Sophia Cortez
Moreno Valley,CA
Summary
Efficient billing professional with 18 years of experience. Productive and diligent with passion for resolving discrepancies through attention to detail and creative problem-solving. Passionate about perpetuating company values through impeccable work ethic and drive.
Overview
19
19
years of professional experience
Work History
Government Billing and Collections II
Air Methods
11.2022 - Current
- Responsible of timely follow-up of claims billed and resolution of accounts oversees account receivables and maintains detailed/accurate account documentation.
- Appeals and or rebills all open underpaid/unpaid claims thoroughly, accurately, promptly with all supporting documents.
- Identify and completes Medically Necessity appeals.
- Responsible for maintaining and updating payor billing and collection guidelines, fee schedules, reporting all payor issued and or denial trends to Lead/Supervisor
- Works cross-functionally to complete multiple department assignments. Review, document and resolve all incoming correspondence, payor calls, patient calls and payments. Verifying insurances for billing.
- Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.
- Counseled debtors on payment options and arranged installment agreements.
- Researched accounts and completed due diligence to resolve collection problems.
- Assisted in implementing procedures and policies to facilitate timely payments.
- Researched billing errors and discrepancies to initiate corrective action.
Credit Specialist
Air Methods
08.2014 - 11.2022
- Reviews and resolves all credit balance accounts for refund overpayments; Solely responsible for 25 states however crossed trained for all 50 states
- Which includes Contracted and Non-Contracted payors, Workers Compensation Claims, Veterans Administration, Auto Insurances, 3rd party payors, Medicare, Medicaid and Tricare claims.
- Handled reprocessing of underpaid/overpaid claims that have processed incorrectly on contract and non-contracted claims
- Disputed refund request that was requested due to usual and customary rates.
- Resolved department correspondence such as valid refunds and disputing incorrect refund request, auditing accounts, ensuring compliance with applicable laws and statute codes for each state, applies to HIPAA regulations and company policies
- Makes phone calls to insurance companies, patients, and third-party vendors to obtain information required to resolve credit balances
- Reviews and works to resolve problematic accounts placed on weekly report by departmental staff for resolution
- Works with staff in multiple departments to assist with telephone inquiries regarding overpayments
- Works on projects when needed.
Claims Examiner
Priority One Billing
10.2009 - 11.2009
- In charge of inputting five offices into new system web-based practice management and clearing house; Entered all physician and patient information; billed out; entered all claims for each office; applied all co-pays; answered phones; made collection calls.
- Managed large volume of medical claims on daily basis.
Claims Reimbursement Specialist
United Health Group
01.2008 - 08.2008
- Processed and completed medical claims, including network authorization, re-pricing and or use of self-refer tables; Processed same day voids and reconsiderations for reimbursements; COB/Medicare.
Biller
Kaiser Permanente
03.2007 - 12.2007
- Input patient and hospital information for billing and charting purposes; Ran daily reports; Special projects; Handled confidential information; CPT and ICD-9 coding
- Executed billing tasks and recorded information in company databases.
- Kept all patient information secure and confidential.
Medical Biller/ Claims Examiner
Chiropractic Network
12.2004 - 12.2007
- Practiced supervisory duties for the medical office, trained new employees, handled patient issues resolved concerns, set up monthly payment plans, posting payments, handled settlements on auto accident cases, set appointments and rescheduled using multi line phone, data entry and filing, billing and collections.
- Paid or denied medical claims based upon established claims processing criteria.
- Verified patient insurance coverage and benefits for medical claims.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
Education
Diploma - Claims Examiner/ Medical billing and Coding
AMERICAN CAREER COLLEGE
Ontario, CA10.2009
Skills
- Great Customer Service
- Excellent Interpersonal Skills
- Self-Starter
- Billing and Collections
- Auditing complex accounts
- CPT/ICD-9 coding
- Basic PC skills Microsoft Word Excel spreadsheets
- Data Entry 50 WPM
- Strong analytical skills and attention to detail
- Insurance Policies
- Filing Appeals
- Collection Processes
- Problem Identification
Timeline
Government Billing and Collections II
Air Methods
11.2022 - Current
Credit Specialist
Air Methods
08.2014 - 11.2022
Claims Examiner
Priority One Billing
10.2009 - 11.2009
Claims Reimbursement Specialist
United Health Group
01.2008 - 08.2008
Biller
Kaiser Permanente
03.2007 - 12.2007
Medical Biller/ Claims Examiner
Chiropractic Network
12.2004 - 12.2007
Diploma - Claims Examiner/ Medical billing and Coding
AMERICAN CAREER COLLEGE
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