Melissa Espinoza-Tovar

• Processed nephrology claims and patient care services with precision and efficiency.
• Verified insurance details, ensuring accurate billing submissions and reducing potential claim rejections.
• Maintained electronic health records for comprehensive service documentation.
• Communicated billing inquiries and payment options clearly to patients.
• Collaborated with providers to resolve billing discrepancies promptly.
• Tracked accounts receivable, initiating follow-ups on outstanding claims.
• Assisted in deploying new billing software to enhance operational efficiency.
• Resubmitted claims to address denials from insurance carriers.

Managed insurance claims to maximize revenue and ensure timely reimbursements.

Processed and submitted claims electronically via Navicure, resolving denials and discrepancies.

Verified patient insurance eligibility daily through effective communication with relevant parties, ensuring accurate billing.

• Gained five years of experience in medical billing and collections within healthcare settings, enhancing revenue cycle management.
• Conducted audits of Medicaid claims and patient accounts prior to monthly statement submission.
• Collaborated with team members to identify process improvements that enhanced operational efficiency.
• Drafted comprehensive reports on billing inquiries and reconciled transactions, contributing to improved financial accuracy.
• Maintained confidentiality of patient records while managing sensitive billing information.

• Verified benefits and eligibility for scheduled patients daily to optimize service delivery.
• Scheduled patients based on availability, urgency, and insurance authorization guidelines.
• Obtained patient blood, urine, and saliva specimens for testing, ensuring accurate results for timely diagnosis.
• Prepared patients and equipment for lumbar injections; recorded vitals, complaints, and medications in EMR.
• Provided pre- and post-operative care to ensure patient comfort and recovery.
• Monitored expiration dates of supplies and sample medications for compliance.
• Maintained organized spreadsheets for payment and collections updates, improving financial tracking and reporting.
• Collaborated with multidisciplinary staff to improve patient care and reduce response times.