MONICA RIVERA
Visalia ,CA
Summary
I am a detail-oriented professional with focus on deadlines and skilled in handling medical billing. Knowledgeable biller who has experience with submitting claims, correcting claim errors or rejections, and reviewing CPT and DX codes to ensure proper billing. I excel at problem solving, customer service, while being efficient. My past experience in a high volume call center has shaped my communication skills and phone etiquette. Experience with medical insurance as well as medical terminology. These qualities create the perfect candidate. My current role in revenue cycle management as an account specialist is creating a better understanding of the billing process.
Overview
8
8
years of professional experience
Work History
Account Specialist
Convergent Revenue Cycle Management
2022.05 - 2024.06
- In my current role with Convergent Revenue Cycle Management I review denied claims and handle 25 accounts per day. This includes analyzing and investigating claims that have been denied by insurance providers.
- Identify reasons for denials which involves me to determine the specific reasons for claim denials, such as coding errors, incomplete information, or lack of medical necessity. I correct errors where I need to address and rectify errors or issues that led to claim denials, collaborating with coding and billing teams as needed.
- Resubmitting claims where I prepare and resubmit corrected claims to insurance companies, ensuring adherence to submission guidelines and timelines.
- Communicate with payers and engage in communication with insurance companies to resolve claim denials, seeking clarification on rejection reasons and providing additional information as required.
- When necessary I appeal denied claims. If necessary, initiate the appeals process by drafting and submitting appeals to challenge denied claims, providing supporting documentation and arguments for reconsideration.
- Tracking and monitoring claims maintain detailed records of denied claims, tracking the status of resubmissions and appeals to ensure timely resolution.
- Collaborate with internal teams by working closely with coding, billing, and other relevant departments to prevent future claim denials by addressing root causes and implementing process improvements.
- Stay Informed by staying updated on changes in insurance regulations, coding guidelines, and other relevant industry updates to enhance claim approval rates.
- I provide feedback and share insights and trends related to claim denials with the team to contribute to continuous improvement in the revenue cycle management process.
Medical Billing Clerk
Family Health Care Network
2021.07 - 2022.05
- Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claims submission
- Checking eligibility and insurance benefits via Availity, Medi-Cal portal,
- Commercial insurance portals, as well as calling insurance directly
- Identifying and billing secondary or tertiary insurances
- Understanding of insurance guidelines and timeframes for claim submission of most for private insurance and Medi-Cal
- Following up on claim denials and resolving denials and submitting appeals when appropriate
- Ensure patient's medical information is accurate and up to date
- Experience with both billing UB-04 and HCFA claims both electronically and paper.
Customer Service Associate / Cigna
CIGNA
2016.09 - 2021.04
- Creative problem solving, critical thinking and empathy skills are essential
- Professional interaction, active and passive listening skills
- Ability to utilize computer-based resources in a highly effective manner to educate and provide accurate responses to customer inquiries
- Ability to be compassionate and empathetic, when appropriate, while handling complex customer inquiries
- Responsible for receiving requests via telephone regarding insurance claims/policies while multitasking and operating on multiple computer applications
- Respond to policy holder's questions or providers for information and assistance
- Dealing with an array of inquiries ranging from moderate to complex issues. Trained to be more proficient with medical insurance
- Responsible for understanding ICD-10, CPT, HCPCS codes
- Ability to prioritize and work independently
- Deliver exceptional level of service to each customer by listening to concerns and answering questions.
Education
Medical Billing - Medical Billing
Career Step
OnlineHigh School Diploma - General Education
Rancho Cotate High School
Rohnert Park, CASkills
- Medical claims submission
- Medical billing knowledge
- Customer service support
- Proficiency in EPIC, Excel, eClinical Works, Availity, Medi-Cal provider portal, Word, Powerpoint, etc.
- Medicare and Medicaid process
- Data Entry
- Teamwork and Collaboration
- Health insurance
Timeline
Account Specialist
Convergent Revenue Cycle Management
2022.05 - 2024.06
Medical Billing Clerk
Family Health Care Network
2021.07 - 2022.05
Customer Service Associate / Cigna
CIGNA
2016.09 - 2021.04
Medical Billing - Medical Billing
Career Step
High School Diploma - General Education
Rancho Cotate High School
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