Melissa Espinoza-Tovar
Medical Billing & Medical Assistant
Pasadena,TX
Summary
Medical Billing & Certified Medical Assistance & Licensed LVN/ LPN focused on team efficiency and
producing high-quality work. Excellent collaborator and relationship-builder familiar with compliance
and documentation requirements. Enthusiastic about taking billing operations to the next level through
proactive leadership and skilled problem solving. Proactive Medical Billing & Medical Insurance with
strong background in financial analysis, budgeting and forecasting. Develops and implements financial
plans and delivers strategic financial advice. Hardworking Billing Manager proficient in overseeing
team operations, implementing improvements and reducing delinquency. Offering 10 years of
experience in Medical and excellent 45 skills. Detail-oriented team player with strong organizational
skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Organized and
dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to
take on added responsibilities to meet team goals. To seek and maintain full-time position that offers
professional challenges utilizing interpersonal skills, excellent time management and problem-solving
skills.
Authorized to work in the US for any employer
Overview
9
9
years of professional experience
1
1
Certification
1
1
Language
Work History
Billing & Coding & Certified Medical Assistance & Licensed LVN
Medical, North Star Medical Group
Houston, TX
01.2017 - 02.2023
- 1
- Minimum of five (5) years Medical Insurance/Healthcare Billing and Collections experience in a medical practice or health system, with a deep understanding of medical billing rules and regulations
- 2
- Two (2) years supervisory or management experience preferred
- 3
- Responsible for all aspects related to insurance claims to maximize revenue streams
- 4
- Provided tenacious follow-up to ensure proper payments were fully collected
- 5
- Followed up timely on all claims to ensure no submission dates were missed
- 6
- Completed necessary appeals and correct claims as needed under strict deadlines
- 7
- Handle monthly statements,payments plans and provide collection support
- 8
- Responsible for analyzing claims and filling secondary claims as needed
- 9
- Audit all Medicaid claims
- 10
- Verified insurance eligibility including contacting both the patient and the insurance corporation by phone on a daily basis as needed to ensure verification
- 11
- Processed refund requests and researched open claim and credit on accounts
- 12
- Audit patient accounts before monthly statement submission
- 13
- Utilized Navicure to file claims electronically
- 14
- Reseach and resolve incorrect payments,EOB rejections and other issues with outstanding accounts
- 15
- Reviewed billing edits and provided insurance providers and correct information
- 16
- Commended for proficiency in multi-tasking when managing administrative work and ensuring top- level patient care and support
- 17
- Reformed all insurance preauthorization forms(for out -patient procedures)and processed utilization reviews.Responsible for the overall billing,collections and payments posting for office visits,out- patient procedures and hospital billing (including selection of ICD10 and CPT coding for all surgical procedures,ancillary procedures,laboratory and pathology and radiology performed on site) 18
- General office duties included:transcription of numerous letter sent to patients dictated by the physicians,working heaving telephone lines,general filing and copying;maintaining an organized working environment.
Medical Referral Coordinator & Medical Records
Raul Rivera
Pasadena, TX
01.2014 - 07.2019
- Obtained patient blood,urine and saliva specimens for various test, including drug screens
- 2
- Prepped Patients and equipment necessary for lumbars injections, as well as recorded patient vitals,complaints and medications in EMR
- 3
- Provided pre- and post -operative care
- Monitored expiration dates of all supplies and sample medications
- 4
- Set up immunization medications and readied patients for injections
- 5
- Daily verification of benefits and eligibility for scheduled patients
- 6
- Maintained and updated spreadsheets to help organize payment and collections informations.
Medical Assistant
Dr.Salim Lakhani
Houston, TX
07.2017 - 01.2018
- 1
- Checking in patient/ entering demographics/vitals
- 2
- Preform diagnostic procedures when ordered
- Given the correct and verify immunizations
- 3
- Keep exam/procedure room stocked/set up according the departmental guidelines
- 4
- Obtain the patient's medical records following appropriate procedures
- 5
- Check the patient's vital signs, to include temperature ,respiration, pulse, weight and blood pressure
- 6
- Received daily referral request assignments to initiate processing of injured workers medical care needs associated with their case
- 7
- Obtained necessary pre-authorizations and pre-certs from insurance companies pre-protocol when applicable
- 8
- Scheduled a variety of appointments including physical therapy,ct ,mri,pain management and follow up appointments
- 9
- Pursues all other resources to obtain insurance information,i.e
- Patient,office or any referral source.
Education
Master of Health Science - Medical Assistance & Medical Billing & Coding
Fortis College
May 2012
Master of Health Administration - Accounting
Houston Community College
September 2009
High school diploma - Data Science
Sam Houston High School
June 1993
Associate's degree - undefined
Skills
- Epic
- Anatomy Knowledge
- Utilization management
- Utilization review
- Microsoft Office
- Supervising experience
- Laboratory Experience
- Nursing
- Analysis skills
- Revenue cycle management
- Communication skills
- Computer skills
- EHR systems
Certification
MEDICAL RECORDS (10+ years)
DATA ENTRY (10+ years)
CMA (5 years)
Phlebotomy (10+ years)
Bilingual (10+ years)
Billing and Coding (5 years)
Referral Coordinator (5 years)
Injections (10+ years)
HIPPA regulations (10+ years)
Insurance Verification (10+ years)
Medical Receptionist (10+ years)
EMR system (10+ years)
Patient Care (10+ years)
Medical Terminology (10+ years)
eClinicalWorks, Certified Medical Assistant (AAMA)
January 2012 to Present
CPR Certification
May 2020 to May 2023
Certified Billing and Coding Specialist
March 2007 to Present
BLS Certification
AHIMA
RHIA
LVN/LPN
January 2018 to June 2024
Timeline
Medical Assistant
Dr.Salim Lakhani
07.2017 - 01.2018
Billing & Coding & Certified Medical Assistance & Licensed LVN
Medical, North Star Medical Group
01.2017 - 02.2023
Medical Referral Coordinator & Medical Records
Raul Rivera
01.2014 - 07.2019
Master of Health Science - Medical Assistance & Medical Billing & Coding
Fortis College
Master of Health Administration - Accounting
Houston Community College
High school diploma - Data Science
Sam Houston High School