Nadia Flores
Conroe,TX
Summary
Results driven medical biller and coder with a continuous improvement mindset, enhancing data integrity and reducing error rates. Proven ability in advanced troubleshooting and effective communication, leading initiatives that streamlined processes and improved user experience. Recognized for exceeding departmental goals and fostering collaboration across teams to achieve optimal oucomes.
Overview
13
13
years of professional experience
1
1
Certification
Work History
EDI Specialist
WebPT
06.2020 - Current
- Conducted regular audits on all EDI transactions, identifying areas of improvement and implementing necessary changes.
- Reduced error rates in EDI transactions by conducting thorough quality assurance checks and implementing corrective actions.
- Led numerous initiatives aimed at improving overall data quality and integrity within the organization''s EDI systems.
- Successfully resolved numerous technical issues related to data transmission between trading partners, minimizing disruptions to daily operations.
- Assisted providers with navigating online portal systems, enhancing user experience and expediting application submissions.
- Prepared and processed provider enrollments with Medicare and Medicaid in multiple states.
Credentialing Specialist
Aspire Hospital
06.2019 - 06.2020
- Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
- Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
- Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
- Enrolled providers and Medicaid, Medicare, and private insurance plans.
- Processed payments that had been received from insurance companies and Medicare.
- Accurately posted payments and adjustments both electronically and manually.
- Consistently maintained high levels of productivity, exceeding departmental goals each month.
Billing Auditor
GE Healthcare
02.2017 - 2019
- Managed relationships with external auditors, ensuring timely completion of audits and implementation of recommended improvements.
- Improved billing accuracy by meticulously reviewing invoices and identifying discrepancies.
- Increased customer satisfaction with accurate invoicing, addressing concerns promptly and professionally.
- Conducted thorough audits of billing records to ensure compliance with industry regulations and standards.
- Streamlined billing procedures by implementing efficient organizational systems and tools.
- Enhanced revenue recovery through diligent audit processes and timely follow-up actions.
Medical Billing Manager
Auxilium Medical Management
09.2012 - 10.2017
- Reviewed billing problems, researched issues, and resolved concerns.
- Worked with customers to develop payment plans and bring accounts current.
- Increased patient satisfaction by addressing billing inquiries promptly and professionally.
- Developed strong relationships with insurance companies through effective communication and negotiation skills, enhancing payment turnaround times.
- Reduced denied claims through diligent review, correction, and resubmission of errors.
- Enhanced revenue cycle management by overseeing timely and accurate claims submission.
- Streamlined claim appeals process by creating clear documentation guidelines and templates for staff use.
- Collaborated with providers and staff to ensure accurate coding for billing purposes.
Education
Medical Billing And Coding Certification -
DeVry University
Chicago, ILSkills
- Continuous improvement mindset
- Database management
- EDI software tools
- Advanced troubleshooting
- Error resolution
- Teamwork and collaboration
- Problem-solving abilities
- Multitasking
- Reliability
- Excellent communication
- Organizational skills
Certification
- Certified Professional Coder-A, AAPC - 2025
Languages
Spanish
Full Professional
Software
Microsoft Office
Salesforce
Waystar/Zirmed
Google Workspace
Encoder
Centricity
Eclinical
Timeline
EDI Specialist
WebPT
06.2020 - Current
Credentialing Specialist
Aspire Hospital
06.2019 - 06.2020
Billing Auditor
GE Healthcare
02.2017 - 2019
Medical Billing Manager
Auxilium Medical Management
09.2012 - 10.2017
Medical Billing And Coding Certification -
DeVry University
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