Melissa Espinoza-Tovar

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 regulation

(2) years supervisory or management experience preferred

• Maintained confidentiality on all patient record data.
• Obtained prompt payments for open bills by interacting with appropriate parties.
• Tallied transactions, verified pricing and rectified errors in system.
• Sent meticulous and accurate bills to collect payment from customers according to company protocol.
• Verified insurance eligibility for patients by calling appropriate parties.
• Worked with [Software] to create and submit large numbers of client invoices each day.
• Coded invoices properly based upon patient services and medical records.
• Drafted reports, contacted customers and reconciled transactions after conducting research into inquiries.
• Investigated and resolved issues to maintain billing accuracy.
• Processed and sent invoices, adjustments and credit memos to customers.
• Answered customer invoice questions and resolved issues discovered during invoicing and collection process.
• Worked with team members and leadership to identify and develop process improvements.
• Completed billing audits in identified timeframes to report and investigate findings.
• Performed data import, scanning or manual keying processes to verify invoice accuracy.
• Input payment history and other financial data to keep customer accounts up-to-date in system.
• Managed numerous client accounts to track and collect money owed.
• Researched and resolved billing inconsistencies and errors through individual and collaborative analysis.
• Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.
• Contacted insurance providers to verify insurance information and obtain billing authorization.
• Managed account receivables to maintain payments within net terms.
• Reviewed vendor documentation to comply with payment guidelines.
• Recorded amounts due for items purchased or services rendered by preparing statements, bills or invoices.
• Leveraged integrated billing software to submit accurate claims.

Responsible for all aspects related to insurance claims to maximize revenue streams

• Provided tenacious follow-up to ensure proper payments were fully collected
• Followed up timely on all claims to ensure no submission dates were missed
• Completed necessary appeals and correct claims as needed under strict deadlines
• Handle monthly statements,payments plans and provide collection support
• Responsible for analyzing claims and filling secondary claims as needed
• Audit all Medicaid claims
• Verified insurance eligibility including contacting both the patient and the insurance corporation by phone on a daily basis as needed to ensure verification
• Processed refund requests and researched open claim and credit on accounts
• Audit patient accounts before monthly statement submission
• Utilized Navicure to file claims electronically
• Reseach and resolve incorrect payments,EOB rejections and other issues with outstanding accounts
• Reviewed billing edits and provided insurance providers and correct information
• Commended for proficiency in multi-tasking when managing administrative work and ensuring top- level patient care and support
• 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)
• 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.

• Obtained patient blood,urine and saliva specimens for various test, including drug screens
• Prepped Patients and equipment necessary for lumbers injections, as well as recorded patient vitals,complaints and medications in EMR
• Provided pre- and post -operative care
• Monitored expiration dates of all supplies and sample medications
• Set up immunization medications and readied patients for injections
• Daily verification of benefits and eligibility for scheduled patients
• Maintained and updated spreadsheets to help organize payment and collections informations.
• Scheduled patients according to availability, urgency and insurance authorization guidelines.
• Reviewed demographic, clinical and insurance information before sending to referred specialists.
• Reviewed referral details and expectations with providers and patients and requested new referrals when necessary.
• Answered questions and resolved concerns raised by both patients and specialists.
• Managed up to [Number] patient referrals daily through multi-line telephone system.
• Prioritized referrals according to urgency and adhered to appropriate referral deadlines.
• Performed additional office duties, handling patient service inquiries and receiving payments.
• Assisted referred patients in filling out applications and insurance forms.
• Reviewed data obtained from referring physicians for completeness and accuracy.
• Verified documents and associated records to catch and resolve discrepancies.
• Compiled, recorded, or coded data from referrals or surveys using computer or specified form.
• Developed productive working relationships with numerous insurance company representatives.
• Identified and resolved inconsistencies in patient responses by means of appropriate questioning or explanation.
• Prepared reports to provide responses to specific problems.
• Collected and analyzed referral data and tallied number of referrals.
• Communicated with patients with compassion while keeping medical information private.
• Explained policies, procedures and services to patients.
• Collaborated with multi-disciplinary staff to improve overall patient care and response times.
• Built work schedules and staff assignments, taking workload, space and equipment availability into consideration.
• Maintained records management system to process personnel information and produce reports.
• Maintained communication and transparency with governing boards, department heads and medical staff.
• Recruited, hired and trained new medical and facility staff.
• Established solid relations with leadership and staff by attending board meetings and coordinating interdepartmental information exchanges.
• Maintained awareness of government regulations, health insurance changes and financing options.
• Directed, supervised and evaluated medical, clerical or maintenance personnel.
• Managed changes in integrated health care delivery systems and technological innovations while keeping focus on quality of care.
• Coordinated work activities and scheduling of medical, nursing and physical plant staff.
• Assessed need for additional staff, equipment and services based on historical data and seasonal trends.
• Monitored inpatient bed use, facilities and staff to provide optimal use of resources.
• Planned and implemented programs for health care or medical facilities supporting personnel administration and training.
• Administered fiscal operations for accounting, budget planning, authorizing expenditures and coordinating reporting.
• Developed medical programs that promoted community health and research.
• Kept informed of advances in medicine and computerized diagnostic and treatment equipment.
• Updated procedures necessary for compounding, mixing, packaging and labeling medications.
• Reviewed non-contracted instrumentation for spine surgeries and initiated vendor contract evaluations in conjunction with operations staff and orthopedic spine and neurological spine specialists.

• Checking in patient/ entering demographics/vitals
• Preform diagnostic procedures when ordered
• Given the correct and verify immunizations
• Keep exam/procedure room stocked/set up according the departmental guidelines
• Obtain the patient's medical records following appropriate procedures
• Check the patient's vital signs, to include temperature ,respiration, pulse, weight and blood pressure
• Received daily referral request assignments to initiate processing of injured workers medical care needs associated with their case
• Obtained necessary pre-authorizations and pre-certs from insurance companies pre-protocol
• Scheduled a variety of appointments including physical therapy,ct ,mri,pain management and follow up appointments
• Scheduled appointments for patients via phone and in person.
• Prepared treatment rooms for patients by cleaning surfaces and restocking supplies.
• Measured vital signs and took medical histories to prepare patients for examination.
• Interviewed and engaged patients to obtain medical history, chief complaints and vital signs.
• Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
• Organized charts, documents and supplies to maintain team productivity.
• Cleaned and maintained medical equipment following procedures and standards.
• Documented notes during patient visits.
• Responded to patient callbacks and phone-in prescription refill requests.
• Educated patients about medications, procedures and physician's instructions.
• Secured patient information and maintained patient confidence by completing and safeguarding medical records.
• Contacted pharmacies to submit and refill patients' prescriptions.
• Assessed, documented and monitored vital signs for patients within outpatient setting.
• Assisted with diagnostic testing by collecting and packaging biological specimens for internal and laboratory analysis.
• Participated in team meetings to improve workflows and contribute to improving patient population outcomes.
• Maintained inventory, vaccination and product expiration logs to record updated documentation for tracking purposes.
• Conducted insurance verification and pre-certification and pre-authorization functions.
• Incorporated outside records into charts and EHR.
• Collaborated with local pharmacies to resolve and clarify issues with patient medication.
• Labeled and completed lab requisitions using ICD and CPT coding.
• Followed principles of asepsis and infection control to meet patient safety guidelines.
• Performed preliminary physical tests to accurately record results in patient history summary.
• Administered rapid tests for COVID and strep to help clinical staff assess conditions.
• Pursues all other resources to obtain insurance information,i.e
• Patient,office or any referral source.