Mayra Silva
Houston,TX
Summary
To obtain a position in an industry that allows me to utilize and enhance my job skills, and in conjunction with my strong will and determination, allows this to be a contributing factor to the success of the organization.
Overview
18
18
years of professional experience
Work History
Claims and Benefits Denial Specialist
Memorial Pulmonary and Sleep Disorder
02.2017 - Current
- Correct denied claims by updating correct CPT code, DX code, or add modifier when applicable and resubmit claim for payment
- Work all denials accordingly and promptly by correcting the issue that caused denial which may be due to incorrect insurance billed, modifier issues, and hospice denials
- Fax or mail medical records as needed for dates of service asked
- Adjust accounts that may deny due to past prompt filing, authorizations, and referrals if applicable
- Follow-Up on appealed claims and sent claims that are pending payment
- Upkeep the allowable sheet and update due to insurance allowable changes for sleep study, durable equipment supplies and office visit
- Able to communicate and or negotiate problematic accounts
- Invoice outside parties about incoming requests
- Collects and manages patient payment plans and accounts
- Use critical thinking skills, organize, and respond to urgent or emergent situations
- Decision in making skills based on correct information and/or analysis of data
- Knowledgeable in all medical Commercial and Government insurance plans
- Ability to remain calm and professional in stressful situations
- Understand payer EOBs and find posting errors of payment and adjustment
- Performs proper follow-up with payor for payment as appropriate
- Payment Posting and Matching
- Resolve all payments with missing Explanation of Benefits (EOB)
- Close and update daily payment batches
- Identify accounts that require refunds
- Familiar with HIPAA and PHI guidelines
PATIENT COORDINATOR
Memorial Hermann Hospital Systems
12.2006 - 02.2017
- Coordinate patient-care services to offer quality care
- Managed approximately 30 incoming calls, emails and faxes per day from customers.
- Counseled patients regarding potential financial assistance eligibility and the process application
- Collects financial information from patient and other sources
- Completes financial assistance calculation worksheets and submits for appropriate level of approval
- Contacted and educated patients on matters related to insurance benefits and payment options or collects past balances including bad debt
- Answers any questions posed by the patient related to a billing or financial concern
- Registered and scheduled patients for all modalities in the outpatient imaging center and handled the collection of co-pays, deductibles or made proper payment arrangement if approved by manager
- Verified medical benefits for copays and deductible for Ultrasounds, CT scans, MRI’s and advised patient of amount due at time of service and assured all orders had correct CPT and diagnosis codes
- Placed hospital bad debt accounts as needed with collections vendors
- Received hospital clean-up project spreadsheets that obtained over two hundred accounts and adjusted accounts accordingly due to past timely filing, patient discount, or claim denial
- Reviewed patient accounts for charity approval and adjusted accounts that were approved
- Worked with collection vendors to updated patient insurance information and bill charges
- Verified patient insurance for eligibility and benefits.
Education
Bachelor in Health Information Management - Health Information Management
Southern New Hampshire University
ManchesterAssociates in Healthcare Management - Healthcare Management
The College of Healthcare Profession
Houston, TX10.2023
Skills
- Claim Denial/Appeals
- Billing
- Insurance Verification
- Knowledge of CPT and ICD-9 code
- Trizetto Clearinghouse
- Attention to Detail
- Payment Posting
- Epic
- E-Clinical
- Customer Service
- Bilingual in Spanish
- Time Management
- Multitasking
Timeline
Claims and Benefits Denial Specialist
Memorial Pulmonary and Sleep Disorder
02.2017 - Current
PATIENT COORDINATOR
Memorial Hermann Hospital Systems
12.2006 - 02.2017
Bachelor in Health Information Management - Health Information Management
Southern New Hampshire University
Associates in Healthcare Management - Healthcare Management
The College of Healthcare Profession
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