Sonia Gonzales
Mesquite,TX
Summary
Organized medical biller boasts several-year career performing difficult multitasking and claims-processing tasks. Works quickly with insurance companies to resolve problematic disputes and handle patient inquiries. Brings can-do attitude to collaborating with medical professionals, insurance providers and clients to handle invoicing within high-traffic office environment. Committed and results-oriented professional willing to go above and beyond to contribute to team objective.
Overview
3
3
years of professional experience
1
1
Certification
Work History
Payment Poster
OMS Medical Billing
04.2024 - Current
- Assisted in resolving payment issues due to incorrect coding.
- Submitted claims to insurance companies.
- Assisted in resolving payment issues, such as rejections or delayed payments due to incorrect coding or missing information.
- Performed insurance verification, pre-certification and pre-authorization.
- Posting insurance, third-party payments, contractual write-offs, and transfers by either electronic means or manually.
- Post denials timely, with the appropriate reason code.
- Transfer balances accurately and in a timely manner so that billing and statements are produced without error.
- Flagged discrepancies in payments not aligned with contracted rates.
- Analyzed and posted 140-160 EOB payments with accuracy
Medical Referral Coordinator
Dr. Selma Mazhar
08.2023 - 11.2023
- Coordinated and managed scheduling of appointments to optimize patient flow and access to care
- Verified insurance coverage and benefits to ensure seamless patient billing and service access
- Maintained accurate and up-to-date medical records to support clinical decision-making and continuity of care
- Facilitated specialist consultations by coordinating logistics and communication between patients and providers
- Managed patient referrals to ensure timely access to necessary specialty care and follow-up
- Enhanced patient communication by providing clear information and support throughout their care journey
Prior Authorization Specialist
White Rock Medical Center
03.2023 - 08.2023
- Processed insurance claims efficiently to ensure timely reimbursement for services rendered
- Evaluated patient eligibility to determine coverage and benefits for healthcare services
- Verified insurance information to confirm active coverage and appropriate benefits for patients
- Submitted pre-authorization requests to facilitate necessary medical procedures and treatments
- Maintained accurate medical documentation to support patient care and ensure compliance with regulations
- Reviewed utilization of healthcare services to assess the necessity and appropriateness of care provided
Medical Billing Specialist
Cergis
12.2022 - 03.2023
- Ensured accurate and timely billing for medical services
- Verified that medical codes were correctly applied to patient records
- Checked patient insurance information to ensure coverage
- Balanced accounts to ensure all payments and charges were correctly recorded
- Submitted and followed up on insurance claims to secure payments
- Recorded payments received from patients and insurance companies
- Prepare and submit accurate and timely claims to insurance companies and government payers.
- Maintain and update patient records and billing information in our electronic health record (EHR) system.
- Follow up on outstanding insurance claims to ensure timely reimbursement.
- Analyze and resolve claim denials, submit appeals, and process corrected claims.
- Reconcile payments and resolve discrepancies.
Medical Billing Specialist
NOCD
02.2022 - 11.2022
- Analyze insurance EOBs to ensure correct payment for all procedures.
- Identify trends and issues with various payers and propose solutions for resolution.
- Process and post insurance payments promptly.
- Submit insurance claims to payers in a timely manner, adhering to compliance regulations.
- Ensure compliance with relevant state and federal agencies.
- Ensure quality and productivity standards are met or exceeded.
- Submitted claims to insurance companies.
- Adhered to HIPAA regulations when handling confidential patient information.
Education
Bachelor of Science - Health Information Management
University of Arkansas Grantham
08-2027
Associate of Science - Medical Coding And Billing
Grantham University
Lenexa, KS06-2024
Skills
- Effective Communication
- Thoroughness In Tasks
- EOB/ERA/
- Health Insurance Expertise
- Strong Organizational Skills
- ICD-9 Documentation Skills
- Medical Claims Processing
- Health Information Administration
- Clinical Terminology Expertise
- Payments Reconciliation
- Remittance Processing
- Effective Time Management
- Strong knowledge of Medicare, Medicaid, Managed Care, and Commercial Plans
Certification
Medical Coding and Billing, 2021
Timeline
Payment Poster
OMS Medical Billing
04.2024 - Current
Medical Referral Coordinator
Dr. Selma Mazhar
08.2023 - 11.2023
Prior Authorization Specialist
White Rock Medical Center
03.2023 - 08.2023
Medical Billing Specialist
Cergis
12.2022 - 03.2023
Medical Billing Specialist
NOCD
02.2022 - 11.2022
Bachelor of Science - Health Information Management
University of Arkansas Grantham
Associate of Science - Medical Coding And Billing
Grantham University
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