Ruby Espinoza
Bakersfield
Summary
Medical Claims Specialist with a strong background in revenue cycle management, specializing in claims resolution and collections. Supervised operations and trained team members to enhance workflow and ensure compliance with billing regulations, delivering effective customer service and improving reimbursement outcomes.
Overview
14
14
years of professional experience
Work History
Collections Supervisor
Hall Ambulance Service Inc.
Bakersfield
12.2012 - Current
- Supervised daily operations of collections department, guiding and supporting team members to enhance performance and meet objectives.
- Reviewed and processed employee timecards to ensure accurate payroll reporting.
- Assisted with training and mentoring employees on billing procedures, claims resolution, collections processes, and company policies.
- Monitored workflow, productivity, and quality standards while assisting with complex account resolution.
- Fostered collaborative team environment, aligning efforts with department goals and driving achievement of performance expectations.
Collections Specialist
Hall Ambulance Service Inc.
Bakersfield
12.2012 - Current
- Managed outstanding insurance and patient accounts to maximize reimbursement and reduce aging balances.
- Investigated and resolved denied, rejected, and underpaid claims by communicating with insurance carriers.
- Disputed incorrectly paid claims and followed up with payers to ensure accurate reimbursement.
- Identified insurance and patient overpayments and processed refunds according to payer guidelines and company procedures.
- Prepared and submitted appeals, including claims involving California AB 716 requirements.
- Worked extensively with Medicare, Medicaid, and commercial insurance plans.
- Applied knowledge of Medicare and Medicaid ambulance reimbursement rates to verify payment accuracy.
- Provided excellent customer service by assisting patients with billing questions, account concerns, payment arrangements, and claim status updates.
- Accepted and processed patient payments securely over the phone while maintaining confidentiality and HIPAA compliance.
Claims Specialist
Hall Ambulance Service Inc.
Bakersfield
12.2012 - Current
- Verified patient insurance eligibility and benefits prior to claim processing.
- Reviewed medical claims for accuracy, completeness, and compliance with payer requirements.
- Maintained detailed financial records and supported revenue cycle operations.
- Assisted with balancing daily payment activity and ensuring proper account documentation.
Billing Specialist
Hall Ambulance Service Inc.
Bakersfield
12.2012 - Current
- Prepared and submitted CMS-1500 claim forms accurately and in a timely manner.
- Uploaded electronic claims through multiple insurance clearinghouses.
- Reviewed claims for completeness and corrected errors prior to submission to minimize rejections.
- Maintained accurate patient demographic and insurance information.
- Developed a strong foundation in medical billing, claims submission, and insurance processes that led to continued advancement within the organization.
Education
High School Diploma -
North High School
Bakersfield, CAVocational School Training -
UEI College
BakersfieldSkills
- Claims processing
- Insurance verification
- Appeals management
- Payment reconciliation
- Revenue cycle management
- HIPAA compliance
- Team leadership
Timeline
Collections Supervisor
Hall Ambulance Service Inc.
12.2012 - Current
Collections Specialist
Hall Ambulance Service Inc.
12.2012 - Current
Claims Specialist
Hall Ambulance Service Inc.
12.2012 - Current
Billing Specialist
Hall Ambulance Service Inc.
12.2012 - Current
High School Diploma -
North High School
Vocational School Training -
UEI College