Toni Renee Villeda
York,PA
Summary
Results-driven Revenue Cycle Specialist experienced in analyzing billing discrepancies and implementing solutions. Expert in navigating complex insurance claims and enhancing collection rates through audits and communication. Focused on improving financial outcomes and patient satisfaction in healthcare settings while resolving complex billing issues.
Overview
25
25
years of professional experience
Work History
Insurance Follow-Up Representative
Bayhealth Medical Group
Dover, DE
07.2025 - Current
- Identified recurrent coding issues and denial patterns for proactive resolutions.
- Followed up with insurance companies on unresponsive claims to expedite resolution.
- Filed corrected claims disputes and appeals, ensuring timely reimbursements.
- Communicated with patients about insurance coverage denials and coordinated benefits clarification.
- Verified insurance eligibility, corrected claim errors, and submitted reconsiderations.
- Reviewed medical documentation to verify accuracy of claims.
- Resolved credit balances and initiated refund requests for applicable overpayments.
- Analyzed billing discrepancies and denials to uncover underlying issues.
Reimbursement Specialist, Patient Services & Billing Representative
Elman Retina Group
Rosedale, MD
06.2021 - 07.2025
- Processed and applied all insurance payments, including EFT, online checks, cash, and credit cards.
- Resolved billing discrepancies through thorough investigations and audits.
- Researched claim rejections to identify issues and facilitate appeals.
- Coded patient care records to ensure accurate billing information.
- Conducted proactive billing analysis to identify cost-saving opportunities.
- Communicated with patients regarding billing inquiries and payment options.
- Advised supervisors and clinicians on billing deficiencies to enhance charge capture efforts.
- Issued monthly billing statements to patients for timely collections.
- Managed daily folders from multiple offices while balancing financial records in Excel.
- Scheduled and registered patients efficiently to enhance workflow.
- Greeted patients, verified insurance information and collected copays.
- Assisted in training new reception staff on office procedures and systems.
Patient Service/Billing Representative
National Retina Institute
Towson, MD
02.2018 - 05.2021
- Managed patient registration and verified insurance information to streamline onboarding process.
- Facilitated collections and processed payments, contributing to improved financial performance.
- Executed daily charge entries, ensuring accuracy of audit charts for compliance.
- Conducted edits and generated charge reports to ensure compliance.
- Answered phone inquiries promptly, providing necessary information to patients.
- Coordinated appointment scheduling to optimize clinic operations.
- Oversaw inventory management to ensure adequate supply levels.
- Trained new front-desk staff, improving team competency and service quality.
Receptionist/ Back-Office Assistant
Complete Pain Care
Abingdon, MD
08.2017 - 02.2018
- Provided exceptional customer service, fostering positive client relations through effective phone communication.
- Scheduled and modified appointments, optimizing client satisfaction and accessibility.
- Verified and obtained insurance information, enhancing accuracy in billing processes.
- Conducted billing follow-ups that increased collection rates significantly.
- Managed collections to minimize outstanding payment balances.
Patient Collection Representative
Fundamental Administrative Services
Sparks, MD
09.2012 - 08.2017
- Executed outbound and inbound customer service and collection calls, enhancing customer satisfaction and collection outcomes.
- Processed patient billing statements with precision.
- Prepared payment reports and reconciled discrepancies promptly.
- Conducted skip tracing and property searches to locate assets.
- Performed estate searches and filed claims accurately.
- Supported legal counsel with drafting collection correspondences.
- Compiled legal files for external legal counsel, streamlining access to critical documentation for case preparation.
- Generated special reports to support VP during month-end processes, ensuring accurate financial reporting.
Front-Desk/Medical Office Assistant
Complete Pain Care
Abingdon, MD
05.2012 - 09.2012
- Managed patient registration and appointment scheduling to streamline patient flow and reduce wait times.
- Answered phone inquiries, delivering timely assistance to enhance patient satisfaction.
- Prepared patients in pre-operative area for surgical procedures with attention to detail.
- Issued and educated patients on in-office durable medical equipment, including back braces and TENS units.
- Conducted in-office urine drug testing, maintaining compliance with medical protocols and supporting patient care.
- Reconciled payments and processed bank deposits accurately.
Proof Operator
Bank of America
Baltimore City, MD
07.2006 - 05.2010
- Operated specialized proofing machines for data verification.
- Endorsed and encoded bank financial center documents to ensure accuracy and compliance.
- Processed financial documents for accuracy and completeness.
- Reviewed transaction records for discrepancies and errors.
- Streamlined payment processing for improved efficiency and productivity.
Patient Billing Services Representative
MedStar Physician Partners
Middle River, MD
05.2004 - 06.2005
- Obtained and verified insurance information for accurate billing processes.
- Executed ICD-9 and CPT-4 coding to ensure correct medical billing.
- Performed charge entry with precision to maintain financial integrity.
- Oversaw accounts receivable processes to enhance revenue cycle management.
- Generated patient aging reports and electronic edit reports for financial tracking.
- Answered phones, delivering exceptional customer service to patients and providers.
- Managed physician credentialing to ensure compliance and operational efficiency.
Third-Party/Patient Billing Representative
Erickson Retirement Charlestown
Catonsville, MD
01.2002 - 11.2002
- Submitted and followed up on third-party claims to secure timely reimbursements.
- Processed resident monthly statements to ensure accurate billing and account management.
- Managed accounts receivable by tracking outstanding invoices and payments.
- Entered charges for services provided in skilled nursing facilities, assisted living facilities, and independent living communities.
- ICD-9 and CPT-4 Coding
- Answered phones, delivering excellent customer service to resolve inquiries and issues.
Education
Certified Medical Billing/Coding -
TESST College of Technology
Baltimore01-2012
High School Diploma -
Bel Air High School
Bel Air, MD01-1999
Skills
- Revenue cycle management
- Claims processing
- Insurance verification
- Medical coding
- Accounts receivable management
- Data analysis
- Waystar and TriZetto clearinghouse platforms
- Epic and NextTech integration
- Availity and Clearwave solutions
- Instamed and TriZetto services
- Zelis and NextGen applications
- Microsoft Office Suite proficiency
- Microsoft Teams and WebEx proficiency
- Attention to detail
- Problem solving
- Team collaboration
- Cross-functional collaboration
- Conflict resolution
- Training and mentoring
- Effective communication
Languages
- English
- Spanish
Timeline
Insurance Follow-Up Representative
Bayhealth Medical Group
07.2025 - Current
Reimbursement Specialist, Patient Services & Billing Representative
Elman Retina Group
06.2021 - 07.2025
Patient Service/Billing Representative
National Retina Institute
02.2018 - 05.2021
Receptionist/ Back-Office Assistant
Complete Pain Care
08.2017 - 02.2018
Patient Collection Representative
Fundamental Administrative Services
09.2012 - 08.2017
Front-Desk/Medical Office Assistant
Complete Pain Care
05.2012 - 09.2012
Proof Operator
Bank of America
07.2006 - 05.2010
Patient Billing Services Representative
MedStar Physician Partners
05.2004 - 06.2005
Third-Party/Patient Billing Representative
Erickson Retirement Charlestown
01.2002 - 11.2002
Certified Medical Billing/Coding -
TESST College of Technology
High School Diploma -
Bel Air High School