NATHALIA ALVAREZ
Account Representative I
Orlando,FL
Summary
Experienced healthcare professional with 13 years of experience in hospital patient account denials and follow-up. Proven record of accomplishment in analyzing denial trends and implementing effective solutions to improve revenue cycle efficiency. Skilled in root cause analysis, appeal writing, and cross-departmental collaboration to reduce claim denials. Proficient in using data to find uncover issues and inform strategic decisions. Committed to enhancing financial performance and ensuring compliance within healthcare organizations.
Overview
15
15
years of professional experience
1
1
Language
Work History
Hospital Account Representative I – Follow Up, Denials, Collections
AdventHealth Hospital Orlando, FL
04.2023 - Current
- Manage insurance billing, Collections and denial Management under general supervision, ensuring timely resolution of issues.
- Review and analyze assigned electronic claims and submission reports to ensure compliance with contractual agreements.
- Examine contracts to determine proper reimbursement protocols and resolve/re-submit rejected claims as necessary.
- Process daily reports, unlisted invoices, error logs, stalled reports and aging accounts to streamline operations.
- Assess previous accounts documentation to determine appropriate actions for resolution.
- Conduct outgoing calls to patients and insurance companies to gather necessary information for accurate billing and collections.
- Respond to incoming inquiries from insurance companies regarding claims status and additional information requests.
- Recognized for strong accuracy and selected within first 10 months to perform peer quality audits, delivering feedback and documenting errors, contributing to improved quality.
- Consistently exceeded quota expectations leading the way among fellow representatives.
Denials Specialist
Conifer Health Orlando, NY
04.2022 - 05.2023
- Efficiently managed the end-to-end denials management process, including identifying and analyzing denied claims, determining root causes, and implementing appropriate actions for resolution.
- Conduct thorough reviews and analyses of denied claims to identify errors, discrepancies, and reasons for denial, such as coding issues, documentation deficiencies, or billing errors.
- Prepared and submitted appeals for denied claims, ensuring timely filing and adherence to payer-specific requirements. This involves gathering supporting documentation, drafting persuasive appeal letters, and presenting compelling arguments for claim reconsideration.
- Communicated and negotiated with insurance companies, payers, and other relevant parties to clarify claim denials, address inquiries, and resolve disputes. Maintained professional and effective relationships to maximize reimbursement and achieve positive outcomes.
- Ensured claims are coded accurately and in compliance with coding guidelines, medical necessity requirements, and payer regulations. Identify coding errors, recommend appropriate adjustments, and collaborate with coding teams for coding-related denials.
- Collaborated with healthcare providers, clinical documentation specialists, and coding teams to identify areas of improvement in documentation processes. Offer guidance, education, and training to enhance documentation quality and reduce denials related to inadequate or incomplete documentation.
- Continuously evaluated and improved denial management processes, workflows, and operational efficiencies. Identify opportunities for streamlining claim submission, enhancing revenue cycle performance, and reducing denials.
- Analyzed denial trends, patterns, and financial impact to identify areas of improvement and developed proactive strategies for denial prevention. Generated reports and presented key findings to management, providing insights for decision-making and resource allocation.
- Conducted training sessions for internal staff members on denial prevention strategies, coding best practices, and payer-specific guidelines. Keep abreast of industry updates and changes in regulations to ensure compliance and knowledge-sharing within the team.
Veterans Affair - Medicare Medical Biller/Auditor
CVS Health Orlando, FL
01.2020 - 03.2021
- Verified payment made by veteran's insurance, Medicare outstanding balances while maintaining quality and productivity requirements.
- Reviewed claims for clerical errors and followed specific periods for resubmission.
- Investigated claim denials and provided resolution for unpaid claims while handling high appeal volume and following the appeal management process.
- Followed worklists to prioritize negative balances as well as collaborating with other teams within the revenue cycle to request relevant information that the payer may need for appeal review.
- Determined correct pricing for CORAM therapy infusion and nutrition therapy claims, contacting Veterans Affairs payers and commercial insurances, as well as determining denial trends.
- Promoted to Auditor within 6 months in medical biller role to Refund request department.
- Reviewed aged claims thoroughly to confirm if appropriate actions were taken by our facility based on our contract with the insurance carrier.
- Created PDF auditor packets with proof of billing grids and other determining factors such as time limits, concluding with reasoning why refund request would be appropriate or denied based on finding.
Account Receivable Denials Specialist
Northshore University Health System New York, NY
07.2016 - 04.2019
- Researched patient medical records while utilizing regulatory and clinical knowledge to determine denied cases as well as addressing cases requiring an appeal.
- Developed strong, supported appeal arguments by utilizing clinical evidence and pre-existing criteria.
- Provided support by reviewing claims prior to resubmission.
- Investigated and prepared to support clinical evidence to support appeal arguments.
- Prepared feedback for provider representative meetings with clients on unresolved issues.
- Provided direct communication with clients on the level of care and documentation decisions.
- Effectively review Patient medical records and translate handwritten notes.
- Followed HIPAA guidelines and regulations to ensure compliance.
Account Receivables Follow up Clerk
Northshore University Health System New York, NY
09.2014 - 07.2016
- Effectively interacted with carriers and notating systems using the standard format.
- Identified revenue opportunities and unpaid claims.
- Responsible for daily workflow assigned in work queues or assigned by the manager.
- Prepared claims for resubmission manually or electronically.
- Reviewed Explanation of Benefits and contacting insurance companies regarding discrepancies.
- Collected denials for appeals support.
- Investigated, analyzed, and resolved problematic and delinquent accounts.
- Utilized websites and applications to assist in confirming eligibility, claim status, and denials.
- Followed HIPAA guidelines and regulations.
- Knowledge of Eagle, AOS Forest Hills, Southside, Lennox Hills, and Huron systems.
Finance Clerical Associate
Bellevue Hospital Center (HHC) New York, NY
03.2014 - 09.2014
- Procedural and administrative activities associated with Business Office Operations as well as clinical.
- Processed new patients for clinical outpatient services, collecting demographics and financial clearance.
- Verified patient's insurance and assisted others with financial counseling such as the HHC Options program by fee-scaling patients based on income and household size.
- Responsible for meeting compliance standards related to HIPPA regulations and HHC.
- Performed all means of cash and applied to appropriate patient accounts.
- Responsible for registering patients for clinical appointments by opening visits for doctors to write their notes as well as closing visits from time to time.
Regional Claims Recovery Specialist
Northshore University Health System New York, NY
04.2012 - 09.2012
- Working Knowledge of hospital systems including IDX and Envision.
- Provided informal, administrative, and clerical services to ensure efficient and accurate financial operations.
- Professional telephone skills and assisted patients to understand billing inquiries and recommending payment options/ financial assistance in both languages (English/Spanish).
- Performed credit/debit transactions to ensure all cash receipts are applied properly to patient accounts.
- Met all HIPAA regulations including handling patient's explanation of Benefits and interacting with insurance companies determining patient's financial responsibilities.
- Performed all activities necessary to collect outstanding balances in a timely matter and monitoring outstanding receivable balances.
Patient Accounts Representative
Medical Recovery Collections Group -Garden City, NY
02.2011 - 03.2012
- Responsible for managing and coordinating delinquent accounts in need of further attention. Targeting current and aged accounts in need of determination status, focusing on reduction and recuperation of receivables.
- Knowledge of Commercial, Workers Compensation, and No-Fault Insurances.
- Follow up communication with patients regarding balances, deductibles, and copayments.
- Compile, analyze and submit monthly denial, Adjustment and Recommended Provider Fault report.
- Working knowledge of varies medical billing applications including MediTech and Eagle.
- Ability to train new hires on proper medical billing procedures.
- High attention to detail led to the designation of a special project with Wyckoff Hospital to correct data discrepancies issues and resubmit claims electronically.
- Within 3 months of hire I was promoted from Account Resolutions Unit to Burke Rehabilitation Hospital billing department.
Education
Health Information Technology
Nassau College
Garden City, NY02.2026
Skills
- Insurance Verification: Proficient in verifying insurance coverage, eligibility, and benefits remotely using insurance databases, online portals, and electronic health records (EHR) systems
- 13 Years in DME Billing & Account Receivable Experience: Deep understanding of medical insurance policies, terminology, coding systems (such as CPT, ICD-10), and industry regulations to accurately interpret and apply insurance guidelines
- Attention to Detail: Highly detail-oriented, with the ability to review and analyze complex insurance policies, claims, and documentation to ensure accuracy and identify discrepancies
- Communication Skills: Excellent verbal and written communication skills to effectively communicate with patients, healthcare providers, and insurance representatives, providing clear explanations of insurance coverage, resolving inquiries, and addressing concerns
- Problem Solving: Strong analytical and problem-solving skills to identify and resolve insurance-related issues, including claim denials, coverage gaps, and billing discrepancies
Timeline
Hospital Account Representative I – Follow Up, Denials, Collections
AdventHealth Hospital Orlando, FL
04.2023 - Current
Denials Specialist
Conifer Health Orlando, NY
04.2022 - 05.2023
Veterans Affair - Medicare Medical Biller/Auditor
CVS Health Orlando, FL
01.2020 - 03.2021
Account Receivable Denials Specialist
Northshore University Health System New York, NY
07.2016 - 04.2019
Account Receivables Follow up Clerk
Northshore University Health System New York, NY
09.2014 - 07.2016
Finance Clerical Associate
Bellevue Hospital Center (HHC) New York, NY
03.2014 - 09.2014
Regional Claims Recovery Specialist
Northshore University Health System New York, NY
04.2012 - 09.2012
Patient Accounts Representative
Medical Recovery Collections Group -Garden City, NY
02.2011 - 03.2012
Health Information Technology
Nassau College