Melissa Espinoza-Tovar
Pasadena,TX
Summary
Experienced Revenue Cycle Manager/LVN offering 15 plus years with a proven track record of leading billing operations, improving team performance, and optimizing revenue. Skilled in revenue cycle management, billing and coding, claims processing, and payment posting. Certified Professional Coder (CPC) with experience using AllScripts. Strong attention to detail and problem-solving skills. Successfully implemented revenue increase initiatives and led process improvement projects resulting in significant financial improvements. Fluent in English and Spanish. Passionate about contributing to a top-notch team and driving continuous improvements. Excited to apply my expertise and make a significant impact in the Revenue Cycle Manager role.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Billing & Coding & Certified Medical Assistance
Medical, North Star Medical Group
2016.02 - 2023.04
- Sent meticulous and accurate bills to collect payment from patients
- Verified insurance eligibility for patients by calling appropriate parties.
- Reconciled transactions and drafted reports through financial analysis for the practice.
- Maintain billing accuracy.
- Worked with team members and leadership to identify and develop process improvements.
- Managed numerous vendor accounts
- Researched and resolved billing inconsistencies through collaborative analysis
- Submitted claims and researched and resolved insurance denials and rejections.
- Managed account receivables
- Prepared statements, payment plans and invoices.
- Leveraged integrated billing software to submit accurate claims.
- Maximize revenue streams coming in and out the practice
- Conduct audit on claims and patient accounts
- Processed refund requests
- Utilized Navicure to file claims electronically
- Research and resolve account balances for patients and Insurance companies
- Restructured all insurance preauthorization forms(for out -patient procedures)and processed utilization reviews.
Medical Referral Coordinator & Medical Records
Raul Rivera
2014.01 - 2019.07
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
- Streamlined referral process by implementing efficient tracking and communication systems.
- Maintained a high level of accuracy in referral documentation, ensuring smooth transitions between healthcare providers.
- Responded to patient inquiries to offer timely updates regarding referral status.
- Reviewed data obtained from referring physicians for completeness and accuracy.
- Developed and maintained strong working relationship with referral sources to streamline processing.
- Called insurance companies to get precertification and other benefits information on behalf of patients.
- Established strong relationships with external providers, facilitating seamless communication and collaboration in patient care.
- Prepared analytical reports to identify and resolve any errors within the referral process
- Served as a liaison between primary care physicians, specialists, and patients to ensure timely access to needed services.
- Kept healthcare providers informed of referral status updates, promoting optimal continuity of care throughout the referral process.
- Recruited, hired and trained new medical and facility staff.
- Directed, supervised and evaluated medical, clerical or maintenance personnel.
- Monitored referrals to foster timely completion and followed up with physicians to facilitate.
- Developed comprehensive knowledge of insurance requirements, advocating for patients when necessary to secure approval for needed services.
- Enhanced patient satisfaction with timely coordination of referrals and appointments.
- Assisted with completion of referral forms and verified data accuracy and completion
- Planned and implemented programs for health care providers and medical facilities.
- Facilitated referrals to other healthcare providers and resources to bridge service gaps.
- Reduced wait times for specialist appointments by proactively identifying available slots and coordinating schedules.
- Assisted with staff training initiatives related to the referral process, sharing expertise gained from professional experience.
- Collaborated with medical staff to ensure appropriate referrals based on individual patient needs and insurance coverage.
- Attended continuing education courses to stay current on referral processes and best practices.
Medical Assistant
Dr.Salim Lakhani
2017.07 - 2018.08
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Obtained client medical history, medication information, symptoms, and allergies.
- Assisted physicians with minor surgeries, including preparing operating room and sterilizing instruments.
- Facilitated seamless patient care with thorough and accurate documentation of medical histories, vital signs, and medications.
- Sanitized, restocked, and organized exam rooms and medical equipment.
- Enhanced clinic efficiency by assisting physicians with routine procedures and diagnostic tests.
- Obtained necessary pre-authorizations and coordinated patient referrals to specialists or other healthcare providers as needed for comprehensive care management plans.
- Administered medications and injections as prescribed, adhering strictly to protocols for patient safety.
- Improved patient experiences by efficiently managing appointments and maintaining organized medical records.
- Measured vital signs and took medical histories to prepare patients for examination.
- Maintained a safe and clean clinical environment by adhering to infection control guidelines and disposing of biohazardous waste properly.
- Performed medical records management, including filing, organizing and scanning documents.
- Aided in accurate diagnoses by performing laboratory tests and preparing specimens for analysis.
- Educated patients about medications, procedures and physician's instructions.
- Assisted with diagnostic testing by collecting and packaging biological specimens for internal and laboratory analysis.
- Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.
- Performed phlebotomy tasks efficiently while ensuring minimal discomfort for patients during blood collection
- Updated inventory, expiration and vaccine logs to maintain current tracking documentation.
- Enhanced patient care by meticulously recording vital signs and updating patient records.
Education
Master of Health Science - Medical Assistance & Medical Billing & Coding
Fortis College
Houston, TX05.2012
Master of Health Administration - Accounting
Houston Community College
Houston, TX09.2009
Skills
- Insurance Verification
- Patient Data Coding
- Invoice Processing
- Appointment Scheduling
- ICD-10 Coding
- Electronic Health Record Applications
- Inpatient and Outpatient Coding
- Utilization management
- Utilization review
- Data Entry
- Records Management
- Coding Error Resolution
- Word Processing Software
- Medical Billing Processing
- Medical Translation
- CCM Management
- PQRI Measurements
- Report Preparation
- Customer Service
- HIPAA Compliance
- Hospital Inpatient and Outpatient Records
- Discharge Documentation
- Epic Systems
- Microsoft Office
- Management experience
- Computer Skills
- Nursing
- Revenue cycle management
- Organization and Time Management
- Teamwork and Collaboration
- Problem-Solving
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
2017.07 - 2018.08
Billing & Coding & Certified Medical Assistance
Medical, North Star Medical Group
2016.02 - 2023.04
Medical Referral Coordinator & Medical Records
Raul Rivera
2014.01 - 2019.07
Master of Health Science - Medical Assistance & Medical Billing & Coding
Fortis College
Master of Health Administration - Accounting
Houston Community College
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
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