Sharon Bilbao

• Communicated with insurance providers to resolve denied claims and resubmitted.
• Posted and adjusted payments from insurance companies.
• Communicated effectively and extensively with other departments to resolve claims issues.
• Assisted patients with understanding their medical bills and provided clarification on complex insurance issues, promoting a positive customer experience.
• Ensured timely submission of claims to various insurance carriers, resulting in prompt payment for services rendered.
• Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
• Collaborated closely with the clinical team to ensure proper documentation was obtained for accurate billing purposes.
• Prepared billing statements for patients and verified correct diagnostic coding.

• Review and analyze eligibility and billing reports ensuring members are properly enrolled and premium payments are correctly applied to accounts.
• Maintain daily production and quality requirements to meet the department service level agreement.
• Process and perform quality control measures on enrollment and disenrollment transactions and billing activities.
• Partmer with Member Services and other departments to address and resolve member issues within the expected timeframes.
• Process payments and refunds updating members accounts to reflect changes.

Bill carriers by inputting proper ICD 10, CPT codes and billing information into the system initiating electronic transmission.

• Researched and resolved billing discrepancies to enable accurate billing.
• Ensured payments are posted properly by verifying the accuracy of coding and charge entry.
• Increased revenue retention by setting up follow-up system for outstanding payments.
• Verified patients eligibility by utilizing appropriate websites and provider portals.

• Verified health insurance policies for all major commercial carriers as well as government healthcare agencies.
• Completed data entry and reviewed CPT and ICD 10 codes for accuracy prior to submission.
• Post payments from both insurance and patients ensuring payments are credited to appropriate accounts for accuracy.
• Oversee that employees were completing verifications of their assigned doctors schedules in a timely manner.
• Trained new team members by relaying information on company procedures and safety requirements.
• Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.

• Responsible for verifying insurance coverage.eligibility, benefits and obtaining authorization and pre certification as required.
• Calculate deductible and co-insurance estimates for the patient per their insurance contract.
• Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
• Assured timely verification of insurance benefits prior to patient procedures or appointments.
• Updated patient records with accurate, current insurance policy information.
• Made contact with insurance carriers to discuss policies and individual patient benefits.