ROSA NATERA-TAVAREZ
Bloomfield,NJ
Summary
Organized, goal oriented, dependable, team player with over sixteen years experience in medical billing, Offering strong analytical skills and attention to detail, with readiness to learn and adapt in medical billing environment. Brings ability to understand healthcare billing processes and utilize software applications for efficient claim processing. Ready to use and develop problem-solving and administrative skills in Medical Biller role.
Overview
11
11
years of professional experience
Work History
Medical Biller
Medloop
12.2023 - Current
- Managed multiple accounts ranging from Podiatry to Behavioral Health.
- Submitted claims to both in-network and out-of-network payers. Also negotiated out-of-network rates for maximum reimbursement.
- Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.
- Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
- Enhanced revenue collections for the medical practice with diligent follow-ups on unpaid claims.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Ensured timely payments from insurance providers through submission of accurate and complete claims.
- Posted and adjusted payments from insurance companies.
- Worked closely with physicians to accurately assign ICD-10 diagnostic codes for optimal reimbursement rates from insurance companies.
- Reduced errors in medical billing by meticulously reviewing patient records and ensuring accurate coding.
- Streamlined billing processes by implementing efficient coding practices, resulting in reduced errors and improved revenue generation.
- Increased accuracy in medical claims submissions by conducting thorough reviews of patient records and insurance information.
- Communicated effectively with staff, patients, and insurance companies by email and telephone.
- Trained and mentored staff on procedures, compliance requirements, and collections techniques.
- Identified and resolved patient billing and payment issues.
- Maintained strong working relationships with healthcare providers, fostering clear communication regarding billing-related matters.
- Located errors and promptly refiled rejected claims.
- Conducted regular audits of patient accounts for potential underpayments or overpayments due to incorrect coding or billing practices.
Medical Billing Manager
ANKLE & FOOT SPECIALIST OF NJ
11.2022 - 12.2023
- Verification of coverage and benefits for specified services.
- Scrubbing entered charges prior to Submission to ensure accuracy & compliance with insurance guidelines. Also to achieve maximum reimbursement for services provided.
- Resolve Denials by submitting Claim Corrections, Reconsiderations and/or Appeals
- Enhanced revenue collections for the medical practice with diligent follow-ups on unpaid claims.
- Posted payments and collections on regular basis.
- Reviewed outstanding balances owed by patients; initiated collection actions if necessary resulting in improved account recovery efforts.
- New Hire Onboarding: Office and System setup
- Assist with developing and implementing office policies, procedures and plans.
- Streamlined billing processes by implementing efficient procedures to improve accuracy and reduce errors.
- Trained new hires for Front Desk Receptionist, which includes patient check-in and check-out. Collecting copays and patient balances. Posting charges and Verification of coverage and benefits for specified services.
- Facilitated seamless collaboration between billing department and healthcare providers to ensure accurate billing information.
- Assist with delegating work to all staff daily to ensure productivity and time management
- Increased patient satisfaction by addressing billing inquiries promptly and professionally.
- Reduced denied claims through diligent review, correction, and resubmission of errors.
- Enhanced revenue cycle management by overseeing timely and accurate claims submission.
- Collaborated with providers and staff to ensure accurate coding for billing purposes.
- Developed policies and procedures for the medical billing department, establishing a strong foundation that supported growth and operational success within the organization.
- Streamlined claim appeals process by creating clear documentation guidelines and templates for staff use.
- Trained and mentored staff on procedures, compliance requirements, and collections techniques.
Medical Billing Manager
NEW JERSEY FOOT & ANKLE CENTERS
10.2020 - 09.2022
- Managed a team of medical billers, providing guidance and support. Contributed to team success by sharing knowledge of best practices in medical billing and coding procedures.
- Reviewed billing problems, researched issues, and resolved concerns.
- Increased accuracy of medical billing by meticulously verifying proper coding for diagnoses and procedures in patient charts.
- Posted and adjusted payments from insurance companies.
- Enhanced revenue cycle management by overseeing timely and accurate claims submission.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Streamlined claim appeals process by creating clear documentation guidelines and templates for staff use.
- Developed policies and procedures for the medical billing department, establishing a strong foundation that supported growth and operational success within the practice.
- Collaborated with providers and staff to ensure accurate coding for billing purposes.
- Optimized cash flow by regularly reviewing aging account balances and implementing tactics for timely collections from patients or insurers.
- Reduced claim denials by maintaining up-to-date knowledge of insurance policies and regulations.
Administrative Assistant/Medical Biller
Universal Health Care Navigators
08.2019 - 10.2020
- Managed daily office operations.
- Managed high-volume phone system
- Supported office efficiency by performing clerical tasks such as data entry, photocopying, scanning, and faxing documents.
- Conducted patient intake interviews, recording and documenting relevant information.
- Confirmed appointments, communicated with clients, and updated client records.
- Verified insurance of patients to determine eligibility.
- Obtained prior authorization for out-of-network services
- Generated documents, obtained Referrals, Submitted orders and Prescriptions approved by provider
- Entered charges & submitted Claims
- Insurance A/R: Claim Correction, Reconsiderations and Appeals
- Processed medical insurance claims and payments.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Posted and adjusted payments from insurance companies.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
Medical Biller/Administrative Assistant/Front Desk Supervisor
Salerno Medical Associates
08.2014 - 08.2019
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Answered multi-line phone system, routing calls, and delivering messages to staff.
- Supported efficient scheduling practices by verifying patient eligibility and coverage prior to appointments.
- Managed filing system, entered data and completed other clerical tasks.
- Managed email correspondence and handled incoming and outgoing mail and faxes.
- Supported office staff and operational requirements with administrative tasks.
- Processed medical insurance claims and payments.
- Managed daily operations of the front office, including staffing, scheduling, patient registration, and financial transactions.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Completed clerical duties and tasks for clinic administration.
- Registered and verified patient records before triage with most up-to-date information.
- Obtained client medical history, medication information, symptoms, and allergies.
- Coordinated patient referrals to specialists or other healthcare providers as needed for comprehensive care management plans.
- Taught patients about medications, procedures, and care plan instructions.
Education
Certificate - Medical Assisting
FORTIS INSTITUTE
05.2014
Certificate - Medical Billing/Coding
BERDAN INSTITUTE
10.2007
Skills
- Time Management
- Oral and Written Communication
- Medical Terminology
- Insurance verification
- Problem-solving skills
- Data entry
- Multitasking
- Billing and collection procedures
- Critical thinking
- Accounts receivable management
- Data analysis
- Adaptability and flexibility
- Organization skills
- Team leadership qualities
- Microsoft Office: Word / Excel
- Google Sheets
- Insurance Portals: Navinet, Availity, Noridain, UHC, Connex, Champs, NJMMIS,
- EMR System: AthenaHealth, Practice Fusion, NextGen Healthcare, ModMed, AdvanceMD, Epic, Tebra
- Optum360 Encoder Pro and Codify
- Adobe
Languages
Spanish
Native or Bilingual
Timeline
Medical Biller
Medloop
12.2023 - Current
Medical Billing Manager
ANKLE & FOOT SPECIALIST OF NJ
11.2022 - 12.2023
Medical Billing Manager
NEW JERSEY FOOT & ANKLE CENTERS
10.2020 - 09.2022
Administrative Assistant/Medical Biller
Universal Health Care Navigators
08.2019 - 10.2020
Medical Biller/Administrative Assistant/Front Desk Supervisor
Salerno Medical Associates
08.2014 - 08.2019
Certificate - Medical Billing/Coding
BERDAN INSTITUTE
Certificate - Medical Assisting
FORTIS INSTITUTE
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