Sonia Reyes
Sanford,FL
Summary
Qualified senior biller and Coding specialist with strong background in billing and account management. Proven track record of improving billing processes and ensuring timely payments. Demonstrated expertise in financial software and billing systems, along with excellent analytical and problem-solving skills.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Senior Biller Representative
ACS/CVS/Coram Pharmacy
01.2023 - Current
- Participate in Multiple projects and served as a backup for other payers including Tricare and VA
- Responsible for reviewing patient accounts thoroughly while using all provided resources to bill claims correctly using the Epic system and HC360
- Experience working Tricare East, Tricare West, Medicare BFD, Aetna, Triwest, VAMC, LOA payers, Medicare MCO and non-Contract
- Develop, coach, and monitor team members efficiently while ensuring high quality service levels to the team
- Supports team supervisor and performs management duties when supervisor is absent or out of office
- Generates comprehensive and detailed reports to distribute among the team as a regular worklists
- Streamlined the billing process for faster invoice generation, resulting in improved cash flow.
- Reduced outstanding accounts receivable balances by consistently monitoring payment status and actively following up on overdue invoices.
- Served as a subject matter expert on complex invoicing scenarios, providing guidance to colleagues when needed.
- Ensured proper documentation of all transactions by meticulously maintaining accurate records within the company''s database system.
- Maintained up-to-date knowledge of billing regulations and compliance requirements, Billing Grid/Contracts as well as benefit plan documents, ensuring company adherence to industry standards.
- Collaborated with other departments to resolve billing discrepancies, promoting interdepartmental cooperation.
- Conducted thorough audits of claims billed by teammates identifying errors and taking corrective actions to prevent future occurrences.
- Participated in process improvement initiatives for the billing department, contributing innovative ideas and sharing best practices with team members.
- Trained new staff members on company-specific billing procedures, contributing to a seamless onboarding experience.
- Optimized billing software usage through regular system updates and customization according to company needs.
Billing Representative – Collector
ACS/CVS/Coram Pharmacy
08.2018 - Current
- Monitor high dollar claims in a daily basis to ensure proper payment/unpaid claim is received
- Analyze patient account (payments, adjustment) and answer detailed question from payers/CVS Representative
- Process claims though CE2K and resolve any rejection obtain
- Analyze billing contracts with PBM insurance plans to process claim accordingly
- Created ECOB’s which enabled me to process patients PBM coverage and copay cards for various secondary payers
- Reviewed and corrected rejected claims; also contacted PBM’s and secondary payers to solve rejections and obtain payable claims
- Created and approved claim adjustments
- Provided support in building a pilot program that reconciled aged out balances which turned into a support center
- Analyzed patient account charges, payments, and adjustments
- Created and maintained the credit card denials spreadsheet, which contained approximately 2,500 denials
- Responsible for posting payments to patient’s account balances
- Responsible to collect payment form the payer
- Reviewed and solved account and billing discrepancies.
Billing Representative- Intake
OMNICARE (acs pHARMACY)
05.2014 - Current
- Responsible for managing inbound and outbound documentation and call intake
- Adhered to HIPPA guidelines and regulations
- Always provided excellent customer services/interpersonal skills
- Handling multiple management assignment projects and multitask in training other employees
- Created a training and job shadowing manual
- Obtain and collected payments from patients
- Effectively perform and a patient collection and provided excellent Microsoft word report to monitor job duty and intake
- Work and partner with other internal departments to resolve issues and held various positions in the company as well
Health Insurance Agent
Connextions- Kaiser Permanente
10.2011 - Current
- Maintained compliance with all industry regulations while completing paperwork accurately and efficiently.
- Educated clients on the intricacies of their health insurance policies, empowering them to make informed decisions.
- Comply with call quality procedures and levels that align with client/team goals
- Meet or exceed all account key performance indicators
- Maintain a mature, engaging, and positive attitude
- Receive inbound calls from customers interested in health insurance products
- Place outbound calls to customers in our database
Education
High School Diploma -
Femenino La Vila
Administrative and Managerial Assistant -
Cenpec
01.1997
Skills
- Project management experience
- Database updates and accurate data entry
- In-depth financial and medical record analysis
- Process improvement initiatives
- Great Interpersonal Skills
- Multitasking Abilities
- All Aspects of Microsoft Word
- Billing Systems: Epic, HC360 and Medical coding
- Accounts Receivables
- Problem-solving abilities
- Invoice and collections Processing
- Auditing proficiency
Certification
- American Training School, Orlando, Medical Assistant, 2005
- College of Insurance, Orlando, Health and Life Insurance Agent, 2011, NBP: W063089
- PEARSON VUE, Orlando, Life Insurance Agent
References
Furnished Upon Request
Languages
English
Professional Working
Spanish
Native or Bilingual
Timeline
Senior Biller Representative
ACS/CVS/Coram Pharmacy
01.2023 - Current
Billing Representative – Collector
ACS/CVS/Coram Pharmacy
08.2018 - Current
Billing Representative- Intake
OMNICARE (acs pHARMACY)
05.2014 - Current
Health Insurance Agent
Connextions- Kaiser Permanente
10.2011 - Current
Administrative and Managerial Assistant -
Cenpec
High School Diploma -
Femenino La Vila
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