Summary
Overview
Work History
Education
Skills
Languages
EHR programs
Timeline
Generic
Swe Garcia

Swe Garcia

Vacaville,CA

Summary

Goal-oriented individual dedicated to prominent levels of customer satisfaction and meeting aggressive business goals. Dedicated and skillful with specialized knowledge in EMR, Health Insurance Benefits, financial counseling, claims and billing procedures. Knowledge of coordination of benefits and requirements Good knowledge of medical terminology excellent data entry. Understands patient confidentiality and HIPAA compliance Excellent understanding of professional claims Clear understanding of insurance options that are available to patients. Strong telephone and communication abilities. Understanding of governmental guidelines and regulations as it relates to Medicare, Medicaid, manage care and commercial insurance Highly familiar with HMO, PPO, EPO, Medi-Cal, Medicare, CCS and Workers Compensations Critical thinking Fully complement in all aspects of Hospice, Skilled Nursing, Home health and DME Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

Overview

22
22
years of professional experience

Work History

Billing and Collection Representative

Providence Health Services
05.2022 - Current
  • Process all payment using various pay services
  • Researching Account
  • Collecting and updating demographic and insurance information
  • Proper HIPAA verification
  • Providers information to callers as appropriate
  • Manage incoming calls and respond to queries in warm and professional manner to ensure highest quality of customer services
  • Appropriate escalation of issues and problems to leadership based upon situation
  • Continually seeks to understand and act upon customer needs, concerns and priorities

ROI/EMR Associate

Dignity Health Medical Foundation
07.2018 - 12.2021
  • Scan documents into electronic medical record (EMR)
  • Archive electronic records and maintain server
  • Provide support to physicians and other clinicians in their use of electronic patient chart and function of computerized physician order entry
  • Review electronic data for completeness, accuracy, and compliance
  • Enter data and verify client paperwork for accuracy
  • Update medical reports to ensure that reports are complete and current and in accordance with all established HIM policies and procedures

Referral Coordinator

Hospice Care /DME, Dignity Health -Mercy Medical Group
12.2016 - 07.2018
  • Assemble information concerning patient's clinic background and referral needs
  • Review details and expectations about referral with patients
  • Assisted provider in planning placement for hospice and or home health and DME services
  • Contacted organizations and insurance companies to ensure prior approval
  • Verified all Hospice, Skilled Nursing benefits and ensure proper billing
  • Ensure that referral is addressed in timely manner
  • Billing insurance or collection in hospice environment

Medical Office Representative

Dignity Health -Mercy Medical Group
07.2016 - 12.2016
  • Collecting and updating demographics and insurance information
  • Verification of health plan eligibility
  • Taking complete and accurate messages
  • Scheduling mutually acceptable appointment times
  • Appropriate distribution of phone call and messages.
  • Answered phone calls and messages for 10-physician [, scheduling appointments, and handling patient inquires

Financial Counselor

Dignity Health Northridge Hospital Medical Center
04.2002 - 07.2016
  • Work closely with and aids other departments, including Case Management, Health Information Management, Social Services, Physician's services, related to insurance coverage information to ensure proper billing
  • Responsible for handling and managing continuous flow of information within hospital
  • Manage incoming calls and respond to queries in warm and professional manner to ensure highest quality of customer services
  • Interview patients to obtain, clarify and verify all demographic and insurance information to determine status on financial clearance as needed
  • Serve as liaison between patient, physicians, insurance companies, and coders
  • Communicates financial responsibility to patient including self- copays, outstanding deductibles, out of pocket, and or liabilities
  • Supported Clinical Research billing and account review as needed
  • Review charges, processing and tracking of on-going research related to clinical billing
  • Monitor accounts to ensure appropriate expected reimbursement applied
  • Reviewing report for outpatient and inpatient census report to identify patient responsibilities
  • Verified accuracy of medical records and insurance information for patients

PBX Operator

Providence Holy Cross Medical Center
01.2005 - 06.2009
  • Obtain necessary information and transfer calls to correct extensions
  • Provides information to callers as appropriate
  • Monitored all alarms located in PBX and notified appropriate personnel as required
  • Responded quickly and accurately to disaster and emergency situations as required, remaining calm

Education

High School Diploma - General Studies

Folsom Cordova Adult School
Ranco Cordova
11.2021

Skills

  • Conflict Resolution
  • Computer Proficiency
  • Payment Arrangements
  • Customer Service
  • Multitasking
  • Telephone Etiquette
  • Inbound / Outbound Calling
  • Customer / History Research
  • Credit and Collections
  • Records Management
  • New Hire Training
  • Call Center Experience
  • Payment Acceptance
  • Team Oversight
  • Account Investigation/ Review
  • Automated Document Scanning
  • Payment Processing/ Scheduling/ Posting
  • Updating Customer Accounts

Languages

Spanish
Native or Bilingual

EHR programs

Strong knowledge of MS office, MS4, SSI, Artiva, DISCAL, All-Scripts, IDX, Experian, Cerner, Midas, EPIC

Timeline

Billing and Collection Representative

Providence Health Services
05.2022 - Current

ROI/EMR Associate

Dignity Health Medical Foundation
07.2018 - 12.2021

Referral Coordinator

Hospice Care /DME, Dignity Health -Mercy Medical Group
12.2016 - 07.2018

Medical Office Representative

Dignity Health -Mercy Medical Group
07.2016 - 12.2016

PBX Operator

Providence Holy Cross Medical Center
01.2005 - 06.2009

Financial Counselor

Dignity Health Northridge Hospital Medical Center
04.2002 - 07.2016

High School Diploma - General Studies

Folsom Cordova Adult School
Swe Garcia