RISHMA MOJICA
Valley Stream,NY
Summary
OBJECTIVE - Meticulous Revenue Cycle Manager with strong background in continuous improvement and revenue performance analysis. Focused and organized with demonstrated success in achieving company goals
Overview
8
8
years of professional experience
Work History
Senior Revenue Cycle Quality & Performance Managem
Northwell Health
12.2021 - Current
- Assessed current revenue cycle procedures and implemented improvements to foster efficiency.
- Monitored and guided revenue cycle operations.
- Supported clinical team members with revenue cycle procedures and addressed issues.
- Completed financial reporting and analysis for billing revenue cycle.
- Identified discrepancies with the agents daily task
- Complied with established internal controls and policies.
- Coordinates the daily activities of staff and information systems activities of organization departments.
- Assesses and monitors staff productivity through standards and metrics to optimize performance and increase efficiency.
- Help oversee our vendors.
- Assist with team's chats when our agents are request assistance.
- Facilitate and organize monthly mangers meetings.
- Tracks actual performance against planned business performance, analyze variances and participates in problem solving to ensure all customer needs are met while maintaining control of the project.
- Assist with training the New Hires.
- Run the department monthly and weekly reports.
Physician A/R Clerk
Northwell Health
01.2019 - 12.2021
- Medical coding understanding
- Knowledgeable in GECB, SOARIAN, AETHENA & EPIC
- Experience, Completing, processing and reconciling insurance claim forms/payments
- Following up on outstanding accounts via telephone and /or written inquiry to patients and or third-party payors
- Inputs charges, payments and adjustments to computerized system or posts to manual records
- Maintains daily, weekly, and monthly records of fees collected
- Processes credit balance reports, prepare pre-collection notices and other Processes credit balance reports, prepare pre-collection notices and other
- Kept patient information confidential and respected patients' rights to privacy according to HIPAA requirements
- Coordinated communications between patients, billing personnel and insurance carriers
Medical Biller
South Nassau Communities Hospital
12.2015 - 01.2019
- Review of bills for correct billing information and charge accuracy
- Process Procedure Authorization and Precertification for Specialty services
- Submission of timely billing
- Processing of patient and insurance payments
- Abide by the standards of Ethical Coding as set forth by AHIMA and CMS
- May periodically create insurance or patient aging reports using the medical practice billing software
- These reports are used to identify unpaid insurance claims or patient accounts
- Enter information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information
- Follow up with insurance company on unpaid or rejected claims
- Resolves issue and re-submits claims
- Applied HIPAA privacy and security regulations while handling patient information
- Completed and submitted appeals for denied claims
- Coordinated communications between patients, billing personnel and insurance carriers
- Reviewed account information to confirm patient and insurance information is accurate and complete
- Oversaw medical coding, charge entry, claims, pharmacy communications and other day-to-day operations of billing department.
Medical Biller
ProHealth Care
03.2015 - 12.2015
- Submitted and accurately processed insurance claims with related medical code verifications and assessments
- Prepared and updated new system to handle billing needs with improved accuracy, reliability, and overall performance
- Completed and submitted appeals for denied claims
- Coordinated communications between patients, billing personnel and insurance carriers
- Organized information for past-due accounts and transferred to collection agency.
Education
BS - Healthcare Administration w/conc, Health Info Mgmt
SOUTHER NEW HAMPSHIER UNIVERSITY
Medical Billing and Coding
QUEENSBOROUGH COMMUNITY COLLEGE
New York, NY01.2016
Skills
- Conflict mediation
- Adaptive team player
- Customer satisfaction
- Personnel records maintenance
- Administrative skills
- Microsoft Office
- Data security procedures
- Billing codes
- Insurance collections
- Training and development
- Claim review
- Revenue Performance
- Build Customer Relationships
Timeline
Senior Revenue Cycle Quality & Performance Managem
Northwell Health
12.2021 - Current
Physician A/R Clerk
Northwell Health
01.2019 - 12.2021
Medical Biller
South Nassau Communities Hospital
12.2015 - 01.2019
Medical Biller
ProHealth Care
03.2015 - 12.2015
BS - Healthcare Administration w/conc, Health Info Mgmt
SOUTHER NEW HAMPSHIER UNIVERSITY
Medical Billing and Coding
QUEENSBOROUGH COMMUNITY COLLEGE
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