Reyna Paulino
Saint Augustine,FL
Summary
Detail-oriented Billing Specialist prioritizes claims by age, date, amount, and payer, achieving swift reconciliations. Identifies trends and collaborates with leadership to address systemic issues, ensuring timely correction of at-risk claims. Maintains a 95% clean claim rate monthly and resolves clearinghouse issues efficiently, ensuring immediate claim release post-correction and escalating system-related issues promptly.
Overview
11
11
years of professional experience
Work History
Billing Specialist
Tower Health Med Group
Reading
01.2017 - Current
- Professional claim submission to all Insurance companies and TPL accounts.
- Researched various insurance plans to ensure accurate billing.
- Interpreted payer Explanation of Benefits and payment information for accurate billing.
- Precisely evaluated and verified benefits and eligibility.
- Ensure compliance with healthcare regulations in all billing practices.
- Monitor and perform research on unbilled accounts.
- Resolve discrepancies in patient accounts through thorough investigation.
- Investigated incorrect billings and processed refunds as necessary.
- Reviewed medical records to ensure accuracy of billing information and patient data.
- Verified insurance coverage and identified third-party payers for billing purposes.
- Investigated clearinghouse issues to streamline claim processing.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Worked with team members to identify and develop process improvements.
- Tracked changes in legislation that could affect billing procedures.
- Trained new team members on company policies and accounting systems to keep team operations productive and efficient.
- Monitored past due accounts and pursued collections on outstanding invoices.
Patient Service Representative
Internal Medicine
Muhlenberg, PA
10.2015 - 01.2017
- Managed front desk operations, including guest check-in and check-out procedures.
- Conducted health insurance verification to ensure patient coverage and eligibility.
- Collected bill payments and copays from patients at point of service to ensure timely revenue flow.
- Assisted patients with billing inquiries to clarify charges and payment options.
- Call insurance companies for prior authorizations for procedures.
- Responded to customer inquiries and concerns via phone to enhance patient satisfaction.
- Reviewed daily care slips for doctors.
Education
Associate - Specialized Business Electronic Health Records
Berks Technical Institute
Wyomissing, PASkills
- Claims processing
- Billing compliance
- Claim submission
- Billing management
- Revenue management
- Medical coding
- Radiology referral management
- Customer service and support
- Dispute resolution
- Due diligence
- Problem-solving skills
- Effective communication skills
Languages
- English, Fluent reading and writing
- Spanish, Fluent reading and writing
Timeline
Billing Specialist
Tower Health Med Group
01.2017 - Current
Patient Service Representative
Internal Medicine
10.2015 - 01.2017
Associate - Specialized Business Electronic Health Records
Berks Technical Institute