Summary
Overview
Work History
Education
Skills
Timeline
Generic
SONIA OCHOA

SONIA OCHOA

Sky Valley,CA

Summary

Qualified front & back office, billing,coding & claims examiner. Detail oriented with 20 years in Healthcare field I provided excellent customer service and team leadership skills. Personable and professional under pressure. Energetic and enthusiastic insurance professional motivated to succeed in fast-paced and deadline-driven professional environment.

Overview

17
17
years of professional experience

Work History

Claims Examiner II

Desert Oasis Healthcare
Palm Springs, California
03.2014 - Current
  • Obtained scanned records and uploaded them into the database
  • Entered numerical data into databases in a timely and accurate manner
  • Outlined the appropriate process and procedures necessary to fulfill and complete inquiries
  • Demonstrated ability to lead and motivate outstanding healthcare teams
  • Adjudicate claims in accordance with Manage care operations, CMS and DMHC guidelines
  • Verify eligibility and members benefits
  • Process all provider claims accurately and efficiently to their contract rates in timely manor
  • Research and resolve customer and provider calls within timely manor
  • Accept all duties and special projects assigned
  • Provide assistance to all co-workers to ensure all claims are completed and corrected for weekly check run
  • Meet productivty and claim error ratio to claims department standards
  • Work closely with Ulitilzation Department to ensure all authorizations are vaild
  • Knowledge in coding, billing, diagnosis and current medical terminology.
  • Managed workloads efficiently by prioritizing tasks based on urgency or importance.
  • Performed data entry into the computer system to record information regarding claim status.
  • Paid and processed claims within designated authority level.
  • Reviewed and resolved open claims and change orders to determine entitlement for additional payment.
  • Tracked progress of pending cases through manual follow-up or automated systems.
  • Analyzed and audited open claims to calculate additional payments owed.
  • Developed a detailed understanding of the company's policies and procedures related to claim processing and payment determination.
  • Obtained necessary information to complete proper evaluation of injury claims.
  • Collaborated with internal departments such as Underwriting, Provider Relations, Medical Management, and Quality Assurance, as needed.
  • Completed required investigations on referred files within established timeframes.
  • Reviewed claims to ensure accuracy, resulting in multiple claim reductions.

Medical Front Office Coordinator

Peter M Scheer DDS, MS
Rancho Mirage, California
01.2013 - 03.2014
  • Scheduled appointments, registered patients and distributed sample pharmaceuticals as prescribed
  • Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge
  • Professionally and courteously verified appointment times with patients
  • Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms)
  • Adeptly managed a multi-line phone system and pleasantly greeted all patients
  • Verified patients' eligibility and claims status with insurance agencies
  • Prepared patient charts accurately and neatly for the clinic
  • Regularly attended dental society and treatment team meetings and in-service trainings to continuously learn about best practices
  • Worked closely with patients before, during and after dental procedures.
  • Greeted patients, answered phones and scheduled appointments.
  • Assigned ICD-10 diagnostic codes to medical records for proper billing and reimbursement.
  • Delivered administrative support to clinical staff and managers by handling [Task].
  • Assisted in preparing paperwork for medical procedures or treatments performed by the office staff.
  • Reconciled account balances after each business day.
  • Performed a variety of clerical duties such as data entry, filing and photocopying.
  • Reviewed charts for completeness prior to appointment times.
  • Prepared and maintained patient files and records.
  • Resolved customer complaints in a timely manner while ensuring adherence to professional standards.
  • Tracked inventory levels of medical supplies and medications needed by the office.
  • Coordinated with other departments within the organization to ensure smooth operation of the front office activities.
  • Managed administrative tasks related to patient visits including obtaining authorizations from insurance companies prior to treatment.
  • Provided assistance with billing inquiries or problems from patients or other healthcare providers.
  • Processed referrals from primary care physicians to specialists.
  • Maintained accurate logs of all incoming calls, messages, faxes and emails regarding patient inquiries or concerns.
  • Verified patient demographics, insurance information and medical histories.
  • Collected payments for services rendered and applied them to appropriate accounts.
  • Resolved customer complaints or answered customers' questions.

Admitting Supervisor

Eisenhower Medical Center
Rancho Mirage, California
03.2007 - 09.2012
  • Oversaw daily office operations for staff of 36 employees & 4 outpatient lab locations
  • Composed and drafted all outgoing correspondence and reports for managers
  • Complied annual recommendations for end of fiscal year budgets
  • Trained new employees on multiple medical billing programs and data entry software
  • Led clinical team in delivering care services that promoted optimal healthcare
  • Investigated and reported issues relating to patient care or conditions that might hinder patient well-being
  • Encouraged creative thinking, problem solving, and empowerment as part of the facility management group to improve morale and teamwork.
  • Checked patient information and insurance coverage.
  • Monitored performance indicators such as length of stay, throughput time and other metrics related to patient flow.
  • Ensured compliance with hospital policies and procedures as well as applicable laws and regulations.
  • Identified potential problems related to patient billing and worked closely with finance personnel on solutions.
  • Developed strategies to improve the efficiency of the admitting process while maintaining quality assurance standards.
  • Assisted in developing new policies and procedures for improving patient experience throughout the admission process.
  • Collaborated with other departments within the organization to ensure efficient workflow between all areas of operations.
  • Coordinated the admissions process for patients, including insurance verification and pre-authorizations.
  • Provided leadership to department staff, ensuring quality service to patients.
  • Coordinated patient paperwork and charts.
  • Determined charges and collected co-pays.

Education

High School Diploma -

Mt San Jacinto High
01.1998

Skills

  • Strong presentation skills
  • Bilingual (Spanish)
  • Creative problem solver
  • Exceptional communication skills
  • Quick learner
  • CTP/ICD-9 and dental coding
  • Self-motivated

Timeline

Claims Examiner II

Desert Oasis Healthcare
03.2014 - Current

Medical Front Office Coordinator

Peter M Scheer DDS, MS
01.2013 - 03.2014

Admitting Supervisor

Eisenhower Medical Center
03.2007 - 09.2012

High School Diploma -

Mt San Jacinto High

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SONIA OCHOA