Sonja Espinoza
Santa Paula,CA
Summary
Medical Billing and Coding Specialist with 20 years of providing administrative and patient support in hospital and medical office settings. Advanced knowledge of private insurance, medicaid, and medicare processes and codes. Professional organized and knowledgeable in Prior Authorizations with a background spent communicating effectively orally and through writing and developing prior authorization workflows.
Overview
15
15
years of professional experience
Work History
Prior Authorization Specialist
Anacapa Neuroscience Center
10.2022 - 03.2024
- Reduced monthly turnaround time for prior authorization requests by utilizing electronic submission methods.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies
- Verify up to 15 patients' clinical criteria for approval or denial of services requiring pre-authorization per day.
Medical Billing and Coder
Legacy Medical Management LLC
04.2021 - 10.2022
- Correctly coded and billed 100 medical claims for various hospital and nursing facilities.
- Managed approximately 100 claim denials per day of patient eligibility and coverage benefits before claim submission.
- Contribute to maintaining positive cash flow within our organization by ensuring weekly timely submission of clean claims and diligent follow-ups on outstanding payments.
Medical Billing and Coder Specialist
Anacapa Neuroscience Center
04.2009 - 10.2020
- Correctly coded all surgical pro-fees for large, multi-specialty surgical clinics for Neuro Surgery, Plastics, Neurology, Pain Management, and Trauma
- Oversee all documentation for medical procedures and hospital admissions, obtain insurance authorizations, enter data into systems, post charges, collect payments, and maintain knowledge of EHR programs
- Maintain physician license, RVU contracts, and insurance contacts
- Serve as interim manager for front and back office.
- Increased monthly high payment processing by promptly addressing any discrepancies or issues raised by insurance carriers.
Education
Certified, Medical Assisting and Billing -
Golden State College
Oxnard, CAHigh School Diploma -
Santa Paula High School
Santa Paula, CASkills
- Medical Terminology
- Utilization Review Experience
- Medical Appeals Handling
- Attention to Detail
- Insurance Verification
- Prior Authorization Process
- Claim Review
- ICD-10 Coding Familiarity
- CPT coding knowledge
References
Reference available upon request
Timeline
Prior Authorization Specialist
Anacapa Neuroscience Center
10.2022 - 03.2024
Medical Billing and Coder
Legacy Medical Management LLC
04.2021 - 10.2022
Medical Billing and Coder Specialist
Anacapa Neuroscience Center
04.2009 - 10.2020
Certified, Medical Assisting and Billing -
Golden State College
High School Diploma -
Santa Paula High School
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