Saaba Mikael
Summary
Professional with over 15 years customer service experience in medical device, pharmaceutical and sales support. Solid background in payor education and identifying reimbursement trends to assist organizational leadership and sales in strategic decision making. Known for reliability and flexibility working West and East Coast with Central territory coverage as needed.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Consultant - Billing & Reimbursement (P-T)
Client - Baldwin Hills Urgent Care
09.2024 - 12.2024
- Improved accuracy of billing by conducting thorough audits and providing education to staff members
- Outlined trends in reimbursement and clams data, allowing clients to make informed decisions about their business operations moving forward
- Reduced claim denials with the implementation of quality assurance measures
- Evaluated payer contracts to identify opportunities for renegotiation, resulting in more favorable terms for clients'' bottom lines.
- Increased revenue for clients by identifying underpayments and negotiating with insurance companies
- Optimized reimbursement processes by analyzing claims data and implementing efficient workflows
- Reviewed documents and expense reports for tax preparation
Patient Access Manager
Intrinsic Therapeutics
11.2022 - 08.2024
- Worked closely with organizational leadership and Market Access to guide operational strategy
- Leveraged payor coverage trends to create effective reimbursement educational tools and refine business strategies
- Assisted in creating strategies and achieving sales targets through effective coordination with the sales team
- Educated sales team on device reimbursement
- Facilitated a smooth onboarding experience to new clients and follow up education as needed to enhance client satisfaction and improve sales retention rates
- Payor education through submission of customized prior prior authorizations
- Provided to patients clear explanation of benefits coverage and out-of-pocket expenses
- Assisted patient in submitting complaints to state insurance commissioner
- Reviewed Explanation of Benefit and appealed underpaid and denied claims as necessary
- Added & updated provider and facility information in CRM
- Monitored inbox and created cases as necessary
Reimbursement Specialist
Derm Tech
11.2021 - 11.2022
- Provided exceptional customer service to inquiries from patients and sales reps
- Identified trends in reimbursement denials, recommending process improvements to minimize future occurrences
- Supported company objectives by maintaining compliance with all relevant state and federal regulations governing medical billing practices
- Researched payer policies, organized and entered data into company's PCM (Payor Contact Manager) database
- Documented processes and drafted workflows into SOPS per company regulations
- Compiled payer-specific denial reports to assist senior managers identify reimbursement trends
- Reviewed coverage policies with Payor Access Department to identify contractual issues
- Conducted benefit investigations via Availity and Waystar
- Initiated prior authorizations as needed
- Billed Commercial and Government claims
- Case by case negotiation for single case payment
- Appealed underpaid and denied claims
- Processed payments and set up payment plans
- Adjusted accounts for prompt pay discounts and provider write-off
Hospital Financial Counselor - Emergency Room
Kaiser Permanente
04.2018 - 10.2021
- Monitored Emergency Room track board for inpatient admissions and discharges
- Conducted bedside interviews with patients and family members and answered questions regarding insurance benefits.
- Provided provide financial counseling- educating patients regarding their health coverage, out-of-pocket costs and financial options
- Processed and awarded hospital MFA (Medical Financial Assistance applications) to qualified patients
- Screened patients for Emergency Medicaid and processed qualified applications on the state Medi-Cal website
- Interviewed patients with work-related injuries, created case and submitted to Workers Comp Department for processing
- Collected co-payments, deductibles and non-member deposits
- Verified insurance benefits prior to patient discharge
- Notified payors and NCM (nurse case managers) inpatient admissions and submitted prior authorizations timely
- Followed up daily with payors on status of inpatient prior authorizations to ensure prompt and accurate claims reimbursement
- Submitted facility claims on Health Connect
- Reviewed WQ (work queues) daily for billing errors and claim
Healthcare Billing Specialist
Sequenom CMM
08.2012 - 04.2018
- Answer inbound reimbursement related inquiries from providers, patients and sales representatives
- Verified patient insurance coverage and benefits for medical claims
- Entered and submitted electronic/paper claims documentation for timely filing
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered
- Reduced claim denials by thoroughly reviewing medical documentation and ensuring accurate coding practices
- Located errors and promptly refiled rejected claims
- Monitored and updated claims status in claims processing system
- Analyzed Explanation of Benefits to verify accurate reimbursement
- Appealed underpaid and denied claims as needed
- Interviewed and assessed uninsured patients for PAP (Patient Assistance Program)
- Adjusted patient accounts for prompt pay discounts
- Collected co-pays and deductibles
Client Services Representative- East & Central
Sequenom CMM
01.2012 - 08.2012
- Handled high volume calls on inbound hotline responding to inquiries and resolving customer service issues from providers, sales reps and patients
- Managed East and Central time zone portfolios as well as overflow from West Coast territory as needed
- Enhanced client satisfaction by providing timely and accurate information on products and services
- Set up new accounts in Salesforce and provide technical support for provider on-line account access
- Ordered and shipped brochures and lab testing supplies to clients
- Instructed providers on proper specimen collection, handling and shipping for optimum test results
- Acted as liaison between lab and client following up on test status and ETA for completion
- Faxed test results to clients
Education
General Electives & Pre-Nursing Prerequisites
San Diego City College
San Diego, CA01-2011
Skills
- Sales support
- Patient Access Patient Assistance
- HIPAA Regulations
- Client relationships
- Strategic planning
- Business development
- Client onboarding
- Salesforce CRM
- ICD-10, HCPCS & CPT
- Medical Terminology
- Government Programs DOD
- Employer Groups IPA
Certification
- Prior Authorization Certified Specialist | National Board of Prior Authorization Specialist | 2023
- HIPAA Awareness for Business Associate | HIPAATRAINING.COM | 2023
- Medical Coding, Billing & Medical Terminology | SDSU | 2013
Timeline
Consultant - Billing & Reimbursement (P-T)
Client - Baldwin Hills Urgent Care
09.2024 - 12.2024
Patient Access Manager
Intrinsic Therapeutics
11.2022 - 08.2024
Reimbursement Specialist
Derm Tech
11.2021 - 11.2022
Hospital Financial Counselor - Emergency Room
Kaiser Permanente
04.2018 - 10.2021
Healthcare Billing Specialist
Sequenom CMM
08.2012 - 04.2018
Client Services Representative- East & Central
Sequenom CMM
01.2012 - 08.2012
- Prior Authorization Certified Specialist | National Board of Prior Authorization Specialist | 2023
- HIPAA Awareness for Business Associate | HIPAATRAINING.COM | 2023
- Medical Coding, Billing & Medical Terminology | SDSU | 2013
General Electives & Pre-Nursing Prerequisites
San Diego City College
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