Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Nayeli Acevedo

Stockton,CA

Summary

Brings proven track record of success in determining eligibility and resolving complex cases. Works professionally with clients to develop and implement successful strategies for maximizing services and benefits. Skilled in problem-solving and identifying solutions meeting clients' needs.

Overview

9
9
years of professional experience
1
1
Certification

Work History

Claims Analyst/Eligibility Coordinator

BeneSys Inc.
07.2018 - Current
  • Managed multiple Health Plan accounts, processing enrollment forms
  • Viewed reports regularly to make sure processing was conducted efficiently.
  • Corrected medical codes to properly classify medical claims.
  • Resolved discrepancies with client applications to verify eligibility.
  • Assisted clients with accurate eligibility form, application and document completion.
  • Followed guidelines when reviewing applicant data to determine eligibility.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
  • Generated and balance monthly reports for multiple health plans.
  • Maintained strict confidentiality with all personal data as per company guidelines.
  • Verified CPTS and ICD-10 to ensure they match claims
  • Adjudicated Medical Claims, processed insurance payments.

MEDICAL BILLER/FRONT OFFICE

STOCKTON PULMONARY
06.2017 - 07.2018
  • Analyzed past due invoices and minimized number of unpaid accounts and claims
  • Maintained patient medical records, reviewed accuracy for insurance claims submissions
  • Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
  • Assisted scheduling appointments and assisted with patient registration
  • Acquired insurance authorization for upcoming procedures ordered by Physicians.
  • Communicated with insurance providers to resolve denied claims and resubmitted.
  • Liaised between patients, insurance companies, and billing office.

MEDICAL BILLER/RECEPTIONIST/VALLEY

MRI AND RADIOLOGY INC
06.2015 - 04.2017
  • Verified insurance of patients to determine eligibility.
  • Reviewed patient records, identified medical codes, and created invoices for billing purposes.
  • Collected payments and applied to patient accounts.
  • Filed and updated patient information and medical records.
  • Helped patients complete necessary medical forms and documentation.
  • Coordinated patient scheduling, check-in, check-out and payments for billing.
  • Transcribed phone messages and relayed to appropriate personnel.
  • Performed various administrative tasks by filing, copying and faxing documents.

MEDICAL BILLING SPECIALIST

TOKAY MEDICAL BILLING INC
07.2014 - 06.2015
  • Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
  • Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
  • Located errors and promptly refiled rejected claims.
  • Posted and adjusted payments from insurance companies.
  • Precisely evaluated and verified benefits and eligibility.
  • Filed and updated patient information and medical records.
  • Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts.
  • Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.

Education

Bachelor of Science - Health Administration

University of Phoenix
Phoenix, AZ

Associate of Science - Interdisciplinary Studies/Elementary Teachers Prep

San Joaquin Delta College
Stockton, CA
05.2010

Skills

  • Eligibility Evaluations
  • Reimbursement Processing
  • Paperwork and Documentation
  • Past Due Balance Management
  • Clerical Support
  • Patient Scheduling
  • Appointment Scheduling
  • Enrollment Procedures
  • Eligibility Monitoring
  • Individualized and Group Training

Certification

COMPLETION OF BLS, CPR AND FIRST AID TRAINING COMPLETION OF MEDICAL TERMINOLOGY COURSE KNOWLEDGE OF HMO’S, MEDICARE AND MEDI-CAL KNOWLEDGE OF ELECTRONIC MEDICAL RECORDS

Timeline

Claims Analyst/Eligibility Coordinator

BeneSys Inc.
07.2018 - Current

MEDICAL BILLER/FRONT OFFICE

STOCKTON PULMONARY
06.2017 - 07.2018

MEDICAL BILLER/RECEPTIONIST/VALLEY

MRI AND RADIOLOGY INC
06.2015 - 04.2017

MEDICAL BILLING SPECIALIST

TOKAY MEDICAL BILLING INC
07.2014 - 06.2015

Bachelor of Science - Health Administration

University of Phoenix

Associate of Science - Interdisciplinary Studies/Elementary Teachers Prep

San Joaquin Delta College

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Nayeli Acevedo