Nancy Aguilar Bautista

40 Hrs. Per Week/ $27.71 Hr./Full-Time GS7 Step 5

As a lead MRT, I am responsible for leading a team of Medical Reimbursement Technicians in accomplishing one-grade interval work and performing work of the same kind and level as the highest level of work accomplished by the team.

• Duties include distributing and balancing the workload, providing on-the-job training, maintaining knowledge of procedures and policies, estimating and reporting on completion of work, and making day-to-day adjustments in accordance with established priorities.
• Maintain current knowledge and answer questions of other employees on procedures, policies, directives, and obtain needed information or decisions from supervisor on problems that come up.
• Monitor ONTRACS and QUICS work lists daily, ensuring all entries are processed before they become delinquent.
• Monitor QR, IVF, EICD, HSRM, MS-DYNAMICS, WORPM, Camp Lejeune programs.
• Estimate and report on the expected time of completion of work, and maintain records of work accomplishments and time expended.
• Keep in touch with the status and progress of work, and make day-to-day adjustments in accordance with established priorities, obtaining assistance from the supervisor on problems that may arise, such as backlogs that cannot be disposed of promptly.
• Review patient records and insurance policies, verifying coverage to minimize denials.
• Provide training to the new team members in medical reimbursement processes, enhancing team proficiency and performance
• Keeping the insurance job aids updated including the most current information.

40 Hrs. Per Week/$21.67 Hr./Full-Time GS 6 Step 5

• As an MRT, I was responsible for performing a broad range of duties related to medical billings and collections, including insurance verification, entering updated information, and maintaining the database. I was a point of contact for other employees on procedures and policies.
• Verifying Veterans' insurance coverage for inpatient and outpatient services.
• Verifying benefits, policy number, pre-certification requirements, insurance company contact information, and effective dates of coverage.
• Merging duplicate plans to streamline facility insurance records to minimize insurance billing errors.
• Documents pre-admission requirements and identifies patients requiring second opinions.
• Responsible for maintaining the integrity of the insurance database and for updating information in the VISTA by utilizing the Insurance Capture Buffer function.
• Assists with the pre-certification process.
• Responsible for denial of claims, take appropriate corrective action, and communicate directly with the Billing, Pharmacy and Accounts Management departments by using interdepartmental work tool (Huron).
• Reviewing and editing insurance policy plans as needed.