ROSEANNE MARTINEZ
Professional Billing & Management Services
Ontario,CA
1
Certification
13
years of professional experience
Revenue cycle and medical billing professional with 8+ years of healthcare experience analyzing claim failures, denials, reimbursement discrepancies, eligibility issues, authorizations, and unpaid accounts across physician and hospital settings. Skilled in tracing revenue leakage through the claim lifecycle, identifying root causes, correcting account data, preparing appeals, and coordinating cross-functional resolution. Working knowledge of Medicare, Medi-Cal, HMO, PPO, IPA, and Workers' Compensation billing; CPT, ICD-10, HCPCS, modifiers, EOBs, CMS-1500 claims, and clearinghouse workflows.
Work History
Medical Biller / Collections
3 Years 4 Months- Analyze failed and rejected claims in the clearinghouse portal, isolate submission errors, and correct claim data to improve clean-claim processing and accelerate reimbursement.
- Investigate denials and underpayment indicators by reviewing payer responses, eligibility records, EOBs, authorizations, and account history; submit corrected claims, rebills, or appeals.
- Reconcile insurance and patient account activity, apply appropriate adjustments, process payments, and clarify remaining patient responsibility.
- Verify coverage through payer portals and direct payer contact, documenting findings and resolving eligibility or coordination issues that delay payment.
- Respond to patient billing inquiries with accurate account explanations, timely follow-up, and professional service.
- Improved revenue cycle performance by identifying billing and collection inefficiencies and implementing processes that increased reimbursement and accelerated cash flow.
- Reduced outstanding A/R by strengthening follow-up procedures, prioritizing high-dollar accounts, and resolving payer issues.
- Increased collections and reimbursement through improved claim follow-up, denial management, and payer communication
- Collaborated with clinical, administrative, billing, and payer teams to resolve revenue-impacting issues and improve reimburseme
- Identified underpayments and reimbursement discrepancies, resulting in recovery of previously uncollected revenue.
- Consistently maintained overall A/R below 9%, demonstrating strong oversight of accounts receivable, payer follow-up, denial management, and collection performance.
Charge Poster
1 Year 9 Months- Reviewed superbills, eligibility, and authorization documentation for completeness before charge entry and claim submission.
- Entered orthopedic charges using CPT and ICD-10 codes, modifiers, and HCPCS codes; billed Medicare, Medi-Cal, HMO, PPO, and IPA plans.
- Supported A/R recovery through paper-claim submission, patient correspondence, account follow-up, registration, and data-quality review.
Patient Accounts Representative / Medicare Biller
2 Months- Managed timely Medicare billing for inpatient and outpatient accounts while following contracted and regulatory billing requirements.
- Analyzed unpaid accounts involving coordination of benefits, Medicare primary/secondary status, and denial conditions to determine corrective action.
- Partnered with HIM, Laboratory, Radiology, and other departments to resolve documentation and account issues affecting bill accuracy and reimbursement.
Medical Biller / Collector
2 Years 2 Months- Completed end-to-end professional billing by validating services against superbills, chart notes, operative reports, and consultation documentation.
- Submitted electronic and paper claims using appropriate CPT and ICD-10 codes and followed denied claims through correction, resubmission, and payer follow-up.
- Managed patient registration, encounter entry, payment processing, and collection calls across HMO, PPO, Medicare, Medi-Cal, and Workers' Compensation accounts.
Medical Biller
11 Months- Processed orthopedic charges and CMS-1500 claims using accurate CPT and ICD-10 coding and supporting documentation.
- Reviewed daily activity reports to identify unbilled new-patient and follow-up encounters and coordinated referrals, authorizations, DME invoices, and dictated reports.
Customer Service, Liverpool Jeans | Order Processor / Customer Service, NYX Cosmetics
4 Years- Supported order and billing operations, account documentation, credit memos, RMAs, vendor-portal activity, chargeback reversals, discrepancy review, and customer resolution.
Education
Certificate in Medical Billing & Coding
Skills
Denial & Rejection Analysis
Accounts Receivable Follow-Up
Reimbursement Variance Review
Root-Cause Investigation
Revenue Recovery
Clean-Claim Resolution
Corrected Claims & Appeals
Eligibility & Benefits
Prior Authorizations
Charge Review
Medicare Billing
Payment Posting & Account Adjustments
EOB Interpretation
Patient Collections
CPT / ICD-10 / HCPCS / Modifiers
CMS-1500
Clearinghouse & Payer Portals
Allscripts
Veradigm
NextGen
Microsoft Office
Personal Information
Title: REVENUE CYCLE ANALYST | MEDICAL BILLING & REIMBURSEMENT
Certification
Certified Nursing Assistant (CNA) — Effective January 2025, BLS Certification — Effective June 2024
Timeline
Medical Biller / Collections
Professional Billing & Management Services
05.2023 - CurrentRead More
Charge Poster
Congress Orthopedic Associates
08.2021 - 05.2023Read More
Patient Accounts Representative / Medicare Biller
PIH Health Whittier Hospital
04.2021 - 06.2021Read More
Medical Biller / Collector
Eastside Orthopedic Medical Associates
01.2019 - 03.2021Read More
Medical Biller
Health First Medical Group
01.2018 - 12.2018Read More
Customer Service, Liverpool Jeans | Order Processor / Customer Service, NYX Cosmetics
01.2014 - 01.2018Read More
East Los Angeles College
Read More