing strategies to improve efficiency. Forward-thinking Operations Specialist bringing seventeen years of expertise in HIM for Healthcare sector businesses. Cultivates rapport with individuals to optimize project goals and output, resolve complex problems and deliver innovative improvement strategies. Proficient in healthcare systems. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
18
18
years of professional experience
Work History
HIM Specialist
Ensemble Health Partners
2023.03 - Current
- Secured confidential patient information from unauthorized access.
- Studied and researched various medical terms as well as software and coding systems.
- Upheld HIPAA regulations and standards for protecting patient information.
- Retrieved medical data for physicians and patients.
- Performed regular quality and validation assessments on patient data to verify accuracy.
- Generated medical reports on patient admissions, treatment and discharge for disbursement to various departments.
- Participated in committees to discuss electronic health records and methods to improve overall workflows.
- Collaborated closely with physicians and nursing staff to improve quality of patient records documentation.
- Conducted education and training activities for physicians, nursing staff and administrative personnel.
- Catalogued patient data in clinical databases and registries according to regulatory practices.
- Followed all company policies and procedures to deliver quality work
- Listened and responded to customer requests and forwarded necessary information to superiors
- Interpreted clients' needs and introduced services to fit specific requirements
- Assisted with staff training to enforce quality, safety and sanitation guidelines
- Followed all company policies and procedures to deliver quality work.
- Improved customer satisfaction rates through proactive problem-solving and efficient complaint resolution.
- Collaborated with cross-functional teams to achieve project goals on time and within budget.
- Conducted thorough research to identify trends and inform decision-making for business growth initiatives.
- Implemented new training programs for staff, leading to higher employee retention rates and better overall performance.
- Monitored industry trends to adapt strategies accordingly.
Charge Capture Specialist
Nicklaus Children's Hospital
2018.07 - 2023.03
- Catalogued patient data in clinical databases and registries according to regulatory practices.
- Retrieved medical data for physicians and patients.
- Performed regular quality and validation assessments on patient data to verify accuracy.
- Upheld HIPAA regulations and standards for protecting patient information.
- Generated medical reports on patient admissions, treatment and discharge for disbursement to various departments.
- Identified issues, analyzed information and provided solutions to problems.
- Skilled at working independently and collaboratively in team environment.
- Responsible for proper training of physician on how to create proper EMR.
- Audit medical records for varies department in daily bases and contact physicians requesting missing information for proper EMR.
- Secured confidential patient information from unauthorized access.
- Studied and researched various medical terms as well as software and coding systems.
- Verified accuracy of accounts payable payments, resulting in 98% reduction in payment errors.
- Coded medical records using Encoder Pro coding structure.
- Reviewed billing sheets to obtain daily service charges
- Implemented efficient workflow processes for expedited charge submission, resulting in improved cash flow.
- Demonstrated exceptional attention to detail when entering patient demographic information, reducing errors that could impact reimbursement rates.
- Developed strong working relationships with providers to effectively communicate charge capture best practices and requirements, fostering an environment of teamwork and collaboration.
Senior Medical Biller
Miami Jewish Health System
2015.05 - 2018.05
- 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
2012.11 - 2015.04
- 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 [Software].
- 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
2011.02 - 2012.09
- 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
2010.04 - 2011.02
- 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
2008.07 - 2009.09
- 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 III
Mercy Hospital
2007.10 - 2008.07
- 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
2006.12 - 2007.09
- 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 - HIM
Kaiser University
Fort Lauderdale, FL09.2024
Medical Administration - Medical Billing And Coding
New Professions Technical Institute
Coral Gables, FL06.2006
High School Diploma -
Institute Camilo Cienfuegos
La Habana, Cuba06.1998
CRCR - CRCR
Health Financial Management Association
Mimai01.2024
Skills
- Expert Problem Solving
- Documentation Management
- Management collaboration
- Technical communication
- Proficient in Cerner, PEDS, Citrix
- Teamwork and Collaboration
- Time Management
- Attention to Detail
- Organizational Skills
- Analytical Thinking
- Team building
- Data Analysis
- Project Planning
- Decision-Making
- Process Analysis
- Team Collaboration
- Process Improvement
Timeline
HIM Specialist
Ensemble Health Partners
2023.03 - Current
Charge Capture Specialist
Nicklaus Children's Hospital
2018.07 - 2023.03
Senior Medical Biller
Miami Jewish Health System
2015.05 - 2018.05
Senior Medical Collector
University of Miami Miller School of Medicine
2012.11 - 2015.04
Collections Coordinator
Miami Children's Hospital
2011.02 - 2012.09
Charge Poster
Miami Children's Hospital
2010.04 - 2011.02
Financial Representative III
Mercy Hospital
2008.07 - 2009.09
Financial Representative III
Mercy Hospital
2007.10 - 2008.07
Medical Billing / Coder – Front Desk
Financial Health Network Inc
2006.12 - 2007.09
Associate of Arts - HIM
Kaiser University
Medical Administration - Medical Billing And Coding
New Professions Technical Institute
High School Diploma -
Institute Camilo Cienfuegos
CRCR - CRCR
Health Financial Management Association
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