Tenecia Lazo
Taylor,MI
Summary
Experienced medical claims professional with 23+ years in claims processing, denial management, appeals, and revenue cycle management. Skilled in CPT coding, ICD-10 coding, and resolving payer issues to protect cash flow and improve billing accuracy.
Overview
24
24
years of professional experience
Work History
RA Specialist
Physicians Billing Medical Services
Livonia, Michigan
11.2022 - 10.2026
- Reviewed medical claims for compliance with regulations.
- Verified patient eligibility for medical claims and determined benefit coverage.
- Verified coverage details with payer systems and billing records.
- Processed medical claims using payer policies and benefit guidelines.
- Facilitated discussions with providers to resolve issues and enhance claim processing.
- Coordinated with providers on claim status, missing data, and corrections.
- Resolved claim denials through follow-up with insurance carriers.
- Investigated claim denials by analyzing medical records and plan terms to ensure proper resolution.
- Reviewed denials, rejections, and underpayments from insurance carriers.
- Addressed issues related to claims denial through detailed investigation. related to denied or underpaid claims in a timely manner.
- Prepared corrected claim submissions for billing review.
- Processed appeals on rejected or partially paid claims, including filing additional paperwork.
- Responded to patient billing questions with clear service support.
- Worked with team members to simplify billing workflows and raise efficiency.
- Developed plans addressing efficiency, cost, and profit-related challenges in billing processes.
- Identified incorrect charges on invoices by comparing them against contracts and fee schedules.
- Assisted with the development of new billing procedures and policies.
- Submitted and tracked medical claims to insurance companies via electronic or paper methods.
Medical Billing Specialist
Allenwood Family Health
Taylor, MI
08.2019 - 08.2022
- Reviewed charts and codes for accurate medical billing at Allenwood Family Health.
- Verified insurance eligibility and coverage before patient visits.
- Submitted claims to Medicare, Medicaid, and commercial insurers.
- Processed insurance claims for family health patients using billing software.
- Followed up on denied claims, correcting billing errors to facilitate timely payments.
- Identified errors and re-filed denied or rejected claims quickly to prevent payment delays.
- Analyzed rejected claims and corrected errors before resubmitting them for payment.
- Submitted appeals for denied claims when appropriate according to the insurance company's criteria.
- Completed appeals and filed and submitted claims.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Coordinated with clinical staff to resolve coding and documentation issues, ensuring accurate claim submissions.
- Maintained detailed records of all billing activities including denials, adjustments, and payments received.
- Maintained timely and accurate charge submission through electronic charge capture, including billing, and account receivables (BAR) system and clearing house.
- Recorded charges, payments, and adjustments in billing system.
- Applied payments, adjustments, and denials into medical manager system.
- Communicated with patients about balances, statements, and payment questions.
- Provided customer service support to patients who had questions about their bills or payments due.
- Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under policies.
- Monitored aging accounts receivable balances, resolving outstanding balances to maintain cash flow.
- Initiated collection efforts on unpaid accounts by contacting insurance companies or patients directly via phone or mail.
- Submitted refund requests for claims paid in error.
- Verified the accuracy of claim data prior to submission to insurance carriers.
- Assisted with the reconciliation of accounts receivable ledgers at month-end close process.
- Created and processed claims to third-party payers using specific coding guidelines.
- Contacted patients for unpaid claims for HMO, PPO and private accounts and performed friendly follow-ups to ensure proper payments were made according to contracts.
- Adhered to HIPAA regulations when handling confidential patient information.
Medical Claims Specialist
Metro Detroit Endocrinology
Dearborn, Michigan
08.2002 - 08.2019
- Timely reimbursement followed accurate, efficient processing of medical claims.
- Accurate claim resolution improved through coordination with healthcare providers on issue follow-up and corrections.
- Eligibility review supported proper benefit confirmation for medical claims.
- Coverage verification completed before patient visits to prevent billing delays.
- Claim submission reached Medicare, Medicaid, and commercial insurers through electronic and paper workflows.
- Claim tracking and provider coordination supported clean status updates, missing data resolution, and corrections.
- Denied and underpaid claims moved toward resolution through prompt follow-up.
- Appeals on rejected or partially paid claims maintained proper documentation and regulatory compliance.
- Accurate medical billing supported through chart review and code review.
- Sensitive member and provider information remained protected under HIPAA standards.
- Current knowledge of CPT and ICD-10 coding principles, government regulations, protocols, and third-party billing requirements supported compliant billing work.
- Audit readiness remained strong through detailed records of denials, adjustments, and payments.
- Billing practices improved through staff guidance and training.
- Patient balance, statement, and payment questions received clear communication and support.
Education
High School Diploma -
LINCOLN PARK HIGH SCHOOL
Lincoln Park, MI06-1993
Skills
- Medical claims expertise
- CPT and ICD-10 coding skills
- Adjudication and denial management
- Strong written communication
- Problem-solving capabilities
- Experience with ECW, Athena, Epic, E Thomas and Trizetto platforms
- Payer system proficiency
- Handling claims appeals
- Revenue cycle administration
Timeline
RA Specialist
Physicians Billing Medical Services
11.2022 - 10.2026
Medical Billing Specialist
Allenwood Family Health
08.2019 - 08.2022
Medical Claims Specialist
Metro Detroit Endocrinology
08.2002 - 08.2019
High School Diploma -
LINCOLN PARK HIGH SCHOOL