Paula Pineda
Medical Biller & Collections
Santa Ana,CA
Summary
Professional medical collections specialist with extensive experience in healthcare billing and revenue cycle management. Known for reducing delinquent accounts and improving payment recovery rates. Reliable team player focused on collaboration and adapting to evolving needs while utilizing strong negotiation and customer service skills.
Overview
2
2
Languages
18
18
years of professional experience
Work History
Medical Billing and Collections Specialist
Hematology Oncology Medical Group Orange County
06.2008 - 01.2024
- Collaborated with insurance providers to verify coverage and expedite claim processing.
- Managed patient billing inquires to resolve discrepancies and ensure timely payments.
- Analyzed collection reports to identify trends and develop targeted action plans for outstanding accounts.
- Established strong relationships with patients, enhancing communication regarding payment options and financial assistance programs.
- Collaborated with insurance companies to expedite claims processing and secure timely reimbursements.
- Established clear expectations for payment arrangements, minimizing misunderstandings between patients and the practice.
- Enhanced revenue recovery through diligent follow-up on delinquent accounts.
- Assisted patients with understanding their financial responsibilities, easing concerns about complex medical bills.
- Completed follow up and appeals on outstanding claims.
- Researched HCPCS, CPT, ICD-9 coding and modifiers.
- Analyzed medical codes for accuracy and compliance with billing regulations.
Medical Billing and Collections Specialist
Financial Data Management
01.2006 - 03.2008
- Managed collection process to optimize recovery rates and reduce delinquency.
- Maintained high volume of calls and met demands of busy and productive group.
- Provided excellent customer service during difficult conversations, defusing tensions while effectively collecting payments.
- Reviewed and verified insurance claims for accuracy, resulting in improved claim approval rates.
- Reduced claim denials by diligently reviewing patient records for correct coding, authorization billing information.
- Provided essential support to the medical billing team, allowing for a more efficient and effective overall operation within the department.
- Collaborated with team members to identify trends in unpaid claims and develop strategies for resolution.
- Assisted in maintaining a high-quality database of patient information by accurately entering demographic and insurance details into the system.
- Improved cash flow through timely follow-up on outstanding accounts, negotiating payment plans, and collecting overdue payments.
- Ensured compliance with industry regulations by staying up-to-date on changes to medical billing procedures and guidelines.
- Processed online and paper appeal submissions and refund requests.
- Corrected, completed and processed claims for multiple payer codes.
Education
High School Diploma -
Horizon High School
Santa Ana01-1992
Skills
- Patient account management
- HIPPA compliance
- Insurance Verification
- Motivation and initiative
- Data entry proficiency
- Debit collection techniques
- Problem-solving
- Customer service
- Teamwork and collaboration
- Attention to detail
- Multitasking
- Microsoft Office (Word, Excel, Outlook) Epic, Meditech, Aria, CureMD
Timeline
Medical Billing and Collections Specialist
Hematology Oncology Medical Group Orange County
06.2008 - 01.2024
Medical Billing and Collections Specialist
Financial Data Management
01.2006 - 03.2008
High School Diploma -
Horizon High School