Summary
Overview
Work History
Education
Skills
Timeline
Generic

Ruby Gonzalez

Charlotte,NC

Summary

Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Experienced in handling high-volume customer needs, quickly assessing each customer and offering on-trend recommendations. Analytical Medical Biller successful at resolving disputes and billing inquiries. Detail-oriented individual with 5 years of experience performing intricate billing procedures with undeniable level of detail. Familiar with private and commercial insurance carriers.

Overview

8
8
years of professional experience

Work History

Retail Health Coordinator

CVS Pharmacy Health
09.2023 - Current
  • Respond to customer inquiries via phone, email, and chat
  • Troubleshoot customer issues and provide technical support
  • Resolve customer complaints and escalate issues to appropriate departments
  • Maintain customer records, update account information, and process orders
  • Monitor customer feedback and provide feedback to management
  • Follow up with customers to ensure satisfaction
    Identify customer needs and suggest appropriate products and services
  • Provided ongoing support to both patients and families throughout their healthcare journey, addressing concerns or challenges as they arose.
  • Conducted regular assessments of patient needs and coordinated services accordingly with relevant healthcare professionals.

Medical Billing Specialist

Emas Spine And Brain
02.2019 - 12.2022
  • Contacted patients for unpaid claims for HMO, PPO and private accounts and performed friendly follow-ups to ensure proper payments were made according to contracts.
  • Reviewed and verified benefits and eligibility with speed and precision.
  • Analyzed and interpreted patient medical and surgical records to determine billable services.
  • Prepared billing statements for patients, ensuring correct diagnostic coding.
  • Remained up-to-date details of patient financial responsibilities, fee-for-service and managed care plans by participating in training programs.
  • Determined prior authorizations for medication and outpatient procedures.
  • Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
  • Contacted insurance providers to verify insurance information and obtain billing authorization.
  • Applied payments, adjustments and denials into medical manager system.
  • Maintained timely and accurate charge submission through electronic charge capture, including billing and account receivables (BAR) system and clearing house.
  • Consistently informed patients of financial responsibilities prior to services being rendered.
  • Submitted refund requests for claims paid in error.
  • Posted and adjusted payments from insurance companies.
  • Posted charges, payments and adjustments.
  • Completed appeals and filed and submitted claims.
  • Accurately coded diagnostics and prepared billing statements for patients.
  • Managed patient check-in and check-out procedures and processed payments.
  • Scheduled follow-up appointments as designated by physician.
  • Booked surgeries according to physician volume and maintained prompt turnaround times.
  • Distributed treatment and procedural information to patients.
  • Handled returned mail and processed foreign items.
  • Completed month-end and year-end closings, kept records audit-ready and monitored timely recording of accounting transactions.
  • Created and updated financial reports on frequent basis to present information to leadership teams.

Authorization Coordinator

Institue of Pain Management
03.2016 - 04.2018
  • Input claim, prior authorization and other important medical data into system.
  • Coordinated resolutions for issues and appealed denied authorizations.
  • Notified ordering providers of denied authorizations.
  • Collaborated with internal departments to provide account status updates.
  • Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
  • Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
  • Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
  • Maintained files for referral and insurance information, entering referrals into system.
  • Determined which party would be liable for payment on medical services by thoroughly reviewing patient insurance coverage.
  • Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
  • Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
  • Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
  • Maintained positive working relationship with fellow staff and management.
  • Proofread documents carefully to check accuracy and completeness of all paperwork.
  • Informed applicants of other agencies providing useful or related assistance.
  • Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.

Education

Medical Insurance Billing & Coding Diploma -

Altierus College
03.2018

Skills

  • Creative Thinking
  • Customer Service
  • Product Knowledge
  • Relationship Building
  • Brand Promotion
  • Active Listening
  • Teamwork and Collaboration
  • Upselling and Cross-Selling
  • Excellent Communication
  • BLS Certified for Healthcare Professionals
  • HIPAA & OSHA Compliant
  • ICD-10 & CPT Coding
  • HCPCS Coding
  • Electronic Data Exchange
  • Managed Healthcare & HMOs
  • Insurance Verification
  • Medical Office Administration
  • EOB Posting
  • Manual & Electronic Claims
  • Microsoft Office
  • Workers Compensation Claims
  • 10 Key Data Entry &Typing
  • Dental and Hospital Inpatient Billing
  • Appointment Scheduling
  • Medicare and Medicaid Claims Processing
  • State and Federal Disability Insurance
  • Medical Terminology and Human Anatomy

Timeline

Retail Health Coordinator

CVS Pharmacy Health
09.2023 - Current

Medical Billing Specialist

Emas Spine And Brain
02.2019 - 12.2022

Authorization Coordinator

Institue of Pain Management
03.2016 - 04.2018

Medical Insurance Billing & Coding Diploma -

Altierus College

Similar Profiles

CREATE PROFILE
Ruby Gonzalez