Tania Pantoja

• I support Claim team in handling transplant patients it including benefits verification,and claim processing.
• I handle appeals,claims adjustments/refunds,Medicare pricing and processing fees,out of network negotiations,subrogation and bill review for medical department.
• Review and research appeal/dispute and provide a written review and responses in a timely manner.
• Calculate adjustment payment of benefits in accordance with coverage information,contract language or plan document, and medical documentation.

• Reviewed and posted daily payments
• Maintained accurate and completed billing system and process.
• Checked monthly reports and analyzed billing data to identify trends and discrepancies.
• Identified trends and provided feedback regarding billing issues and uncollectible accounts.
• Verified that medical procedures were medically necessary and within insurance coverage guidelines.
• Assisted with answering telephone to provide requested billing information.
• Reconciled and balanced accounts on a monthly basis.
• Obtained signatures for financial responsibility and treatment procedures from patients or guardians.
• Resolved patient billing issues and collected payments.
• Reviewed and posted daily payments.
  Maintained accurate and complete billing system and process.

Checked monthly reports and analyzed billing data to identify trends and discrepancies.

• Identified trends and provided feedback regarding billing issues and uncollectible accounts.
• Posted payments to in electronic medical records system upon receipt of payment for claims.
• Business consultations with treatment plan cost with and without insurance coverage

• Created new patient charts to include personal and insurance information and reason for visit.
• Obtained signatures for financial responsibility and treatment procedures from patients or guardians.
• Resolved patient billing issues and collected payments.
• Communicated with third party payors to obtain insurance benefits and authorizations.
• Registered patients by obtaining necessary and accurate financial and demographic information.
• Optimized patient satisfaction and provider time by scheduling appointments in person or by telephone.
• Resolved patient billing issues and communicated with insurance carriers.
• Used ICD-10-CM and CPT coding to complete records.

• Collaborated with other departments, customers and insurance companies to resolve claims in an efficient and timely manner.
• Conducted timely reviews of claims to ensure accuracy and completeness of documentation.
• Corrected processing errors by reprocessing, adjusting and recouping claims.
• Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
• Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers.

• Welcomed on-site visitors and directed to appropriate personnel.
• Interacted with management and colleagues to resolve important administrative matters.
• Scanned and documented new patient information in electronic health records for registration purposes.
• Recorded patient and insurance payments, maintaining accurate financial records.
• Scheduled patients for exams and screenings.
  Used basic knowledge of medical terminology in daily office tasks.
• Updated patient records, medical histories, and contact information for traceability.
• Collected co-payments and co-insurance and issued appropriate receipts during check-in.
• Communicated with physicians and staff to gather information for referrals.
• Obtained authorization for referrals and diagnostic testing using proper documentation.

• Collaborated with other departments, customers and insurance companies to resolve claims in an efficient and timely manner.
• Contacted necessary family members, doctors and other related persons to collect missing information.
• Reviewed insurance policy coverage, determining validity of patient requests for claims.
• Calculated claim amounts and distributed invoices to uphold payment requirements.
• Performed administrative duties by verifying documentation, researching facts and contacting other parties involved to determine fault percentages and minimize potential losses.

• Collaborated with other departments, customers and insurance companies to resolve claims in an efficient and timely manner.
• Contacted necessary family members, doctors and other related persons to collect missing information.
• Reviewed insurance policy coverage, determining validity of patient requests for claims.
• Calculated claim amounts and distributed invoices to uphold payment requirements.
• Counseled and assisted patients with application processes for available financial assistance programs.
• Resolved patient billing issues and collected payments.
• Reviewed charts for accuracy and completeness prior to patient visits.
• Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.

• Customized insurance programs to suit individual customer needs.
• Verified patient information on claims paperwork, checking for and preventing mistakes.
• Calculated claim amounts and distributed invoices to uphold payment requirements.
• Reviewed insurance policy coverage, determining validity of patient requests for claims.
• Scheduled medical appointments for patients.
• Answered incoming calls, scheduled appointments and filed medical records.
• Facilitated communication between patients and various departments and staff.