Mercedes Wear
Aventura,FL
Summary
Proven expert in medical accounts receivable at Platinum Dermatology Partners/ADM/SPC, I excel in reducing claim rejections and boosting reimbursements through meticulous CPT coding and HIPAA-compliant practices. My analytical problem-solving and exceptional customer service skills have significantly enhanced revenue and streamlined billing operations, achieving a notable increase in reimbursement rates.
Overview
23
23
years of professional experience
Work History
Medical Accounts Receivable
Platinum Dermatology Partners/ADM/SPC
10.2001 - Current
- Ensured accurate coding and billing practices, resulting in reduced claim rejections and faster reimbursements.
- Reduced account receivables aging through diligent follow-up on outstanding claims and prompt resolution of denials.
- Established effective relationships with insurance company representatives to expedite claim processing times and increase reimbursement rates.
- Updated and maintained patient accounts within the billing system, ensuring accurate records for future invoicing and reimbursement processes.
- Maintained confidentiality of patient information by adhering to strict HIPAA regulations throughout the billing process.
- Provided exceptional customer service while addressing patient inquiries regarding billing issues or concerns.
- Assisted with staff training on updated medical coding systems, ensuring accuracy across all team members'' workloads.
- Developed comprehensive reports for management detailing trends in revenue generation, collection efforts, and outstanding balances.
- Collaborated with the collections department to address overdue accounts and recover outstanding payments.
- Enhanced revenue by identifying and resolving billing discrepancies in patient accounts.
- Optimized workflow processes, enabling a reduction in errors and improvement in overall team productivity levels.
- Conducted thorough audits of patient files to ensure proper documentation and accurate invoicing.
- Resolved complex billing issues involving multiple parties by effectively coordinating communication among healthcare providers, insurers, and patients.
- Facilitated clear communication between medical providers, insurance companies, and patients for smooth billing operations.
- Contributed to practice growth by providing detailed analysis of revenue patterns that informed strategic business decisions on expanding services or locations offered.
- Implemented quality assurance measures to minimize errors in data entry, leading to increased claim approval rates from insurers.
- Organized and filed all necessary documentation related to medical billing procedures, maintaining a streamlined office environment conducive to efficient operations.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Verified insurance of patients to determine eligibility.
- Posted payments and collections on regular basis.
- Collected payments and applied to patient accounts.
- Filed and updated patient information and medical records.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Liaised between patients, insurance companies, and billing office.
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Delivered timely and accurate charge submissions.
- Prepared billing statements for patients and verified correct diagnostic coding.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
- Adhered to established standards to safeguard patients' health information.
- Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
- Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
- Used data entry skills to accurately document and input statements.
- Handled account payments and provided information regarding outstanding balances.
- Audited and corrected billing and posting documents for accuracy.
- Utilized various software programs to process customer payments.
- Monitored outstanding invoices and performed collections duties.
- Entered invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
- Maintained accurate records of customer payments.
- Kept vendor files accurate and up-to-date to expedite payment processing.
- Reconciled accounts receivable to general ledger.
- End of day process
- Availity Acknowledgment Reports (999, ACK, TXT, DPR, IBT, EBR, EBT, 277 IBR and 277 EBR)
- Save all ERA Reports from Availity
- Bring in EFTS from the Payor Website's and save in Easy Print , EDI Files and Billing Drive
- Carrier Refunds
Education
No Degree -
Miami Dade College
Miami, FLSkills
- CPT coding knowledge
- HIPAA Compliance
- Critical thinking abilities
- Collections experience
- Medical terminology understanding
- Insurance Verification
- Denial Management
- Analytical Problem Solving
- Accounts receivable management
- Medical Coding Expertise
- Payment posting
- Teamwork and Collaboration
- Medicare Knowledge
- Customer Service
- Electronic Claims
- Electronic Carrier Reports
- Billing and Collection Procedures
- Multitasking and Organization
- Claims review
- CMS-1500 Billing Forms
- Critical Thinking
- ICD-10 Coding
- Accounts Receivable
- Claims Processing
- Data Entry
- Worker's Compensation Knowledge
- Medical Terminology
- Electronic Health Record Software
- Work Prioritization
- Insurance Billing
- Account Reconciliation
- Commercial and Private Insurance
- Medical Software Nextgen
- Medical coding knowledge
- Account Management
- HIPAA Compliance Certification
- Insurance Claims
- Medical Billing
- Technologically proficient
- Problem-Solving
- Time Management
- Attention to Detail
- Refunds
- Multitasking
- Reliability
- Excellent Communication
- Organizational Skills
- Team Collaboration
- General accounting
- Paperwork and documentation
- Microsoft Office
- Task Prioritization
- Medical record security
- Regulatory Compliance
- ICD-10
Languages
English
Spanish
Board of Directors
Bravura Condominium Association, Vice President, December 2022 - Present
Timeline
Medical Accounts Receivable
Platinum Dermatology Partners/ADM/SPC
10.2001 - Current
No Degree -
Miami Dade College