Nely Guerreo
Los Angeles,CA
Summary
With over 10 years of experience in healthcare, I have supported billing, collections, and financial workflows across multiple clinics. I bring strong attention to detail, organization, and the ability to coordinate effectively across departments in fast-paced environments. I’m seeking a role where I can contribute to daily operations while continuing to grow and develop new skills.
Overview
14
14
years of professional experience
Work History
Rev cycle Medical Biller
Aids Healthcare Foundation
Los Angeles, California
08.2023 - Current
- Process medical claims using electronic billing systems efficiently.
- Communicate with insurance providers to resolve claim discrepancies.
- Maintain compliance with healthcare regulations and billing guidelines.
- Review patient records for accurate coding and billing information.
- Reviewed patient insurance information to ensure accuracy and completeness of claims submission.
- Contacted insurance providers to verify insurance information and obtain billing authorization.
- Followed up on unpaid claims with insurance companies or other third party payers through phone and written correspondence to ensure timely payment.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
- Facilitated effective coordination between clinics and departments to improve workflow efficiency.
- Researched discrepancies between billed charges and payments received from insurance companies or other third party payers.
- Generated reports to track and monitor payments due from insurance companies or other third party payers.
- Applied HIPAA privacy and security regulations while handling patient information.
Medical Billing Supervisor
NuHealth Surgical Center/ Orange View Healthcare
Santa Ana, CA
03.2019 - Current
- Managing the billing department.
- Supervise the processing and completion of claims including underpayments, EOB denials, appeals, follow-ups, and corrected claims.
- Receiving superbills from a multi-specialty surgery center, including and not limited to surgeons' fees, DME, and PCP.
- Knowledgeable of CMS-1500, UB-04 forms, ICD-10, and CPT guidelines and coding.
- Managed the revenue cycle process to ensure efficient billing and collections.
- Directing workload appropriately. Coordinating and directing the activities of the billing operations.
- Following overall department protocol; State, Federal, and payer requirements, guidelines, and regulations.
- Administer appropriate training and provide newly hired employees with the overall protocol starting with EOB comprehension, billing, and posting until I see growth.
- Direct monthly aging reports and weekly follow-ups on open/unpaid claims.
- Knowledge of accounting and bookkeeping procedures.
- Maintain great rapport with Doctors and patients and staff.
Collection Specialist
HealthCare Debt Recovery
Irvine, CA
04.2016 - 03.2019
- Receiving unpaid or partially paid claims in my department. Thoroughly going through each claim history to resolve any denial or coding issues.
- Resubmitting claims for a higher payment attaching appeals (depending on denial or low payment).
- Working with HMO, PPO, Workers Comp, (settling) Attorney Liens, Medical, and Medicare.
- Collecting payments from patients such as co-insurance/deductibles and copay.
- Balance billing patient for portions not covered by the insurance carrier.
- Accounts receivable, posting, adjusting payments.
- Working with multiple databases filled with over 100 different anesthesiologist and multi-specialist doctors around the US.
- Intake/return insurance and patient calls.
- ICD 10 proficient.
- Knowledge of rules, regulations, appeal process, and timely filing regarding insurance billing coverage and collection process.
Medical Biller
Sunshine Medical Center
Garden Grove, CA
10.2012 - 04.2016
- Supervise the billing office, making sure everything is up to date.
- Thoroughly checking other employee's work, making sure there are no errors, and if so we go over them and correct them accordingly.
- Setting up software with 3 different companies, Medisoft, Collaborate, and our most recent one Daisybill.
- Setting up our facility to be contracted with Medicare and other insurance carriers when asked of me.
- Going over errors with employees and correcting them while teaching them multiple rules/regulations, modifiers, denials, global period, E&M details etc.
- Training new employees with the different aspects of work that we expect from them such as Medical Billing/Coding/Collecting.
- From Workers Compensation Rules and Regulations to PPO all while Collecting/Billing/Coding multiple Radiology/Pathology/E&M/Pre-op/Podiatry office visits and surgeon fees.
- Thoroughly inspect patient's documents, case histories, and forms such as intake and insurance forms, while performing front and back-office duties.
- Collecting and posting payments.
- Contacting patients and insurance companies for outstanding balances.
- Invoicing patients, adding patients into a collection software (Transworld, QuickBooks).
- Writing out all paid/denied claim amounts for different procedures on Excel by date of service, payment date, and the amount paid, and if claims were denied I resubmit if applicable, making notes as to why.
- Following up on unpaid claims.
- Resubmitting corrected claims.
- Sending out first and second level appeals.
- Billing/Coding/ pricing medical procedures done on our patients.
- Submitting the claims to WorkerComp/PPO/HMO/Attorney liens on UB 04/CMS 1500 (02-12) claim forms.
- Specialize in Radiology, Pathology, DVT, DME, Fluoroscopy, Podiatry and Internal Medicine billing along with Outpatient billing.
Education
Associate of Arts -
Santa Ana College
Santa Ana, CA04-2026
Skills
- Critical thinking
- Teamwork and collaboration
- Work prioritization
- Calendar & Meeting Coordination
- Patient communication
- Procedure coding
- Medical billing
- Problem resolution
- Fluent in (English and Spanish)
- Dependable and responsible
- Friendly, positive attitude
- Attention to detail
- Flexible and adaptable
Timeline
Rev cycle Medical Biller
Aids Healthcare Foundation
08.2023 - Current
Medical Billing Supervisor
NuHealth Surgical Center/ Orange View Healthcare
03.2019 - Current
Collection Specialist
HealthCare Debt Recovery
04.2016 - 03.2019
Medical Biller
Sunshine Medical Center
10.2012 - 04.2016
Associate of Arts -
Santa Ana College