Scarly Ortiz

• Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
• Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
• Communicated with insurance companies to research and resolved coding discrepancies.
• Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.

• Reviews medical records to identify pertinent diagnoses and procedures relative to the patient's health care encounter.

• Assigns Evaluation & Management (E/M) level for emergency room encounters- facility and professional

• Assigns principal and secondary CPT codes and associated charges for procedures and injections/infusions performed in the emergency room

• Assign appropriate modifiers to CPT codes based on hospital, payer, or state guidelines

• Abstracts appropriate information from the medical record based on the guidelines provided by the client and after a thorough review of the medical record.

• Solicits clarification from the physician regarding ambiguous or conflicting documentation in the medical record using guidelines provided by the client.

• Participates in Coding Roundtables through presentation of materials, articles and current issues related to coding and Health Information Management.

• Maintains current knowledge of the information contained in the Coding Clinic, CPT Assistant, and the Official Guidelines for Coding and Reporting.

• Maintains effective and professional communication skills.

• Contributes to a positive company image by exhibiting professionalism, adaptability and mutual respect.

• As needed, assists with development and implementation of revenue cycle strategies and workflows that will enhance cash collections, expedite account resolution and streamline billing processes
• Reconciles revenue cycle matters such as past due accounts and invoices; reviews aging balances and takes appropriate actions to resolve unpaid receivables.
• Composes and maintains billing and/or billing compliance associated correspondence
• Determines proper account resolution and/or adjustment as needed
• Performs charge entry and/or payment posting within practice management billing system as needed
• Tracks and resolves issues on denied claims
• Resubmits or appeals claims as required
• Escalates more complex claim issues when necessary
• Obtains, reviews and updates patient demographic and insurance information within practice management billing system
• Verifies patient insurance eligibility and obtains necessary pre-authorization numbers, if required, prior to appointment date
• Facilitates communication and collection of any fees due from patient
• Answers phones, responds to billing inquiries and disputes.
• Evaluated client needs and developed tailored solutions to increase positive customer ratings.
• Addressed problems with accounting, billing, and service delivery to maintain and enhance client satisfaction.

• University of Miami
• Follows up on claims to Medicare/Medicaid on a daily basis as well work any corrections that are not accepted by Medicare/Medicaid by signing on DDE and/or FMMIS
• Reviews and works any reports on Medicare/Medicaid on as needed basis
• Refers re-bills of late charge or late charge credits as needed by the Government area to Billing Staff
• Works daily or highlights for Specialty Collector Medicare/Medicaid rejections either from Remittance Advice or correspondence
• Assists and works on all TPL Audits on a timely fashion
• Maintains a working knowledge of all Government Guidelines from the Centers for Medicare & Medicaid Services (CMS) using their websites
• Attends all corporate compliance programs and seminars or educational programs that maintain awareness of laws and regulations affecting the department
• Assists or works Medicare/Medicaid credit balances weekly
• Maintains level of productivity while maintaining accuracy on all assigned accounts
• Reports any obvious errors with HCPCS and ICD-9 / ICD 10 to Lead Collector/Biller or Manager
• Ensures all self -administered Drugs charges have been handled properly either by billing Medicaid, patient
• Assists specialty collector on all payment differential between Medicare co-insurance and Medicaid payment
• Responsible for maintenance and control of unbilled insurance file for given section of patient accounts
• Reviews files daily and spot checks final bills for accuracy and readiness for billing
• Prepares and submits claims via (E-Premis) electronic billing system to carriers and intermediaries within 24 hours after all information is available for Billing
• Follows up on any pending claims that require billing interaction
• Responsible for accurate accounting of all claims
• Maintains accurate Patient Financial Folders on Patient Accounts
• Complies will all rules and guidelines that govern collection activities
• Processed billing calls and answered questions from patients and third-party carriers.
• Processed online and paper appeal submissions and refund requests.

• Research accounts and resolved disputes, performed follow-ups on unpaid insurance claims, contacted third parties to expedite payments, utilize standard and ad-hoc IDX, EPIC reports to identify credits and determine if refund necessary
• Responsible for credit resolution of patient accounts for multi – specialty clinical groups across Medical College for Physician Organization Business Office
• Responsible for maintaining credit accounts receivable under 90-day aging category for all assigned departments
• Develop and maintain productive relationships with third party insurance carriers to facilitate resolution of overpaid accounts and avoid creation of offsets and retractions
• Prepare and process payment transfers between accounts as required
• Maintain Unidentified Suspense accounts under $100k monthly
• Responsible for training new staff in department
• Responsible for processing all refund requests into IDX for issuing of refund checks
• Assist Supervisor of Refunds Department as needed
• Disperse all insurance refund checks with corresponding data
• Contact insurance carriers and patients to obtain information necessary to resolve credits across accounts
• Adjust small balance credits as needed
• Prepares and process transfer in lieu of patient or insurance refund, when appropriate
• Utilizes insurance carrier’s explanations of benefits to advise manager of any identifiable trends or pattern that may cause creations of credits
• Monitors and processes daily credit reports to ensure credits and processed timely and in accordance with department standards
• Prepare credit audit reports and spreadsheets
• Interacts with unapplied fund analyst to adjust credits in Unapplied Account
• Performs transfer of monies to appropriate groups
• Post all refunds and related adjustments to IDX noting financial comments accordingly
• Spearheaded various administrative and clerical task according to needs of unit, prepared correspondence related to duties of position and liaised with appropriate resource person.

• Reviews registration forms for completeness and accuracy of patient’s information
• Verify insurance coverage for medical/dental procedures, high dollars services, and for on-going course of treatment
• Post insurance payments, cash receipts, and adjustments to patient’s accounts accordingly
• Answer on-site patient inquiries regarding account or payment status for all practices
• Notify patient and arrange for alternative payment methods when insurance coverage does not cover services/course of treatment
• Ensure timeless of charges entry and payment posting and reconcile payment and charges batches on daily basis
• Assist providers with their Ages Trial Balances and follow-up on patients’ account
• Analyze patients’ accounts for uncollected accounts and ensure submission all claims, follow up with collection agency on outstanding accounts
• Document results of insurance verifications, financial counseling, responses to information requests and other appropriate activities on QSI and /or IDX
• Reported weekly statistics on patient volume
• Manage systems transition from IDX to QSI for accurate transition of patients’ information and accounts
• Monitors customer services activities to ensure proper all transactions and correspondence is resolved courteously and expeditiously
• Conduct Chart audits to ensure proper documentation is process to correct insurance companies.

• Saint Mary’s hospital
• Evaluates performance of staff, makes recommendation to unit manager
• Cross-train staff members
• Collect time sheets and reviewed information against units sign-in book for payroll
• Delegated daily functions to staff members
• Assisted Dentist with dental diagnostic digital x-ray, Digital X-ray, Scanning X-rays (Panorex, Periapical, Bitewings)
• Sterilized and disinfected dental instruments
• Set-up instrument trays (General, Oral-surgery, Prosthodontic, Pedo, Endo, etc.)
• Prepared dental material such as pour, trim and polish study cast
• Assisted four hand chair side assisting in all specialties, mixing dental materials, prepared tray set-ups, scanning x-rays, intravenous sedation setup
• Provided post-operative instructions prescribed by the Dentist
• Instructed patients of oral hygiene and plaque control programs
• Prepped preliminary impression for study cast and occlusal registration for mounting study cast
• Ensured the cleanliness of dental space and polished all removable appliances
• Purchased necessary materials and sustained inventory
• Maintained and repaired clinical equipment

• Cleaned and sanitized dental tools and equipment, straightened treatment rooms, and restocked supplies to prep for next patient and maintain health and safety practices.
• Sanitized trays, instruments, and surfaces for clean dental office setting and patient safety.
• Successfully assisted dentist by performing four-handed dentistry and other chair-side duties.
• Sterilized rooms and prepped equipment and instruments for [Number] procedures daily.

• Children’s aide society
• Cleaned and sanitized dental tools and equipment, straightened treatment rooms, and restocked supplies to prep for next patient and maintain health and safety practices.
• Sanitized trays, instruments, and surfaces for clean dental office setting and patient safety.