M ELENA ROMERO

• Resolves inaccurate payments with insurance carriers that are not in compliance with payer contracts or governmental agency rates on individual accounts.
• Utilizes specialized knowledge of contracts, regulatory or contractual billing guidelines to determine an account's ability to pay after initial rejection from the payer.
• Coordinates duplicate billings, coordination of benefits, medical records and clinical documents as needed to expedite payment of insurance claims.
• Assists Patient Accounting Rep III with the planning and organizing of departmental activities as needed.
• Analyzes underpayments and overpayments to identify root causes and examines claims to ensure payers are complying with contractual agreements.
• Collaborates with payer contracting and other areas of the revenue cycle, if necessary, to resolve issues pertaining to a claim payment.
• Communicates directly with payers to follow up on outstanding claims and resolve payment variances, responds to payer inquiries and concerns, and works to develop and maintain positive relationships with payers.
• Helps to work and resolve accounts from other staff members' workloads to prevent backlogs and fills in as needed for absent staff.
• Responsible for account follow-up for all assigned accounts.
• Maintains system work queues based on electronic payers' error reports as assigned, including but not limited to DNB, Claim Edits, Front-End Rejections, No Response from payers, Variances, Underpayments and Overpayments.

• Check- in and check-out patients, Collect copay, deductible, coinsurance and outstanding balances. Schedule appointments for follow up care, well woman exams, prenatal care, in office procedures and ultrasounds.
• Efficiently and accurately gather and input patient/guarantor demographics and financial information.
• Explain financial agreement for global maternity care and pre-collect monthly payments.
• Balance and close daily batch of all money collected.
• Prepare reconciliation report to submit daily deposit.
• Obtain authorization for diagnostic tests, maternity global care, IUD insertion and removal on Availity.
• Verify benefits for family planning. Prepare new patient and new pregnancy packets.
• Acts as a liaison between the physician, patient and insurance companies to include obtaining referrals and/or authorizations.
• Assist with answering incoming calls. Scheduling new patient and follow up appointments.

• Efficiently and accurately gather and input patient/guarantor demographic and financial information.
• Responsible for scheduling for two cardiologists.
• Check-out patients, schedule diagnostic tests and follow-up appointments.
• Collect payment for services rendered.
• Perform daily reconciliation of all money collected. Assist with phones and cover check-in counter.
• Maintains basic understanding of the medical needs during the screening process for scheduling an appointment.
• Consistently and constantly reviewing the schedules daily and communicates all changes to providers, staff and other departments.

Billing Duties

• Handled revenue cycle process for all payers.
• Electronic and paper claim filing, claim status follow-up, manual and electronic posting of all insurance and patient payments, balance and close daily batch and prepare bank deposits.
• Work aged trial balance and open claims reports.
• Send monthly statements for patients outstanding balance.
• Set up payment arrangements, review outstanding accounts, send accounts to collection agency and code accounts in the system.
• Assist in the training of new employees and setting their daily goals.

Front office support duties

• Covered check-in counter, obtained patient's medical history, and confirmed patients files were accurate and complete.
• Covered check-out counter, collect copay and previous balance. Schedule follow-up appointments. Post daily charges, close daily batch and prepare bank deposit.
• Cover phone operator, answer incoming calls, schedule appointments, verify insurance eligibility and benefits.
• Run Encounter Resolution reports daily.