Michelle Alvarez
Braselton,Georgia
Summary
Competent Accounts Receivable Specialist bringing 21 years of experience handling accounts receivable functions. Exemplary skill in resolving billing disputes, providing excellent customer service and applying payments. Recognized for effective leadership with consistent achievement of objectives.
Overview
21
21
years of professional experience
Work History
Medical Collections Specialist
Christus Healthcare/Tandym
10.2024 - Current
- Work from spreadsheet to clean up Meditech system because they change their software to EPIC leaving old accounts (180 days and older) in the system that need verification of which network was used to price the claim.
- Verify if the claim is priced per the No Surprise billing act and if so, use the QPA calculator to calculate the patient portion. If needed send an appeal to dispute the underpayment.
- Work underpayments to find out if the claim was paid correctly per the contract. If it is not paid per the contract, we are to send an appeal with documentation to show proof that the claim was paid incorrectly.
- Work NSA billing act accounts that are paid out of network and per the no surprise billing act
- Change the plans if they are in the incorrect insurance plan so the contract adjustment is adjusted to the correct insurance plan (Aetna, Cigna, UHC etc..)
- Call insurance companies to receive EOBs not in the system to verify what network it was priced through.
- Call insurance companies if a claim is paid incorrectly and not paid per the contract rate to have the claim sent back for reconsideration.
- If the reconsideration is denied send an appeal with back up documentation of why we show the claim is underpaid and needs to be paid per the correct rate.
- Send appeals on denials for various reasons such as not authorization on file, Denial of a Rev code that should have been paid, implants, DRG denials, DRG downgrades... etc.
- Make correct adjustments that are needed on the account to show the correct contractual adjustments with the correct expected amount per the contracted rate.
- Verify if the claim was processed with any patient co-pay, co-insurance, or deductible and transfer to the patient balance.
- Remote contract worker working from home
Life & Health Insurance Agent
Senior Select
09.2023 - 09.2024
- Request leads for seniors who are interested in life insurance
- Once the lead is received go door knock to verify if the senior is in need of life insurance
- If they need life insurance perform questions to verify what plan they will fit into
- Gather all necessary information from the client (address, phone, medical background, beneficiary, social security, bank info) and fill out the application online on the carrier’s website.
- Answer any questions the client may have
- Follow up ever quarter to make sure the client has no questions and has no other needs
Medicare Health Insurance Agent
Results CX Health Agent
09.2024 - 11.2024
- Take phone calls from seniors who call in to sign up for Medicare part C to fit them into a plan that fits their needs
- Educate the customer about the products available to them
- Help the customer make an informed decision about their Medicare plan for the upcoming year
- Go over the plans that are available in their area and verify their coverage before signing them up into a plan.
- AHIP certification attained for 2025
- Very heavy phone call volume
- Working from home with little supervision
Patient Account Rep 1
Medix/Orlando Health
01.2023 - 08.2023
- Payer rejects/refunds/no response from the insurance
- File appeals for claims that have been denied
- Address credit balances on the A/R and resolve
- Check the contract agreement for the assigned payer to make sure the claim was paid correctly.
- Collecting from Government & Commercial insurances
- Worked all denials and followed up on them to verify they were paid.
- Worked the rejections that the clearinghouse did not accept due to invalid information to correct the information so the claim would be sent to the payer to be paid as a clean claim.
- Maintains system work queues based on electronic payers' error reports as assigned including but not limited to DNB, Claim Edits
- Assists Patient Accounts Specialist Rep II/III with ongoing projects and departmental activities as assigned
- Maintain productivity of 32 accounts a day
Billing Specialist
North Georgia Urgent Care
01.2022 - 08.2022
- Open all mail and distribute. Make copy of all checks to be deposited.
- Pull all EOB’s and ERA’s to be manually posted from the payer’s website or via payspan.
- Run all payments made by credit card from the payers through Transaction Express.
- Received a weekly EFT list of monies deposited from the payers to be posted. I would go to the EFT list in Nextgen and auto post all EFT’s received. If there were denials, I would work all the denials when I posted the payments so there were no delays in recouping the money.
- Ran the insurance A/R ledger of outstanding balances for follow up to either send the claim that had not been received, or the denial follow up.
- All denials worked and followed up on them to verify they were paid.
- Worked the rejections that the clearinghouse did not accept due to invalid information to correct the information so the claim would be sent to the payer to be paid as a clean claim.
- Entered billing charges and made sure the medical records were complete and the diagnosis were billable.
- Answered patient phone calls and took payments over the phone via credit card through Transaction Express.
- Worked all denials and appealed to ensure proper payment was received.
Business Manager
Infinite Roofing Solutions, LLC
09.2021 - 01.2022
- Coordinates and schedules roofing installs for the week
- Call insurance companies to follow up on the depreciation checks
- Complete payroll for the week
- Invoice the insurance companies for the scope of work and provide the contract, invoice and pictures to receive the depreciation check.
- Take incoming customer calls with any concerns or to provide information regarding their roof install
- Accounts payable and receivables
- Take incoming calls from the insurance companies regarding claims.
Top Dollar Underpayment Analyst Work From Home
Parallon - Nashville, TN
11.2019 - 09.2021
- Researches and resolves top dollar underpayments which include all payers, (all Commercial payers, Blue Cross, Blue Shield, Aetna, Culinary…etc.)
- Verify that the correct insurance company is correct in the system to pull and compare the correct contract has been used.
- Perform first validation on the underpayment and assign the discrepancy reason code, call payer for underpayment on why the claim is underpaid, send appeals.
- Pull UB, EOB and contract to verify that a true underpayment has occurred.
- Analyze and compare the EOB, UB-04 and contract to verify what procedure code (CPT), DRG, surgery rates have not been paid according to the contract. Work with inpatient and outpatient claims.
- Use Conculty, Artiva and the payer websites that are available to us to verify the underpayments.
- Call insurance companies to initiate a payment for the underpayment, follow up on reconsiderations and appeals and understand how they paid the claim.
- Appeal the underpayment and send it to the insurance company if needed.
- Follow up on the appeals and claims to keep them within the timely filing.
- Escalate contract issues to the Supervisor.
Underpayment Analyst Work From Home
Parallon - Nashville, TN
02.2019 - 10.2019
- Researches and resolves underpayments which include all payers, (Managed Care/HMO, PPO, Medicare, Medi-cal and Medicaid.)
- Verify that the correct insurance company is correct in the system to pull and compare the correct contract has been used.
- Perform second validation of discrepancy reason code assigned by the Discrepancy Analyst.
- Pull UB, EOB and contract to verify that a true underpayment has occurred.
- Analyze and compare the EOB, UB-04 and contract to verify what procedure code (CPT), DRG, surgery rates have not been paid according to the contract. Work with inpatient and outpatient claims.
- Use Conculty, Artiva and the payer websites that are available to us to verify the underpayments.
- Call insurance companies to initiate a payment for the underpayment, follow up on reconsiderations and appeals and understand how they paid the claim.
- Appeal the underpayment and send it to the insurance company if needed.
- Follow up on the appeals and claims to keep them within the timely filing.
- Escalate contract issues to the Supervisor.
Government Biller and Collections
Northeast Georgia Medical Center
02.2018 - 10.2018
- Is responsible for accurate and prompt follow-up of unpaid or denied claims/charges. Rep is also responsible for providing outstanding customer service to both patients and staff members. Rep must be able to research difficult accounts and report any specific denial trends to management. Rep will be responsible for staying up to date with all assigned payer updates.
- Billed Medicare and Medicaid for the skilled nursing facility through EPIC system.
- Corrected edits that restricted the claim from being transmitted electronically to the payer.
- Follow on unpaid claims to Medicare, Medicaid, Blue Cross, Blue Shield, BSBS, Humana etc.
- Resolve and dispute denials from the payers.
AR Team Manager
PaymentsMD-Sandy Springs
10.2016 - 10.2017
- Run productivity and process audits for team members.
- Run daily, weekly and monthly reports to ensure claims are being paid and to verify any trends with payers.
- Process all timecards and time off requests.
- Receive, process, adjust and post payments from all insurance companies. BCBS, Aetna, Cigna, United Health, Medicare, Medicaid, Medical, etc.
- Call various insurance companies/and or patients to collect medical payments.
- Review denials and follow up via phone and appeal if necessary.
- Process emergency room claims for Medicare; Medicaid, all commercial insurance carriers and BCBS
- Assured quality compliance in the collection process.
- Knowledge of HIPAA guidelines on privacy, transactions, and security.
- Accurately document data information in company database.
- Assist team members on special project to meet deadlines in a timely manner.
AR Collections and Denials
The Longstreet Clinic - Gainesville, GA
08.2015 - 10.2016
- Review all incoming denials after they have been posted.
- Identify why the claim has been denied and obtain supporting documentation and other applicable information necessary for the appeal process.
- Follow up on claims that have not been paid yet by contacting the payer via website or by phone.
- Prepare, submit and follow up on appeals that have been submitted to insurance companies in a timely manner.
- Document the internal system to reflect all notes from the contact that has taken place.
- Insurance follow up consists of the following payers all commercial payers, HMO, PPO and Medicare.
- Verify that the claim was coded properly using the CPT co des, ICD-10 and CMS guidelines.
- Correct claims if necessary and send them with the proper documentation.
Senior Underpayment Analyst
Parallon Business Performance Group
05.2014 - 08.2015
- Review and analyze all underpayments for a specific payer at a time and create payer packages on a spreadsheet to present to the payer.
- Verify how it was underpaid.
- Compile all underpayment accounts into discrepancy categories and report to manager on a summary and detail level per payer.
- Generate designated payer package(s) every month for previous month's activity.
- Communicate monthly with payer(s) on status of accounts and payment pending from the payer package. Implement tracking mechanism to follow-up on accounts.
- Develop reports showing accounts that have been resolved by the payer.
- Report trends and issues happening with a payer.
- Meet with managers to effectively communicate and resolve payer issues, set and prioritize goals and improve the collections processes.
- Interpersonal skills - able to work effectively with other employees, patients and external parties.
- Follow up on accounts in a timely manner to keep them from aging.
- Send appeals to payers with the backup showing the dispute to ensure resolution of the claim and payment.
Underpayment Analyst
Parallon Business Performance Group
11.2012 - 08.2015
- Research and resolves underpayments which include all payers, (Managed Care/HMO, PPO, Medicare, Medi -cal.)
- Verify that the correct insurance company is correct in the system to pull and compare the correct contract has been used.
- Perform second validation of discrepancy reason code assigned by the Discrepancy Analyst.
- Pull UB, EOB and contract to verify that a true underpayment has occurred.
- Analyze and compare the EOB, UB and contract to verify what procedure, DRG, surgery rates have not been paid according to the contract.
- Use the various systems that are available to us to verify the underpayments.
- Call insurance companies to initiate a payment for the underpayment and understand how they paid the claim.
- Appeal the underpayment and send to the insurance company if needed.
- Follow up on the appeals and claims to keep them within the timely filing.
- Escalate contract issues to the Supervisor.
Credit Balance Specialist
Children's Hospital Los Angeles Medical Group
02.2010 - 01.2012
- Assumed responsibility for all credit balance accounts using the IDX system which included Managed Care/ HMO, PPO, Commercial, Medicare, Medi-Cal, CCS and patient accounts.
- Audit cash posting batches for misapplied payments.
- Research unidentified payments and apply to proper account or refund to payer for wrong payment.
- Review documentation and reports, contract fee schedules, ICD-09 and CPT codes to ensure proper refunds.
- Review EOB's for correction of misapplied payments and .
- Follow-up with insurance payment duplications, credit /account adjustments (i.e. reversals, adjustments), and account transfers if applicable and initiate refund requests.
- Post identified adjustments to accounts to coincide with requested refund with back up documentation.
- Identify accounts to be escheated to state or federal agencies.
- Identify trends occurring on claims not being paid correctly or not being paid per the contract rates and report to management. Contact appropriate parties (i. e. insurance company, patient) for accurate resolution of credit balance.
- Identify missing charges that have not been posted to accounts.
- Post refund checks and mail out to appropriate parties. Assisted with Medicare and Medi-Cal modifier corrections and provided assistance to group Coder for correction of Coding issues.
- Bill proper payer resulting from payment from incorrect payer; follow up on the account to insure payment from proper payer. Accountable for timely follow up on all accounts billed.
- Knowledge of collections to dispute refund requests from insurance companies.
Medical Billing and Collections Specialist
Southern California Orthopedic Institute
10.2007 - 02.2010
- Analyzed specialty orthopedic claims regarding charges, payments/balances, and errors.
- Reviewed EOB's and responded to correspondence from the insurance payers.
- Contact the insurance company for appeals of improper payment of claims.
- Corresponded with patients regarding insurance coverage and payment due.
- Maintained accounts receivable of approximately $500,000 for HMO, PPO, Workman's Comp, and Commercial Insurance.
- Reviewed and researched insurance and patient credit balances and issued refund requests.
- Backed up payment posting when help was needed.
- Reduced accounts receivable from $350,000 to $109,000.
Education
Bachelor of Arts - Psychology
Chapman University
Orange County, CA01.2010
Diploma - Medical Billing
Courtesy Career College
Canoga Park, California01.2004
Associate of Science - Business
College of The Canyons
Canyon Country, CA01.2002
Skills
- BILLING (22 years), MEDISOFT, EPIC (Less than 1 year), IDX (1 year), EXCEL, familiar with most health insurance website (ie Availity, Cigna, Caresource, Peachstate Health, Peachstate Health Medicaid etc),
- HIPAA compliance
- Patient account management
- Insurance verification
- Medical terminology
- Medical billing procedures
- Data entry proficiency
- Problem-solving
- Customer service
- Multitasking
- Excellent communication
- Critical thinking
Additional Information
- SOFTWARE SKILLS
- IDX, MPV, CCS PIP Website, Medical Website, Word, Excel, Medisoft billing software, Pacware billing software, Centricity billing system, EPIC, Artiva, Conculty medical billing system, Nextgen, Transaction Express, Meditech
Timeline
Medical Collections Specialist
Christus Healthcare/Tandym
10.2024 - Current
Medicare Health Insurance Agent
Results CX Health Agent
09.2024 - 11.2024
Life & Health Insurance Agent
Senior Select
09.2023 - 09.2024
Patient Account Rep 1
Medix/Orlando Health
01.2023 - 08.2023
Billing Specialist
North Georgia Urgent Care
01.2022 - 08.2022
Business Manager
Infinite Roofing Solutions, LLC
09.2021 - 01.2022
Top Dollar Underpayment Analyst Work From Home
Parallon - Nashville, TN
11.2019 - 09.2021
Underpayment Analyst Work From Home
Parallon - Nashville, TN
02.2019 - 10.2019
Government Biller and Collections
Northeast Georgia Medical Center
02.2018 - 10.2018
AR Team Manager
PaymentsMD-Sandy Springs
10.2016 - 10.2017
AR Collections and Denials
The Longstreet Clinic - Gainesville, GA
08.2015 - 10.2016
Senior Underpayment Analyst
Parallon Business Performance Group
05.2014 - 08.2015
Underpayment Analyst
Parallon Business Performance Group
11.2012 - 08.2015
Credit Balance Specialist
Children's Hospital Los Angeles Medical Group
02.2010 - 01.2012
Medical Billing and Collections Specialist
Southern California Orthopedic Institute
10.2007 - 02.2010
Bachelor of Arts - Psychology
Chapman University
Diploma - Medical Billing
Courtesy Career College
Associate of Science - Business
College of The Canyons