Raquel Castrellon
Sylmar,CA
Summary
Skilled Billing Manager adept at maximizing productivity and bringing 2024-year track record of success. Knowledgeable about daily accounts receivable operations, collections and reporting. Open and clear communicator with a consistent approach to reviewing and improving processes.
Overview
15
15
years of professional experience
Work History
Billing Supervisor
Keck Medical Center of USC
Los Angeles
08.2023 - Current
- Assisted in training new staff on insurance verification processes and procedures.
- Collaborated with other departments such as billing and coding personnel to resolve complex cases.
- Verified insurance coverage and eligibility for services using computer software.
- Adhered to established departmental policies and procedures related to insurance verifications.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Contacted patients to confirm demographic information and communicate financial responsibilities.
- Determined estimated self-pay portion by calculating charges, co-insurance and deductibles.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Monitored employee productivity levels on a regular basis to identify areas of improvement.
- Provided ongoing training to address staff needs.
Operations Manager II
Clinicas del Camino Real
03.2019 - 08.2020
- Overseeing the management of multiple FQHC health centers in accordance to the mission of Clinicas del Camino Real
- Developing standardized policies and procedures and best business practice
- Training, coaching, and mentoring the Health Center Manager's
- Working closely with appropriate staff to integrate managed care plan requirements into clinic procedures
- Coordinating the integration of special programs, projects, and services into health care clinic operations
- Overseeing performance compliance with clinic service contract, including state and federal designing implementing, modifying, and monitoring new systems and processes at the Health Centers
- Ensuring the efficiency of outpatient medical care, operations, customer service, and quality of all Health Centers
- Ensures the Health Centers meet business objectives and financial goals
- Leading state and health plan audits, CDPH, HRSA, NCQA, and Joint Commission to ensure that all facilities are in compliance and protocols are being followed to maximize proper health care.
Billing Manager
Healthline Medical Group
Van Nuys, CA
04.2016 - 03.2019
- Full oversight and responsibility for Healthline billing operations
- Responsible for leading and planning the billing department, oversees all areas of reimbursement operations to ensure timely and accurate for Inpatient, Outpatient, and Client Invoices
- Ensure Health Insurance Claims are followed up and completed in a timely manner
- Daily monitoring of all accounts receivable collections
- Monthly monitoring and reporting of productivity, billed claims, denied claims, unbillable claims, adjustments, and write offs
- Research information for compliance with local, state, and federal regulations as needed and directed
- Plans and implement written policies and procedures to facilitate communication and timely information flow to improve quality assurance and compliance issues
- Ensures training guides are maintained for training new staff and cross-training purposes to ensure the proper workflow
- Ensure all billing staff complies with the legal mandates of HIPAA for client confidentiality and release of information
- Prepare weekly and monthly reports to track accounts receivables and financials.
Medical Billing Director
Valley Professional
Calabasas, CA
06.2010 - 03.2016
- Overseeing and opening new multi specialty clinics in Southern California, Arizona, and Louisiana
- Developing standardized policies and procedures for delivery of health care services training staff to implement policies and procedures
- Hiring, training, developing, and delivering performance reviews
- Working closely with appropriate staff to integrate managed care plan requirements into clinic procedures
- Coordinating the integration of special programs, projects, and services into health care clinicoperations
- Overseeing performance compliance with clinic service contract including state and federal designing implementing, modifying, and monitoring new systems and processes at all sites
- Ensuring the efficiency of outpatient medical care, operations, customer service, and quality of all clinics
- Leading state and health plan audits to ensure that all facilities are in compliance and protocols are being followed to maximize proper health care
- Overseeing the development of new health centers facilities and meeting budgetary outlines
- Monitors and maximizes the company's billing and collections effort, develops and implements billing processes and staff facilitation to provide timely and accurate billings to all types of payers
- Consistent reviews, revises, and makes recommendations for billing procedures as needed
- Update company manual and corporate billing literature as required
- Prepare weekly and monthly reports to track accounts receivables and financials.
Claims Examiner
Health Net
Woodland Hills, CA
06.2009 - 06.2010
- Processes all claims eligible or ineligible for payment, Matches authorizations to claims and Determines level of reimbursement.
Education
Bachelor's -
University of Phoenix
05.2009
Skills
- Extensive knowledge in PPO, HMO, Medicare, Medi-Cal FFS, Workers' Compensation and Personal Liens
- Bilingual
- Strategic thinking
- Excellent analytical
- Problem-solving skills
- Strong leadership skills
- Accounts Receivable Expertise
- Research and Due Diligence
- Managed Care
- Healthcare Management
- Supervising experience
- Medical collection
- Reporting Requirements
- Team Development
- Strategic Decision-Making
- Claims Processing
- Audit Procedures
- Billing Dispute Resolution
- Medical Billing and Collections
Languages
Spanish
Professional
Timeline
Billing Supervisor
Keck Medical Center of USC
08.2023 - Current
Operations Manager II
Clinicas del Camino Real
03.2019 - 08.2020
Billing Manager
Healthline Medical Group
04.2016 - 03.2019
Medical Billing Director
Valley Professional
06.2010 - 03.2016
Claims Examiner
Health Net
06.2009 - 06.2010
Bachelor's -
University of Phoenix
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