Roxanne Cruz
Wasco,CA
Summary
Motivated medical biller who is dedicated to continually enhancing expertise in the field of DME and O&P. With the ability to multitask, prioritize workload, and meet deadlines, I thrive in dynamic work environments where efficiency and precision are paramount. Attention to detail ensures accuracy in all aspects of work, from administrative tasks to complex billing issues. Committed to meeting compliance and regulatory standards, I approach every task with a focus on maintaining integrity and adherence to established guidelines. I am eager to contribute my strengths to a team-driven organization while furthering my professional development.
Overview
6
6
years of professional experience
Work History
Billing/Clinical Supervisor
Bakersfield Prosthetic & Orthotic Center
03.2020 - Current
- Conducted thorough eligibility checks utilizing electronic systems or contacting payers directly.
- Verified patient insurance coverage, benefits, and any pre-existing conditions impacting billing.
- Communicated effectively with patients to gather necessary insurance information and ensure accuracy.
- Facilitated the authorization process for DME and O&P services as required by payers.
- Collaborated with clinicians to obtain pre-certifications ensuring coverage compliance.
- Demonstrate in-depth knowledge of Medicare guidelines and billing procedures, including claims submission, coding protocols, and documentation requirements.
- Updated patient information and medical records in EMR systems.
- Enhanced accuracy of claims submissions through thorough reviews and staff training.
- Collaborated with physicians and other healthcare providers to resolve complex billing issues promptly.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Communicated with insurance providers to resolve denied claims.
- Prepared appeals for all insurance plans.
- Delivered timely and accurate charge submissions.
- Assisted patients by determining financial assistance available and setting up payment plans.
- Analyzed medical records to satisfy insurance company criteria.
- Submitted electronic and paper claims to insurance companies such as, Medicare, Medicaid, and PPO plans to collect medical payments.
- Led patient account reconciliations by identifying and rectifying discrepancies within patient accounts, ensuring accurate billing and collection processes.
- Prepared billing statements for patients and verified accuracy.
- Collected payments and applied to patient accounts on a regular basis.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Developed and maintained courteous and effective working relationships.
- Managed a team of 5 medical billers, providing guidance and support for their professional development.
- Managed and trained staff, established and monitored goals, and conducted performance reviews.
Medical Biller
Physician's Medical Billing
01.2018 - 03.2020
- Utilize EMR systems to create charges for medical services rendered.
- Efficiently post payments received from patients, insurance companies, and third-party payers.
- Reconcile payment data with billing records to ensure accuracy and completeness.
- Identify and address any payment posting discrepancies or inconsistencies promptly.
- Investigate and resolve billing discrepancies and unpaid claims in a timely manner.
- Implement proactive measures to reduce aging of accounts and improve revenue collection.
- Prepare and submit appeals for denied or underpaid claims, adhering to payer guidelines and deadlines.
- Compile necessary documentation and evidence to support appeals, including medical records and coding information.
- Track appeal progress and follow up with payers to ensure timely resolution and reimbursement.
- Produced and mailed monthly statements to patients and assisted with related requests for information and clarification.
- Responded to patient concerns and questions on daily basis.
- Generated monthly billing and posting reports for management review.
- Delivered timely and accurate charge submissions.
Education
Certification - Medical Billing And Coding
UEI COLLEGE
Bakersfield03.2017
Skills
- Proficiency in preparing and submitting claims to insurance companies and third-party payers, via paper and electronically
- Strong problem-solving skills to address denial issues and rectify billing errors
- Ability to gather and analyze supporting documentation to strengthen appeal cases
- Familiarity with Medicare, Medicaid, and commercial insurance billing regulations
- Ability to navigate payer portals and online resources for claim status inquiries and eligibility verification
- Effective negotiation skills to resolve claim disputes and discrepancies
- Capacity to handle multiple appeals while maintaining productivity and quality standards
- Awareness of evolving healthcare policies and industry updates impacting billing and reimbursement
Languages
Spanish
Native or Bilingual
Timeline
Billing/Clinical Supervisor
Bakersfield Prosthetic & Orthotic Center
03.2020 - Current
Medical Biller
Physician's Medical Billing
01.2018 - 03.2020
Certification - Medical Billing And Coding
UEI COLLEGE
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