Sandy Dubon
Las Cruces,NM
Summary
Accomplished Medical Biller with a proven track record at Pacific Therapy Services, adept in insurance verification and resolving denied claims, enhancing revenue collections by over 10%. Skilled in team collaboration and negotiation, significantly reducing claim denials through meticulous review and efficient communication with insurance providers.
Overview
27
27
years of professional experience
Work History
Patient Account Representative III
MDRS Spine and Sport
03.2021 - Current
- Responsible for managing and resolving outstanding claims for Medi-cal Health Plans, IPAs and other assigned payers.
- Respond timely to payers denials with appropriate appeals or claim corrections.
- Responsible for AR performance including over 90s in relation to total AR. e.g.10% or less
- Ensure all denied claims are address effectively and timely.
- Identified denial trends and discuss possible solutions with management.
- Resolve patient billing questions.
- Provide costumer service support to patients
- Identify and record any irregularities done at clinic level (e.g. missed authorizations, incorrect billing, incorrect demo or insurance information.
- Update computer system with accurate billing, demo or insurance information.
- Other Accounts Receivable support, as needed.
Medical Biller
Performance Therapy
09.2013 - 03.2021
- Verified insurance of patients to determine eligibility, filed and updated patient information and medical records for 2 offices
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Managed appeals process for denied claims
- Ensured timely payments from insurance and applied to patient accounts.
- Implemented quality control measures to identify potential errors before submitting claims, reducing rejections significantly.
- Delivered timely and accurate charge submissions.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Trained new team members in medical billing software, increasing efficiency within the department.
- Organized filing system for patient records, expediting access to essential documents when needed.
- Prepared billing statements for patients.
- Streamlined billing processes by implementing efficient procedures to improve accuracy and reduce errors.
- Maintained up-to-date knowledge of billing software and healthcare regulations.
- Facilitated seamless collaboration between billing department and healthcare providers to ensure accurate billing information.
- Advanced department's electronic billing capabilities, leading training sessions for staff on new software features.
- Used data entry skills to accurately document and input statements.
Medical Biller
Pacific Therapy Services
02.1998 - 08.2013
- Verified insurance of patients to determine eligibility.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
- Ensured timely payments from insurance providers through submission of accurate and complete claims.
- Collected payments and applied to patient accounts.
- Posted payments and collections on regular basis.
- Accurately entered patient demographic and billing information in billing system for 4 offices
- Supported efficient scheduling practices by verifying patient eligibility and coverage prior to appointments.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Trained new team members in medical billing software, increasing efficiency within the department.
- Prepared billing statements for patients.
- Reviewed outstanding balances owed by patients; initiated collection actions if necessary.
- Assisted patients in understanding insurance benefits, leading to a positive experience during their visit.
- Negotiated with insurance providers to resolve payment disputes, ensuring fair compensation for services rendered.
- Advanced department's electronic billing capabilities, leading training sessions for staff on new software features.
- Responded to customer concerns and questions on daily basis.
- Used data entry skills to accurately document and input statements.
- Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
- Audited and corrected billing and posting documents for accuracy.
- Monitored outstanding invoices and performed collections duties.
- Processed payment via telephone and in person with focus on accuracy and efficiency.
- Maintained accurate records of customer payments.
Education
High School Diploma -
Santa Paula Union High School
Santa Paula, CA06-1983
Skills
- Insurance verification, Insurance billing, collections experience
- Accurate payment posting for insurance and patients
- Data entry proficiency
- Verbal and written communication
- Organizational skills
- Training and teaching
- Negotiation and resolution
- Documentation and recordkeeping
- Microsoft office
- Billing Software: PTOS, Kareo, Webpt, Raintree
Languages
Spanish
Native or Bilingual
Timeline
Patient Account Representative III
MDRS Spine and Sport
03.2021 - Current
Medical Biller
Performance Therapy
09.2013 - 03.2021
Medical Biller
Pacific Therapy Services
02.1998 - 08.2013
High School Diploma -
Santa Paula Union High School
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