Theresa L-Rue
Rialto,CA
Summary
20+ Proven Years of Experience in Healthcare Revenue Cycle/ Medical Billing Chargemaster, Coding, Billing, Refund Analysis from EOB’S, Auditing, Authorizations, Denials/Appeals, Compliance, and Collections. 3M, PBAR, MedSeries4, Change Healthcare, nThrive.
Overview
24
24
years of professional experience
Work History
Healthcare Revenue Cycle
Independent Contractor
Rialto, CA
12.2022 - 04.2024
- Processed Medical Billing for Professional and Hospital Services Accounts from Beginning to End which included: Insurance Verification, Coding, Electronic Billing, Refund Analysis from EOB’S, Auditing, Authorizations, Denials/Appeals, Compliance, and Collections for Physician Outpatient Claims, and Hospital/Surgical Claims starting at 60 Days A/R to 365 Days
Healthcare Revenue Cycle
PrimeHealthCare HBS
Ontario, CA
05.2017 - 12.2022
- Healthcare Revenue Cycle/Auditor/Compliance in House Coding, Medical Billing, Auditing, Denials/Appeals, Compliance, Collections for Physician Outpatient Claims, and Hospital/Surgical Claims starting at 60 Days A/R to > 365 Days Charge Master Analysis of CCI, MUE Edits using Soarian
- HL7 Interface troubleshooting during implementation process
- Coding, (ICD 9, ICD 10, CPT, HCPCS)
- Used 3M, nThrive, Change Healthcare, PBAR, MedSeries4 as clearinghouses
- Electronic Billing, (CMS 1500/UB04)
- Refund Analysis from EOB’S Auditing, (CMS 1500/UB04) Insurance Payer Collections Authorizations
- Denials/Appeals Compliance
- Patient Payment Plans Physician Credentialing Physician Liaison
Management/Medical Consultant
Qwest Medical & Healthcare Consultants
Los Angeles, CA
02.2008 - 02.2017
- Medical Billers, Collectors, Comprehensive Healthcare Revenue Cycle Staff
- Charge Master Analysis/Management
- Coding (ICD 9, ICD 10, CPT, HCPCS)/Management NCCI Edits, MUE Edits, Electronic Billing, (CMS 1500/UB04) Management
- Refund Analysis from EOB’S
- Utilized Soarian for editing insurance information, CPT Codes, Diagnoses etc
- Collecting on Outpatient and Surgical Claims starting at A/R 60 Days to > 365 Days HEDIS Reviewer
- Auditor
- Used several different clearinghouses including Endeon, Trizzetto, 3M, nThrive and more
- Patient Registration/Admitting/Financial Counseling/Management Insurance Payer Analysis/Management
- Payer Trend Analysis/Management Denial Analysis/Management Compliance Officer/Policies
- Patient Payment Plan Analysis/Management
- Current Knowledge of CMS Federal Health Insurance (Medicare Part A, B, D/Medi-Cal/Medicaid, CCS), and Managed Care/HMO Insurance Standards
- Physician Credentialing/Insurance Company Carrier Credentialing
- Performed Continuous Education for the Consultants in all aspects of Revenue Cycle
Assistant of Professional Services Department of Revenue Cycle Management
UCLA Ronald Reagan Medical Ctr.
Westwood, CA
01.2005 - 01.2008
- Coders, Medical Billers, Auditors, Collectors
- Complex Comprehensive Revenue Cycle Management, Management of NCCI Edits, MUE Edits
- Coding, (ICD 9, ICD 10, CPT, HCPCS)
- Electronic Billing, (CMS 1500/UB04) Refunds from EOB’S
- Researched Performances of Medical Centers Fees and or Professional Fees, Prior to Corrective Actions
- HEDIS Auditor
- Knowledge of CMS Federal Health Insurance (Medicare Part A, B, D/Medi-Cal/CCS), and Managed Care/HMO
- Authorizations
- Insurance Payer Analysis Denial Analysis Compliance Officer
- Patient Payment Plan Analysis
- Physician Credentialing/Insurance Company Carrier Credentialing
- Performed Continuous Management, and Education for the Consultants in all aspects of Revenue Cycle
- Reportage of Findings, Strategic Planning, Corrective Action, and Implementation of New Standards for the Organizations to Achieve a Higher Performance in Revenue Cycle
- Managed JCAHO Revenue Cycle Audits
Ophthalmology Insurance Coordinator, Workers Comp. Coordinator
Wolstan Eye Associates Ophthalmology Medical Group
Torrance, CA
01.2000 - 01.2002
- Patient Insurance Verification
- Financial Counseling ICD-9/10/CPT Coding Medical Billing, Refunds
- Managed Care/Authorizations/Referrals
- Reviewed, and Submission of Outpatient Medical Claims to various Insurance Carriers, and Workers Comp
- Carriers
Education
Psycology
UC San Diego
San Diego, CASkills
- Healthcare Revenue Cycle
- Medical Billing
- Coding (ICD 9, ICD 10, CPT, HCPCS)
- Auditing
- Compliance
- Collections
- Charge Master Analysis
- Electronic Billing (CMS 1500/UB04)
- Refund Analysis from EOB’S
- Insurance Verification
- Denials/Appeals
- Patient Payment Plans
- Physician Credentialing
- HL7 Interface troubleshooting
- Knowledge of CMS Federal Health Insurance
- Managed Care/HMO Insurance Standards
- 3M
- PBAR
- MedSeries4
- Change Healthcare
- NThrive
- Epic-Resolute HB/PB
- Allscripts
- Athena
- Cerner
- Soarian
- NextGen
- Lytec
- Mckesson
- Medi Soft
- Medical Manager
- PrimeClinical
- EClinicalWorks
- Nextech
- Office Ally
- Compulink
- ChartMaxx
- EZ Claim
- Meditech
- Excel
- Word
Timeline
Healthcare Revenue Cycle
Independent Contractor
12.2022 - 04.2024
Healthcare Revenue Cycle
PrimeHealthCare HBS
05.2017 - 12.2022
Management/Medical Consultant
Qwest Medical & Healthcare Consultants
02.2008 - 02.2017
Assistant of Professional Services Department of Revenue Cycle Management
UCLA Ronald Reagan Medical Ctr.
01.2005 - 01.2008
Ophthalmology Insurance Coordinator, Workers Comp. Coordinator
Wolstan Eye Associates Ophthalmology Medical Group
01.2000 - 01.2002
Psycology
UC San Diego
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