Nancy Ramirez
Los Angeles,CA
Summary
Experienced in patient access management with a strong focus on revenue cycle optimization. Expertise in leading cross-functional teams, resolving billing issues, and communicating revenue cycle trends to support strategic decision-making, fostering a culture of accountability and continuous improvement.
Overview
18
18
years of professional experience
Work History
Insurance Biller
USC Care Medical Group
Pasadena, California
01.2025 - Current
- Resolved and appealed claim denials and rejections to enhance revenue cycle.
- Correct charge and claim discrepancies.
- Resolved patient billing problems. Followed up on patient unpaid balances by rebilling, telephone contract.
- Managed the update of patient demographics and insurance information.
- Achieved productivity and accuracy standards set by management.
- Completed various responsibilities as directed by the supervisor.
Patient Access Manager
Acuity Eye Group
07.2024 - 12.2024
- Full revenue cycle management of the organization
- Oversaw day-to-day activities of authorization, invoicing, and collections department, ensuring operational efficiency.
- Oversees denials management, including reporting, accountability, and resolution.
- Leads in development and implementation of policies/procedures to assure compliance with new regulatory standards affecting billing/revenue.
- Created and implemented metrics for productivity and quality, enhancing departmental performance and accountability.
- Managed, trained, and coached individual team members, creating personnel development and succession plans.
- Summarized and communicated revenue cycle successes, challenges, and trends to executive team to inform strategic planning.
- Collaborates with the Finance team to manage the month-end close and annual audit processes
Billing Specialist
Cedars-Sinai
Pasadena, California
01.2022 - 07.2024
- Coordinated resolution and appeal processes for denials and rejections, enhancing claim approval rates.
- Correct charge and claim discrepancies.
- Managed the process of updating patient demographics and insurance information.
- Streamlined revenue cycle operations, contributing to improved financial performance.
- Met productivity and accuracy standards set by management, ensuring timely processing of billing tasks.
Billing Specialist
Huntington Health Physicians
Pasadena, California
01.2018 - 01.2022
- Corrected charge and claim discrepancies to ensure accurate billing.
- Responsible for processing payer correspondence, edits and aged account receivable, and identifying and correcting billing errors.
- Monitored and implemented follow-up procedures for unpaid/delinquent third-party claims, including SC Pipa, Medicare, and Blue Shield.
- Resolved patient billing problems and followed up on unpaid balances through rebilling and direct communication.
- Handled billing and collection duties for physician services to ensure timely payments.
- Review self-pay patients' accounts and follow up on delinquent accounts.
- Post credit card payments that come in mail/phone calls.
- Meet Productivity and accuracy standards as established by management.
- Assisted with closing Month End and Coding.
- Training with new providers with Ingenious Med System for charges.
- Executed projects directed by the Director.
- Oversaw team activities to ensure continuity of services while supporting the director.
- Maintained accurate patient demographics and insurance information.
Billing Specialist
Facey Medical Foundation
Mission Hill, CA
01.2015 - 01.2018
- Managed payer correspondence and aged accounts receivable, identifying and correcting billing errors to ensure accurate reimbursements.
- Resolved patient billing issues, following up on unpaid balances through rebilling and direct communication to enhance collections.
- Addressed and appealed denials and rejections.
- Reviewed EOBs and RAs for errors, initiated appeals, and resubmitted claims, recovering unpaid balances effectively.
- Monitored and implemented procedures to follow-up on unpaid/delinquent third party, Sc Pipa, Medi-Care, Blue Shield, and other third-party claims.
- Maintained accurate patient demographics and insurance information.
- Correct charge and claim discrepancies.
Billing Specialist
Health Net of California, Inc.
Glendale, California
01.2008 - 01.2014
- Processed authorizations for outpatient, inpatient, durable medical equipment, skilled nursing, physical therapy, and occupational therapy.
- Analyzed and reviewed authorizations / referrals for Medi-Cal and state health programs.
- Met quota and timeliness for daily productions of authorizations.
- Triaged cases to appropriate nurses for further determination if needed.
- Coordinated communication to facilitate timely patient discharges.
- Executed assigned tasks to enhance operational processes.
Education
High School Diploma -
Eagle Rock Jr/Sr High School
Los Angeles, CA06-1994
Skills
- Project management
- Management expertise
- Leadership abilities
- Problem solving
- Communication skills
- Bilingual
Timeline
Insurance Biller
USC Care Medical Group
01.2025 - Current
Patient Access Manager
Acuity Eye Group
07.2024 - 12.2024
Billing Specialist
Cedars-Sinai
01.2022 - 07.2024
Billing Specialist
Huntington Health Physicians
01.2018 - 01.2022
Billing Specialist
Facey Medical Foundation
01.2015 - 01.2018
Billing Specialist
Health Net of California, Inc.
01.2008 - 01.2014
High School Diploma -
Eagle Rock Jr/Sr High School