Olivia Ponce

• Reviewed insurance claims to ensure accuracy and regulatory compliance, minimizing errors in processing.
• Processed appeals for denied or rejected claims, facilitating timely resolutions and enhancing customer satisfaction.
• Ensured all regulatory requirements were met when submitting claims for payment.
• Verified insurance coverage and identified third-party payers for billing purposes.
• Calculated billing charges, prepared and submitted claims to insurance companies.
• Managed patient accounts and resolved billing discrepancies efficiently.
• Coordinated with healthcare providers to obtain necessary documentation.
• Updated patient records in the electronic health record system accurately.
• Collaborated with departments to address and resolve customer inquiries about billing, improving overall service quality.

• Coordinated with third-party payers to resolve claims issues, ensuring timely payment.
• Processed appeals for denied or rejected behavioral health claims, achieving resolution within established timelines.
• Collaborated with billing, coding, and clinical departments to address outstanding claims payment issues.
• Stay up to date on payer-specific billing requirements, filing deadlines, and appeals processes.

Managed denied physical therapy claims, resolving issues to facilitate timely reimbursement.

• Resubmitted denied claims for reimbursement to ensure timely payment.
• Conducted follow-up calls with payers regarding denied claims, appeals, and medical record submissions.
• Coordinated with insurance companies to follow up on payment inquiries and claim issues.
• Submitting medical records and appeals
• Reviewing EOBS
• Posted payments to patient accounts to maintain accurate financial records.
• Reviewed aging reports to identify overdue accounts for collection efforts.

Collected information to support office staff and supervisors' decision-making.

• Sorted and distributed incoming mail to appropriate departments efficiently.
• Uploaded clinical records and notes to ensure accurate patient documentation.
• Timestamp all incoming urgent and routine authorization request from Dr. offices.
• Transferring new authorization request to the correct department (NON HMO, HMO)
• Preparing onboarding binders for all the new hires
• Maintained and updated office files and database systems for efficient information retrieval.
• Supported yearly audits by gathering necessary documentation.

• Verifying member's coverage and eligibility with Insurance for Substance Abuse
• Obtained member deductibles, co-insurance, and out-of-pocket expenses to ensure accurate billing and coverage understanding.
• Verified authorization requirements with insurance carriers.
• Contacted insurance companies to follow up on substance abuse claims.
• Analyzed claims issues, denials, and appeals to identify trends and improve resolution processes.
• Obtaining EOBs Posting Insurance payments, co-pays, deductibles
• Researched and identified reasons for overpayments and implemented corrective actions to rectify discrepancies.

Requested authorization for durable medical equipment from various insurance networks including worker compensation and private insurance (Humana, Aetna, Blue Cross).

• Managed incoming calls from adjusters, patients, and third-party administrators to resolve inquiries and facilitate effective communication.
• Verified patient deductibles and assessed in-network and out-of-network benefits to provide accurate financial information to patients.
• Verifying eligibility for private insurance and Medicare patients
• Verified pricing for services and dates of service

• Collected and verified patients' information to streamline the intake process.
• Delivered customer service by addressing inquiries and resolving issues to enhance patient satisfaction.
• Scheduled appointments and maintained updated calendars to ensure efficient patient flow.
• Answering phone calls
• Workers Compensation authorizations Submitting RFAs to the Insurance Company
• Processing and ordering medical equipment.