Sofia Luevano, CPC CPMA
McKinney,TX
Summary
Well versed in medical office management. Including, but not limited to; correcting and resubmitting claims, composing patient charts, and assessing health records to identify proper diagnosis codes for billing purposes. Experience in reviewing, analyzing, and overseeing medical record information to obtain prior authorizations from insurance companies and ensure payment. Consistently proved my ability to meet deadlines and achieve different objectives. Prioritized crucial tasks while maintaining the high standards expected of my role. Ability to adapt to any circumstances and willingness to acquire as much knowledge as possible.
Overview
6
6
years of professional experience
2
2
Certifications
Work History
Medical Biller and Coder
Brooks Eye Associates
03.2024 - Current
- Correctly coded and billed medical claims for various patient visits including comprehensive exams, office visits, diagnostic testing, in-office procedures and procedures done in ambulatory surgery center.
- Reduced claim denials through meticulous verification of eligibility, prior authorization, LCD guidelines, NCCI edits, claim data accuracy and completeness prior to claim submission.
- Worked closely with physicians to accurately assign ICD-10 diagnostic codes for optimal reimbursement rates from insurance companies.
- Participated in continuing education opportunities to stay current on advancements within the field of medical billing and coding, thereby elevating the overall quality of work.
- Verified signatures and checked medical charts for accuracy and completion.
- Followed up with medical staff regarding missing information in patient records.
- Maintained accuracy, completeness, and security for medical records and health information.
Admin/Claims
Affinity Eye Care
09.2019 - 03.2024
- Maintained knowledge of benefits claim processing, medical terminology, procedures and HIPAA regulations.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments to appropriately assign the correct diagnosis and procedure codes.
- Processed medical insurance claims and payments.
- Queried the doctors when necessary to clarify any documentation in the patients record
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Audited and corrected billing and posting documents for accuracy.
- Handled account payments and provided information regarding outstanding balances.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Checked patient insurance, demographic, and health history to keep information current.
- Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.
- Greeted guests at front desk and engaged in pleasant conversations while managing check-in process.
- Scheduled, coordinated and confirmed appointments and meetings.
- Completed data entry and filing to keep records updated for easy retrieval.
Customer Service Representative
AppFolio Property Manager
06.2019 - 09.2019
- Handled customer inquiries and suggestions courteously and professionally.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Answered constant flow of customer calls with minimal wait times.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Assisted customers with Spanish-language inquiries in a timely and professional manner.
Education
Degree in Progress -
Collin County Community College District
Plano, TXSkills
- Comprehension of medical terminology/anatomy and physiology
- Vast knowledge with different computer software
- Exceptional time management prowess
- Customer service competence
- Detail oriented with a perfectionist outlook
- Excellent organizational skills
- Bilingual (English and Spanish)
- Proactive
- Meticulous
Certification
- CPC - Certified Professional Coder
- CPMA - Certified Professional Medical Auditor
Timeline
Medical Biller and Coder
Brooks Eye Associates
03.2024 - Current
Admin/Claims
Affinity Eye Care
09.2019 - 03.2024
Customer Service Representative
AppFolio Property Manager
06.2019 - 09.2019
Degree in Progress -
Collin County Community College District
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