Suzanne Trujillo Caver
Ft George Meade,MD
Summary
Self-Motivated Bilingual Medical/Dental Office Biller with Excellent Customer Service Skills Wishes to Make Meaningful Contributions to a Growing Organization.
Medical billing professional with strong focus on accuracy and efficiency in processing healthcare claims. Demonstrates thorough understanding of insurance guidelines and billing procedures. A reliable team player who adapts to changing needs and is committed to achieving optimal results through collaboration and attention to detail.
Overview
23
23
years of professional experience
Work History
Medical Biller Specialist
Leidos QTC Health Services
01.2023 - Current
- Invoiced medical services to the Department of Defense to provide individual and group readiness services for the Reserve Health Readiness Program (RHRP). Our mission is ensuring that all service members from all branches of service achieve 'ready to deploy' status. This billing includes medical and dental services for in-clinic, virtual, and group events.
- Assisted in developing automation using Macros file for Excel to ensure accurate billing of high dollar invoices for every Service Component with its corresponding contract for services.
- Approved all charges in our electronic medical records system, and verified all charges were within contract limitations and Service Component guidelines.
- Interpreted daily audit results and processed billing adjustments both manually and through automation BOT.
- Communicated interdepartmentally with Operations, Contracting, and Provider Liaisons when charges needed to be verified and researched.
- Assisted in developing specialized invoices to be uploaded into the Department of Defense SAFE portal to meet the highest levels of HIPAA standards.
- Recommended ways to improve the process and quality of invoicing to minimize cost.
Administrative Service
CITC Central Texas VA
11.2019 - 10.2021
- Receives phone calls utilizing the Automated Call Distribution (ACD) system from veterans, family members, community vendors, VA providers/staff, Choice contractor, etc., while providing exceptional customer service.
- Responds appropriately and/or ensures messages are communicated to PAS staff in a timely manner.
- Independently performs a full range of duties related to the delivery of healthcare services.
- Ensures special instructions or requirements for each request are clearly outlined prior to submitting to the Care in The Community (CITC) provider.
- Identifies and provides any supporting information or documentation needed for each referral.
- Makes initial phone calls to veterans to determine if they opt in/out of the Veterans Choice Program (VCP) and documents the phone call in the Computerized Patient Record System (CPRS) following established guidelines.
- Establishes constructive and effective working relationships with office staff of CITC providers to schedule appointments, resolve issues, and ensure ongoing patient care.
- Medical Support Assistant (MSA) maintains these relationships through ongoing customer service activities, problem resolution, and timely response to requests.
- Reviews the daily CITC consult report to identify the status of all open community care consults to determine if additional actions are required for the completion of all active consults.
- Utilized various computer equipment, software packages and systems (FBCS, VISTA, Microsoft Office, CPRS, Vendor Portals, Triwest, SRM, PPMS) and troubleshoot minor problems.
- Remains knowledgeable of changes in the processes and procedures involved in CITC by completing training opportunities to improve technical knowledge and enhance performance roles.
- Gathers needed information and ensures information/data is sent to the provider prior to the scheduled appointment to ensure continuity of care.
- Establishes collaborative relationships with VA providers and their staff to ensure efficient communication and problem resolution related to CITC requests to expedite timely approval.
- Follow established guidelines for medical for medical record management involving release of information; performs other duties as assigned to accomplish the mission of the program or the service and receives documentation related to CITC requests.
- Notates receipt on the correct consult/note and uploads information into the veteran's record, ensuring accuracy in attaching the results to the correct CITC consult.
- Collaborates with CITC RN staff to obtain clarification or additional needed information to process requests/referrals.
- Schedules appointments using Vista/VSE and HSRM scheduling options.
- Complies with mandatory training requirements for the outpatient scheduling process and follows all established Veteran Affairs (VA) guidelines in scheduling non-count appointments.
- Screens each CITC request/referral for technical completeness, accuracy and urgency.
- Facilitates immediate need of CITC providers to obtain stat information/data so patient's care or treatment is not delayed.
- Functions as primary administrative contact and process subject matter expert for the CTVHCS CITC program.
- Operates as a trusted resource for patients referred through the CITC program by provided community care processes.
- Assist in the monthly and quarterly collecting, compiling, tracking, and analyzing of statistical information to meet program goals and guidelines.
- Creatively found ways to reduce the number of pending consults to be scanned by staff by providing the service Administrative Officer (AO) recommendations.
- Collaborated on several focus groups to improve consult process and reduce active consults to a scheduled status and finally to consult completion.
- Assisted per request of AO in Timekeeping duties for staff of 110+ employees due to the sensitive nature of the service.
Financial Counselor for Patient Access
Seton Medical Center Harker Heights
02.2018 - 10.2019
- Made phone calls to patients and physician offices and documented patient and referral information into a computerized medical record system for follow up.
- Upload medical records into EPIC system imaging and alert appropriate clinical staff to review and confirm the information is related to the scheduled facility appointment.
- Received orders via fax or on shared electronic medical record from multiple physician offices for insurance verification and interpretation to ensure orders met hospital guidelines for scheduling.
- Scheduled, rescheduled and cancelled patient's appointments per patient and hospital request.
- Entered all no-show information on scheduling module for preparation of calling patient's to rescheduled missed appointments.
- Entered information to wait list for patient appointments.
- Prepared packets for outpatient clinic visits and registration packets for inpatient visits.
- Ran daily census report to reconcile with clinical staff for all patients admitted to inpatient and observation status.
- Monitored both inpatient and outpatient appointments for areas of responsibility with regards to insurance verification.
- Completed registration for all patients that were admitted from our Emergency Department or direct admit from another facility.
- Ensured all encounter forms for outpatient visits were accounted for and were completed in order to bill and receive proper credit of outpatient services.
- Verified insurance benefits and demographic information for all patients to receive patient copays, deductibles and out of pocket expenses.
- Able to navigate on multiple insurance company portals to obtain eligibility and patient liability.
- Assisted in the process of all emergency and non-emergency transfers to other private facilities or the VA.
- Prepared and submitted pre-certification notifications per insurance requirements.
- Communicated all pertinent information to patients, co-workers, and clinical staff members with regards to insurance benefits, coverage, and discharge information.
- Mailed packets to patients per request regarding itemized bills.
- Able to independently manage all position responsibilities with little supervision.
- Able to set priorities and deadlines while constantly adjusting the workflow to meet patient and supervisor needs.
- Utilize various computer equipment, software packages and systems to research and enter pertinent information regarding patient referrals, and prior authorization requests.
- Extensive knowledge of medical terminology.
- Able to effectively and professionally communicate with all senior leaders and clinical staff with regards to patient care and safe discharge.
- Met with senior leaders daily, to help identify patient's concerns in order to perform the tasks required to deliver a great patient experience in an accurate and timely manner.
- Ran several reports to ensure that no overbooking to ensure proper patient flow with various providers.
- Visited with patients extensively with regards to insurance benefits and coverage and followed up when needed for additional patient questions and or concerns.
- Follow established guidelines for medical record management involving release of information.
- Assist in tracking and analyzing statistical information for a more efficient patient scheduling and referral process system when reaching out to patients.
Registration Specialist
Orthopedic Associates of HI, LLC
05.2014 - 05.2017
- As a first point of contact for a multi physician orthopedic practice, greeted all new patient for 10 physicians and 3 physician assistants and or nurse practitioners for the purpose of registration.
- Obtained all demographic information performed insurance verification of all scheduled patients.
- Provided patients with registration forms and assisted with completion of all forms prior to visit with physician.
- Answered and explained all rules that may have affected patient care.
- Obtained appropriate insurance information and co-pays when required.
- Spoke with patients and potential patients on the telephone in the role of a receptionist, answering questions or referring callers to nurses and doctors.
- Scheduled, rescheduled and cancelled patient appointments.
- Entered all admission information in the patient's medical electronic record.
- Various medical computer systems were used to obtain all of patient's information.
- A thorough and deep understanding of and medical coding and terminology ensured that all information entered was accurate for patient billing and treatment.
- Maintained a high level of access to both patient's personal and financial information such as sensitive medical information for the use of diagnosis and treatment procedures.
- Followed all appropriate rules and regulations established to protect patient confidential information under our HIPPA rules.
- Worked with multiple medical systems to obtain patient information with regards to medical diagnostic testing and laboratory findings for patient care.
- Access to multiple hospital systems to obtain inpatient registration information when scheduling appointments for surgery center.
- Able to work independently with little to no supervision.
- Able to identify patient needs and or concerns in order to perform the tasks required for patient care in an accurate and timely manner.
- Able to effectively communicate and interact with people of different backgrounds and other healthcare team members in a courteous and professional manner to complete the task at hand.
Personal Banker/Small Business Specialist
JP Morgan Chase
11.2011 - 02.2014
- Performed teller transactions through face-to-face interactions with customers by handling financial transactions accurately and efficiently while helping customers by introducing them to partners.
- As a banker played a vital role in the customer banking experience for a leading global financial services firm by building relationships with customers by providing them with products and services to meet all their financial needs.
- While a banker my primary goal was to acquire, retain, deepen and manage relationships with customers by generating growth in balances through the sale, marketing promotion and referral of products utilizing a disciplined approach.
- Worked from an assigned portfolio while recognizing the needs of customers in the lobby by listening to their financial needs and providing products and service recommendations.
- As a Small Business Specialist ensured that all small business customer's needs were fully met by recommendations and referrals to merchant services, payroll representatives and cash management services.
- Partnered with specialists such as loan officers, business bankers and financial advisors to ensure customers received the access to experts who would be able to help them with specialized financial needs.
Patient Support Services Coordinator
Centro De Salud Familiar La Fe, Inc.
02.2009 - 02.2011
- Oversaw and recruited employees for five medical clinics.
- Supervised up to 16 employees in this community health care clinic.
- Monitored front office functions to include medical records/archives regarding patient care.
- Processed all incoming and outgoing medical correspondence regarding patient care.
- Performed highly complex support services administration work in executive level such as communications, printing, publication services, mail, transportation, records, forms, reports, and purchasing of supplies and equipment.
- Provided management assistant, statistical and administrative support duties for over ten physicians.
- Conducted department management reviews and prepared descriptive reports.
- Served as training coordinator and assisted with development of training manual for all clinic employees (both nursing and administrative) in new EPM system within the organization.
- Conducted reviews of existing department administrative procedures and department policies.
- Received and screened visitors and telephone calls when front office personnel were unavailable for training.
- Maintained organization and office filing system responsibilities.
- Prepared documentation and presentations in proper medical format with attentions to grammar and punctuation.
- Efficiently managed employees at various levels in the organization to ensure patient were treated fairly and respectfully.
- Organized flow of operational clinic processes in all aspects of medical front office environments such as scheduling, rescheduling and cancelling of patient appointments, greeting of patients, discharge of patients, medical records, coding, billing and correspondence.
- Assisted customers and communicated positively and in a friendly manner while taking action to solve problems quickly and efficiently.
- Advised all employees on any new changes and roles to ensure continuity of care with patients and practice policy and procedures.
- Handled all issues that arose interoffice and regarding patient care.
- Maintained monthly and quarterly audit of all medical charts for reporting to state and federal entities due to funding of grants.
- Prepared and provided all end of month reports to administration in a timely manner and maintained detail medical records audits to report to state and federal entities.
- Organized and coordinated multiple high visibility projects simultaneously.
- Arranged and maintained appointment calendars for all physician and staff.
- Routed incoming mail to staff and work sections.
- Adhered and complied with all safety regulations and standards set before in the clinics to observe safe work procedures.
- Reported all observed workplace hazards, injuries, occupational illness, and/or property damage resulting from workplace mishaps to the incident coordinator.
- Handled all employee files to assure accuracy and security.
- Maintained all training files and ensured they were updated yearly.
- Submitted and reviewed all employee timesheets for accuracy.
- Adhered to established standards of actively supporting the principles of the EEO program and prevention of sexual harassment.
- Ensured that all employee year end reviews were completed fairly, accurately and in a timely manner.
- Performed duties outside of clinic such as event planning for community-based organizations in our endeavor to give back to the community.
- Managed over 45 volunteer staff for clinic organizational days.
- Utilized supervisory experience to ensure continuity and execution of events planned for the community.
Billing and Collections Supervisor
Affordable Dental Incorporated
02.2008 - 12.2008
- Monitored daily functions of front office staff to ensure proper data entry of all patient demographic information and insurance verification was completed on all patients scheduled and treated.
- Ensured office maintained daily productivity goals.
- Organize the flow of operational program processes set in a dental clinic office environment to ensure proper patient care.
- Scheduled, rescheduled and cancelled appointments per patient or physician request.
- Advised staff on development and implementation of clinic directives and procedures.
- Entered all no-show information to patient chart for monitoring.
- Monitored the electronic wait list for hygiene appointments.
- Received and directed phone calls made to clinic.
- Develop internal policies, procedures and work methods to ensure proper documentation and coding of each patient encounter form prior to claims submission and finalizing patient chart review.
- Reviewed all patient charts for accuracy before submission of electronic filing.
- Performed all eligibility, copays, and authorizations needed for clinic visits.
- Ensured that open communication was available to all staff with providers and fellow staff members.
- Maintained communication with all patients as they were seen in office to ensure that welcome policy was in effect.
- Able to set priorities and deadlines while adjusting to the patient workflow in order to meet patient needs.
Assistant Office Manager
Manor Care Health Services
01.2007 - 01.2008
- Assured accurate data entry of client information, record and tie out census daily of patient admits.
- Responsible for all patient copays/liability and hospice billing on a monthly basis.
- Analyzed and reconciled various accounts including statements to ensure accuracy and collectivity.
- Supported the facility with resident trust activity for banking purposes and monitor resident funds for appropriateness.
- Processed all incoming mail for patient care.
- Received and directed phone calls with regards to patient care.
- Scheduled, rescheduled and cancelled patient external appointments when requested by facility physician and or resident family members.
- Processed all emergency and non-emergency transfers to private hospitals or local VA.
- Applied all deposits and resolved differences to patient account ledgers.
- Identified and processed accounts that were deemed collectible and forward to corporate for electronic submission.
- Assisted management in developing and implementing policies and procedures for facility.
- Worked closely with management when recognizing of employee inconsistencies, errors, of the need for additional training when working with other departments or facilities.
- Independently worked to prepare and complete all data entry for month end close requirements with established deadlines.
- Maintained appropriate filing system as outline in policy and procedures of facility.
- Established and maintained effective working relationships with supervisors, co-workers, and facility personnel.
- Extensive knowledge of reimbursement regulations as well as laws, and guidelines pertaining to healthcare.
- Adhered to the company's code of conduct and business ethics, policy, HIPPA, and safety policies including documentation and reporting responsibilities.
Office Manager
Fritz F. Lemoine Jr., MD, Internal Medicine
01.2003 - 12.2006
- Maintained an effective relationship and communication with patients, families, management, staff, contractors' insurance companies and the outside community.
- Greeted all scheduled and non-scheduled patients to clinic.
- Obtained all demographic and insurance information and entered into electronic medical record.
- Verified all insurance benefits.
- Collected all patient copays upon discharge.
- Submitted all physician ordered referral to external clinics and or facilities for patient care.
- Worked from several medical systems to obtain diagnostic testing and or procedures prior to scheduled appointments for patient care.
- Reviewed the patient encounter form to ensure all data was captured for billing purposes.
- Ensured that all charges were captured and entered within the timelines established by physician.
- Ensured that all payments were entered, balanced and deposited in a timely manner.
- Assured medical records maintained with respect to patient confidentiality, security, completeness and timeliness.
- Assured that practice followed HIPPA and security regulations.
- Ensured that revenue cycle was maintained to facilitate practice reimbursement was appropriate.
- Made sure that staff was scheduled appropriately to provide adequate coverage during all hours of operation.
- Maintained accurate time and attendance records while reporting in a timely manner.
- Worked with staff in progressive coaching and counseling to develop or discipline employees as necessary.
- Worked with physician schedule to maximize physician productivity daily.
- Responsible for verification of patient insurance benefits, daily collections (co-pays, deductibles, coinsurance, etc.), daily charge entry, daily bank deposits, daily reconciled batches, daily submission of outpatient total.
- Responsible for ensuring the consistent and appropriate interpretation, evaluation and application of the policies and procedures of the practice.
- Ensured that all tasks assigned to employees were completed in a timely and efficient manner.
- Coordinated in specific functions and activities of assigned practice to include IT, accounting, HR, payroll, materials management, and other support services.
- Support and participate in all marketing initiatives for the physician.
- Promoted the philosophy, mission and vision of the practice to employees, patients, and other contacts outside the facility.
- Provided a safe and complete environment for the delivery of patient care through operational processes and protocols, inventory control, and equipment checks.
- Corrected any known deficiencies.
- Responsible for providing support service to the physician including compliance, auditing, coding, credentialing, accounts receivable, denial management and ensured cost-effective, high-quality health care services for all patients.
Education
Diploma -
El Paso High School
El Paso, Texas06.1987
Skills
- Insurance claims
- Medical billing
- Insurance billing
- Electronic claims
Personal Information
- Citizenship: US
- Nationality: US
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Software
MS Office
Excel
Timeline
Medical Biller Specialist
Leidos QTC Health Services
01.2023 - Current
Administrative Service
CITC Central Texas VA
11.2019 - 10.2021
Financial Counselor for Patient Access
Seton Medical Center Harker Heights
02.2018 - 10.2019
Registration Specialist
Orthopedic Associates of HI, LLC
05.2014 - 05.2017
Personal Banker/Small Business Specialist
JP Morgan Chase
11.2011 - 02.2014
Patient Support Services Coordinator
Centro De Salud Familiar La Fe, Inc.
02.2009 - 02.2011
Billing and Collections Supervisor
Affordable Dental Incorporated
02.2008 - 12.2008
Assistant Office Manager
Manor Care Health Services
01.2007 - 01.2008
Office Manager
Fritz F. Lemoine Jr., MD, Internal Medicine
01.2003 - 12.2006
Diploma -
El Paso High School