Sandy Esparza
Upland,CA
Summary
Dynamic medical billing professional with extensive experience at Trinity Health, excelling in insurance denial management and claims analysis. Proven track record in processing high dollar claims and initiating successful appeals. Skilled in EPIC charting and adept at fostering relationships with payors to ensure timely reimbursements. Committed to billing guideline adherence and patient satisfaction.
Overview
15
15
years of professional experience
Work History
Billing & Follow-Up Representative II
Trinity Health
04.2024 - Current
- Follow up on high dollar claims.
- Read/interpret correspondence, charged documents, Explanation of Benefits (EOBs), Remittance Advice (RA) and all insurance forms.
- Look up denials, payment, EOP in web portals (Availity, CareSource, NaviNet. Priority Health, HAP, WPS.)
- Worked with Medicaid, Medicare denials, Medicare Advantage: Claim edits, Front Rejections, combining accounts, readmissions accounts, skipped accounts, cancelled claim accounts.
- Process late coding and late charges in EPIC.
- Initiate reconsideration and appeals.
- Draft, compose, and submit appeal letters specific to coding issues consistent with the most updated American Medical Association current procedural Terminology.
- Process adjustments accurately based on denial.
- Authorization lookup, request.
Patient Biller 3 /RADIATION ONCOLOGY DEPT
UCLA Health
Los Angeles, CA
07.2019 - 05.2024
- Radiation Oncology Billing and Collections Physician/Facility claims.
- Worked with all Commercial and Medicare payors.
- High Volume of Data Entry daily to input charges in Epic / Aria.
- Reading doctor notes, coding.
- Register patient demographics.
- Read/interpret correspondence, charged documents, Explanation of Benefits (EOBs), Remittance Advice (RA) and all insurance forms.
- Accurately processing inpatient and outpatient claims to third party payers, following all mandated billing guidelines.
- Ensuring Timely Filing guidelines are met.
- Process tracers, denials, and related correspondence.
- Worked with EPIC.
Medical Biller
KPC Healthcare
Santa Ana, CA
08.2018 - 07.2019
- Daily initial billing of high dollar accounts.
- Secondary billing.
- Adjustments.
Account Manager
Skyline Urology
Torrance, CA
09.2016 - 08.2018
- Check eligibility of insurance.
- Update patient demographics.
- Coding review or bundles codes.
- Receive credit card payments by phone.
- Medicare, Medi-Cal, HMO and all private insurance billing.
- Pathology Billing.
Medical Collector
Lawndale Orthopedic Group
Lawndale, CA
07.2014 - 09.2016
- Follow-up on unpaid claims.
- High Dollar & Low balance accounts as well patient copay deductible collection.
- Medicare, Medi-Cal, HMO, Workers Comp, Managed care and all private insurance billing.
- Contact Insurance by phone/email for follow-up.
- Set Account goals to meet a number of accounts per day. 40+.
Insurance Representative/Medical Billing
California Service Bureau
Alhambra, CA
06.2011 - 09.2013
- Answer phones.
- Check eligibility of insurance.
- Follow-up on unpaid claims.
- Insurance Appeals.
- Receive credit card payments by phone.
- Hospital Billing on high dollar accounts.
- Medicare, Medi-Cal, HMO, Workers Comp, Managed care and all private insurance billing.
Education
Medical Billing Course -
Bell High School
Los Angeles, CA08.2008
Skills
- EPIC charting
- Insurance denial management
- Billing guideline adherence
- Medical coding compliance
- Reconsideration processing
- Claims analysis
Languages
Spanish
Full Professional
Timeline
Billing & Follow-Up Representative II
Trinity Health
04.2024 - Current
Patient Biller 3 /RADIATION ONCOLOGY DEPT
UCLA Health
07.2019 - 05.2024
Medical Biller
KPC Healthcare
08.2018 - 07.2019
Account Manager
Skyline Urology
09.2016 - 08.2018
Medical Collector
Lawndale Orthopedic Group
07.2014 - 09.2016
Insurance Representative/Medical Billing
California Service Bureau
06.2011 - 09.2013
Medical Billing Course -
Bell High School