Summary
Overview
Work History
Education
Skills
References
Timeline
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Richard Herrera

Inglewood,CA

Summary

Dynamic Revenue Cycle Specialist with a proven track record at Onpoint Healthcare Partners, excelling in revenue analysis and claims processing. Adept at resolving denials and enhancing cash flow, I leverage strong problem resolution skills to drive operational efficiency and maximize collections, ensuring compliance with HIPAA regulations and fostering collaboration across departments.

Overview

33
33
years of professional experience

Work History

Revenue Cycle Specialist

Onpoint Healthcare Partners
Arizona City
08.2023 - 07.2025
  • Maintained up-to-date records on billing activities including adjustments, refunds, credits.
  • Identified areas of improvement to increase revenue performance.
  • Managed cash flow by monitoring incoming payments versus outstanding invoices.
  • Monitored daily collections activity and reported any discrepancies or irregularities.
  • Responded promptly to client inquiries about their account balances or payment arrangements.
  • Ensured all transactions were accurately recorded in the accounting system.
  • Assisted with the development of policies, procedures, and processes related to revenue management.
  • Developed strategies to maximize the collection of payments.
  • Researched customer accounts for accuracy in billing information.
  • Reviewed contracts to ensure compliance with company standards and regulations.
  • Provided support for customers regarding billing inquiries, pricing issues, and payment plans.
  • Documented all conversations between patients and staff related to collections activities.
  • Ensured compliance with applicable laws governing debt collection practices.
  • Worked with insurance companies to ensure timely reimbursement of claims.
  • Participated in weekly meetings with management team members to review progress towards goals.
  • Collaborated with other departments within the organization to resolve any billing issues.
  • Analyzed unpaid medical bills and determined appropriate collection action.
  • Provided support during audits by providing requested documentation in a timely manner.
  • Maintained accurate records of all patient account activity within the system database.
  • Reviewed and processed patient accounts for collections purposes.
  • Monitored accounts receivable aging reports on a regular basis.
  • Trained new staff members on proper procedures for collecting payments from customers.
  • Assisted in the resolution of credit balances due to overpayment or incorrect coding issues.
  • Contacted patients via telephone, mail, and email to discuss payment options.
  • Processed claims and forwarded information to Medicare, Medicaid and commercial insurance companies.
  • Identified discrepancies and carrier issues regarding billing and reimbursements.
  • Corrected, completed and processed claims for payer codes.
  • Sent incomplete or incorrect claims to supervisors for proper adjudication.
  • Took billing calls, questions and concerns from patients and third party carriers.
  • Worked closely with delinquent account holders to collect and reconcile accounts through approved channels.
  • Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
  • Contacted insurance companies to check status of claim payments.

Revenue Cycle Representative

Texican Inc.
Woodland Hills
07.1992 - 09.2022
  • Evaluated existing systems against industry best practices to enhance operational efficiency.
  • Managed multiple projects simultaneously, ensuring timely completion within budget constraints.
  • Analyzed complex information from diverse sources to identify patterns and trends.
  • Audited legal documents to verify compliance with policies and procedures.
  • Provided strategic advice on operational processes and business development initiatives.
  • Facilitated organizational changes to drive improvement across various departments.
  • Maintained positive relationships with staff and management to foster collaboration.

Medical Collections Specialist

Temp Unlimited
Cerritos
08.2001 - 08.2017
  • Ensured compliance with HIPAA regulations related to patient privacy rights.
  • Collected payments on past due accounts by making calls to patients, insurance companies, and other third-party payers.
  • Analyzed account trends and identified areas needing improvement in overall collections process.
  • Developed an effective collection strategy in order to maximize cash flow while minimizing bad debt write offs.
  • Performed research on unpaid claims involving complex issues such as coordination of benefits, Medicare Secondary Payer rules.
  • Identified, researched and resolved payment discrepancies with Medicare and Medicaid carriers.
  • Verified patient demographic information and insurance coverage to ensure accurate claims submission.
  • Prepared necessary documents for legal action when necessary for non-payment of services rendered.
  • Attended continuing education courses as required by law or company policy in order to stay current on industry trends.
  • Followed up promptly on all pending items until final resolution was achieved.
  • Provided training sessions on collections procedures and policies for new employees.
  • Audited accounts receivable aging reports for accuracy and completeness of data entry into collections software program.
  • Interpreted Explanation of Benefits statements from insurance companies for denied or underpaid claims.
  • Processed credit card payments over the phone using a secure payment system.
  • Sent out monthly billing statements to clients who had outstanding balances due.
  • Reviewed medical records to determine if additional documentation was needed for claim resolution.
  • Researched eligibility status changes in order to ensure timely filing of claims with insurers.
  • Maintained up-to-date knowledge of Medicare and Medicaid regulations related to reimbursement policies.
  • Flagged return claims and dealt with insufficient payments.
  • Researched and rectified account discrepancies.
  • Answered phone calls and responded to questions and concerns.
  • Reviewed claims for coding accuracy.
  • Sent incomplete or incorrect claims to supervisors for proper adjudication.
  • Identified discrepancies and carrier issues regarding billing and reimbursements.
  • Took billing calls, questions and concerns from patients and third party carriers.
  • Corrected, completed and processed claims for payer codes.
  • Processed claims and forwarded information to Medicare, Medicaid and commercial insurance companies.
  • Attended provider meetings and workshops when appropriate.
  • Oversaw daily collections and accounts receivable activities, developing robust strategies to maximize collections and reduce aged accounts.
  • Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
  • Notified credit departments and turned over records to attorneys when customers failed to respond to collection attempts.
  • Wrote appeal letters to insurance companies for denial of claims.
  • Used excellent verbal skills to engage customers in conversation and effectively determine needs and requirements.
  • Contacted insurance companies to check status of claim payments.
  • Monitored overdue accounts using automated information systems.

Education

High School Diploma -

Compton High School
Compton, CA
06-1982

Some College (No Degree) - Business Administration

Cal State Northridge
Northridge, CA

Skills

  • Revenue analysis
  • Emdeon
  • Claims processing
  • Microsoft Word / Excel
  • Problem resolution
  • Cerner
  • Medicare / DDE
  • Availity
  • HIPAA, CMRI, and SSA regulation policies and procedures
  • NaviNet
  • Spot
  • High-dollar project management
  • Coordinating documents
  • HIPAA compliance
  • CPT and ICD-9, ICD-10
  • Analyzing claims
  • Professionalism and ethics
  • Revenue cycle management
  • Computer Savvy
  • Medical billing
  • Payment posting
  • Asset management
  • Resolve Denials
  • Multitasking
  • Supervised collectors
  • Professionalism
  • Credit analysis
  • Claims processing proficiency
  • Medtech
  • Familiar with LCD/Articles
  • Change healthcare /Optum

References

References available upon request.

Timeline

Revenue Cycle Specialist

Onpoint Healthcare Partners
08.2023 - 07.2025

Medical Collections Specialist

Temp Unlimited
08.2001 - 08.2017

Revenue Cycle Representative

Texican Inc.
07.1992 - 09.2022

High School Diploma -

Compton High School

Some College (No Degree) - Business Administration

Cal State Northridge

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