Rafael Lomas
Converse
Summary
Results-driven Medical Billing and Collections Specialist with proven success at Bowhead in reducing claim denials and enhancing revenue collections. Proficient in insurance verification and coding, with strong analytical skills and a commitment to compliance. Adept at fostering teamwork and professionalism to improve cash flow and streamline billing processes.
Overview
24
24
years of professional experience
Work History
Accounting Clerk III
Bowhead
02.2018 - Current
- Verified insurance of patients to determine eligibility.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
- Filed and updated patient information and medical records.
- Ensured timely payments from insurance providers through submission of accurate and complete claims.
- Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
- Enhanced revenue collections for the medical practice with diligent follow-ups on unpaid claims.
- Liaised between patients, insurance companies, and billing office.
- Supported efficient scheduling practices by verifying patient eligibility and coverage prior to appointments.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Trained new team members in medical billing software, increasing efficiency within the department.
Medical Biller
Zenith Laboratory Services
02.2017 - 02.2018
- Verified insurance of patients to determine eligibility.
- Filed and updated patient information and medical records.
- Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
- Delivered timely and accurate charge submissions.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
Medical Billing and Collections Specialist
Integrity Managment Services
02.2016 - 02.2017
- Collaborated with team members to identify trends in unpaid claims and develop strategies for resolution.
- Compiled and tracked outstanding balances owed to medical facilities.
- Promoted a positive work environment by consistently demonstrating professionalism, mutual respect, and cooperation with fellow team members.
- Improved cash flow through timely follow-up on outstanding accounts, negotiating payment plans, and collecting overdue payments.
Medical Insurance Verification Specialist
Skytoxicology
11.2014 - 02.2016
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Updated patient records with accurate, current insurance policy information.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
Mixer Operator
Mrs. Bairds Bread
07.2001 - 11.2013
- Complied with all company policies regarding food safety and sanitation, ensuring the production of high-quality, safe products for consumers.
- Documented daily production activities accurately, providing valuable data for performance analysis and optimization efforts.
- Consistently met production deadlines through effective time management and task prioritization skills.
- Minimized waste generation through careful measurement of ingredients and attention to detail during mixing operations.
Education
Medical Billing And Coding
Lamson Institute
5819 Northwest Loop 41011-2014
Skills
- Office software (microsoft word, power point,teams,Adobe)
- Military software(Rev Cycle,Abacus,GIQD,SSI,Power Chart,cosmetic surgery)
- Electronic medical records filing and billing
- Billing concepts
- Insurance verification/Eligibility
- Coding (ICD-9,CPT,Intro ICD-10)
- Coding extraction from doctors notes
- CMS 1500/billing training
- claims collection
- charge posting from EOB
Timeline
Accounting Clerk III
Bowhead
02.2018 - Current
Medical Biller
Zenith Laboratory Services
02.2017 - 02.2018
Medical Billing and Collections Specialist
Integrity Managment Services
02.2016 - 02.2017
Medical Insurance Verification Specialist
Skytoxicology
11.2014 - 02.2016
Mixer Operator
Mrs. Bairds Bread
07.2001 - 11.2013
Medical Billing And Coding
Lamson Institute
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