Shirley Ochoa
El Paso,TX
Summary
Results-driven Medical Billing Specialist with strong attention to detail and desire to help transform business operations. Dedicated to quickly increasing profitability and reducing expenditures through general ledger entries and account reconciliations. Expert in processing payments to minimize outstanding debt, excess fees, and interest. Knowledgeable in verifying information within accounting ledger against vendor information to maintain payment accuracy. Detail-oriented with focus on deadlines and skilled in handling medical billing without errors. Knowledgeable in data confidentiality and privacy practices when reviewing patient information. Hardworking Billing Manager proficient in overseeing team operations, implementing improvements and reducing delinquency. Offering 6 years of experience in HealthCare Industry and excellent skills. Veteran Billing Manager focused on team efficiency and producing high-quality work. Excellent collaborator and relationship-builder familiar with compliance and documentation requirements. Enthusiastic about taking billing operations to the next level through proactive leadership and skilled problem solving.
Overview
5
5
years of professional experience
Work History
Senior Billing Manager
Atlantis Behavioral Health Services
12.2022 - Current
- Accurately and completely produces, processes, collects, and/or posts transactions or other designated functions in timely manner with minimal direction from management.
- Maintains competency, meets work standards, and maintains proficiency to perform all daily transactions and functions.
- Assists in leading and openly supporting management in all departmental and organizational initiatives to achieve departmental and cash goals.
- Completes special projects timely and accurately.
- Shares expertise with staff, coordinates onboarding, and conducts education and training.
- Ensures that billing, follow-up and collection policies, procedures and guidelines are accurate, accessible and communicated to staff.
- Proactively identifies, communicates, quantifies, and monitors account detail or workflow processes for barriers in work environment.
- Recommends process improvements or courses of action for problem resolution to management.
- Quantifies or trends issues that recur in order that management may correct issues from point of origin and assists with implementation of such measures.
- Monitors various billing data feeds entering billing system and team member must have strong analytical skills to detect out of tolerance values from normal levels which can indicate potential billing errors.
- Strong Excel skills – ability to create pivot tables.
- Excellent time management and organizational, follow-up and follow-through skills.
- Able to work independently, prioritize work, be flexible, creative. proactive, provide guidance, work out of box initiatives, be team player, have ability to drive issues toward successful resolution.
- Review monthly financial, suspense, collections, commissions, and variance reports collaborating with Billing Specialists to take necessary action for correction.
- Manages transitions to changing billing and coding environments as they occur through each payor source including Medicaid, Medicare, Commercial, and Private Pay.
- Correct and recover 1'000.000.00 PSR target management under paid claims for Superior, El Paso, Molina, Amerigroup, and Molina
- Revenue Cycle and Action Plan Processes for training, eligibility, posting, scrubbing failed claims and activities, clearing house, payer ID and claim status.
- Trains billing and clinical staff in use of new codes and establishes new processes to accommodate changes as needed to maintain efficient workflow and uninterrupted collections.
- Maintains current information on Third Party Payors, including thorough knowledge of ICD-10 and CPT codes, and keeps staff informed of insurance provisions & changes.
- Ensures that current fee schedules and billing manuals are being used for all payers billed while adhering to all organizational billing policies and procedures.
- Develops monitoring and tracking systems for billing.
- Claim rejection and provides detailed bi-weekly reports.
- Oversees monthly audits of for departmental efficiency and accuracy related to medical coding and payment accuracy and integrity.
- Monitor aged accounts bi-monthly working with staff to address oversights or problems within payers.
- Ensure staff follow process to work unpaid claims and backlogs.
- Reviews established accounts for bad debt write off.
- Assists Controller with monthly accounting close of patient revenues by analyzing billing activity.
- Maintains EHR super user status including active participation in user groups, upgrades and staff training as needed.
- Ensures patient confidentiality and provides patients with needed information as requested.
Lead Biller
Atlantis Behavioral Health Services
05.2022 - 12.2022
- Research and resolved incorrect payments, EOB rejections and other issues with outstanding accounts.
- Provided tenacious follow-up to ensure proper payments were fully collected.
- Handled internal collections as well as preparing information to outside collection agencies.
- Accurately applied payments to patient accounts.
- Reviewed patient procedure reports and bills for accuracy and completeness and obtained any missing information.
- Oversee preparation of statements and bills.
- Maintain and/or ensure maintenance of client records related to invoicing and bill payment.
- Review work of billing staff to ensure accuracy, resolving inconsistencies as needed.
- Create and provide prioritized list of clients to be invoiced to team members.
- Locate, or assist in location of, hard-to-reach clients.
- Draft and distribute weekly reports of invoicing and billing metrics.
- Advise staff on proper, legal parameters for collections practices.
- Provide customer support to customers with disputes or inquiries. concerning invoices or billing process.
- Hires new billing staff as necessary and completes performance evaluations as required by Atlantis Behavioral Health policy.
- Develop and maintains training processes for both new hires and existing staff.
- Reviews and recommends updates to Atlantis Behavioral Health Billing Policies bi-annually, and as necessary.
- Participates in Provider and Team meetings both internally and externally as assigned.
- Verified accuracy of accounts payable payments, resulting in 85% reduction in payment errors and check reissues
- Used data entry skills to accurately document and input statements.
- Responded to customer concerns and questions on daily basis.
- Audited and corrected billing and posting documents for accuracy.
- Handled account payments and provided information regarding outstanding balances.
- Collaborated with customers to resolve disputes.
- Monitored outstanding invoices and performed collections duties.
- Maintained accurate records of customer payments.
- Utilized various software programs to process customer payments.
- Processed payment via telephone and in person with focus on accuracy and efficiency.
- Generated monthly billing and posting reports for management review.
- Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
- Entered invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
- Kept vendor files accurate and up to date to expedite payment processing.
- Reconciled accounts receivable to general ledger.
- Generated accounts payable reports for management review to aid in financial and business decision making.
- Created improved filing system to maintain secure client data.
- Processed vendor and supplier payments on weekly basis.
- Disbursed petty cash by recording entries and verifying documentation.
- Reconciled accounts receivable to general ledger.
- Responded to customer concerns and questions on daily basis.
- Used data entry skills to accurately document and input statements.
- Responded to customer concerns and questions on daily basis.
- Handled account payments and provided information regarding outstanding balances.
- Used data entry skills to accurately document and input statements.
- Responded to customer concerns and questions on daily basis.
- Used data entry skills to accurately document and input statements.
- Audited and corrected billing and posting documents for accuracy.
- Used data entry skills to accurately document and input statements.
- Responded to customer concerns and questions on daily basis
- Handled account payments and provided information regarding outstanding balances.
- Maintained accurate records of customer payments.
- Utilized various software programs to process customer payments.
Medical Coding and Billing Specialist
Children's Pediatric Practice & Night Clinic
06.2018 - 04.2022
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Correctly coded and billed medical claims.
- Posting
- Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
- Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records
- Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
- Attained up-to-date knowledge of coding requirements through continuing education courses and certification renewal
- Communicated with insurance companies to research and resolved coding discrepancies
- Utilized active listening, interpersonal, and telephone etiquette skills when communicating with others
- Monitored changes in coding regulations to provide recommendations for compliance
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
Claims Examiner
Assured Benefits Administrators
11.2020 - 10.2021
- Directed claims negotiations within allowable limit of $500,000 and supported successful litigations for advanced issues.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Interviewed claimants and witnesses to gather factual information.
- Researched claims and incident information to deliver solutions and resolve problems.
- Handled complaints and grievances using negotiating and problem-solving skills.
- Handled complaints and grievances using negotiating and problem-solving skills.
- Consulted police and hospital records when needed.
- Investigated properties to determine extent of damage and estimate repair costs.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Examined claims forms and other records to determine insurance coverage.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Maintained contact with claimants and attorneys to determine treatment status.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Resolved complex, severe exposure claims using high service-oriented file handling.
- Analyzed information gathered by investigation and report findings and recommendations.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Evaluated original investigation reports and documents to resolve secondary concerns.
- Clarified coverage of losses to policyholders and provided assistance in itemizing damages and finding alternative living arrangements.
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Identified suspicious losses and contacted manager for investigative assistance.
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
- Maintained suspicious claims database and prepared reports for supervisors.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Synthesized data into comprehensive quarterly written reports for management.
- Established productive working relationships with public officials and law enforcement officers.
Medical Coding and Billing
Children's Pediatric Practice & Night Clinic
05.2018 - 06.2018
- Managed health records
- Applied ICD-10 coding under supervision.
- Used tools to convert ICD-9 and ICD-10 codes.
- Updated and processed insurance claims for time and accuracy
- Submitted claims to Medicare, Medicaid, and private health insurance providers.
- Received excellent feedback from my supervisor.
Education
Associate of Science - Medical Coding & Billing
Southwest University At El Paso
06.2018
Skills
- Revenue Cycle Management
- Medical Billing Processing
- Insurance Billing
- Coding Error Resolution
- ICD-10 Coding
- EMR Systems
- Accounts Payable and Receivable
- Account Analysis Expertise
- Manage Cash Flow
- Invoice Processing
- Collections Actions
- Patient Chart Management
- Workflow Planning
- Collections
Languages
Spanish
Native or Bilingual
Timeline
Senior Billing Manager
Atlantis Behavioral Health Services
12.2022 - Current
Lead Biller
Atlantis Behavioral Health Services
05.2022 - 12.2022
Claims Examiner
Assured Benefits Administrators
11.2020 - 10.2021
Medical Coding and Billing Specialist
Children's Pediatric Practice & Night Clinic
06.2018 - 04.2022
Medical Coding and Billing
Children's Pediatric Practice & Night Clinic
05.2018 - 06.2018
Associate of Science - Medical Coding & Billing
Southwest University At El Paso
Similar Profiles
Candace JacobsonCandace Jacobson
Mental Health Admissions Coordinator at Odyssey Behavioral Healthcare. Behavioral Health Services and FacilitiesMental Health Admissions Coordinator at Odyssey Behavioral Healthcare. Behavioral Health Services and Facilities
Megan BackleyMegan Backley
Behavioral Health Technician at Polara Health Behavioral Health ServicesBehavioral Health Technician at Polara Health Behavioral Health Services
Titilayo (TALIA) RajiTitilayo (TALIA) Raji
Psychiatric Nurse Practitioner Internship at Gracious Health Behavioral Health ServicesPsychiatric Nurse Practitioner Internship at Gracious Health Behavioral Health Services