Vanessa Lopez
Summary
Reliable Medical Biller with over 20 years of coding and medical terminology knowledge. Polished and hardworking performer with background overseeing accounts and handling records management tasks. Team-oriented person with great decision-making skills.
Overview
26
26
years of professional experience
Work History
Medical Biller - Behavioral Health Therapist
Self-Employed
02.2022 - Current
- Created provider billing process for small behavioral health provider
- Medical coding for psychotherapy treatments
- Billing & follow up for all revenue billing cycles
- Cash & Payment posting.
Service Account Manager
Optum
11.2018 - 07.2021
- Management Team directly responsible for support of CAS' (Client Account Specialists)
- It is vital that the CAS keep this team informed of day-to-day operations, goals, and concerns
- Ensures CAS' fully comprehend the process required to initiate client claims for Credit Balance
- Assists RAMs (Regional Account Managers) with unresolved and/or problem claims and funneling appropriate questions to the CAS for review and resolution via the OZ ticket process
- Assists in resolving network issues and equipment malfunctions
- PRS/Data Mining Leadership - Collaborate on outstanding issues, trends and requests as needed
- Ensuring client guidelines are following state/federal regulations
- Utilization of client systems for necessary job functions
- Working typically in an independent role but as part of a larger team
- Ability to work remotely with minimal direct supervision
- Communicate and/or meet with the client appropriately to ensure Optum is meeting the needs and expectations of the customer and build a good rapport with the customer contacts by establishing professional working relationships to ensure operational efficiency
- Meet and exceed the production and quality goals set forth by both Optum and the customer
- This includes meeting deadlines for specified projects and making sure that expectations are consistently being met
- Generate necessary reporting, daily/monthly/quarterly/annually and as requested by client
- Anticipate customer needs and proactively identify solutions, be accountable for improving business operations.
Sr. Recovery Specialist
Optum
01.2018 - 11.2018
- Reviewing and understanding the current provider relationship(s) and A/R history
- Diving into data - reviewing/analyzing all the sources of the outstanding balances
- Building confidence among the internal teams related to the A/R data
- Understanding the issues and potential obstacles and offering new ideas in resolving them
- Discussing the findings as a collaborative team before we approach the provider
- Developing a unique strategy with each provider and establishing realistic metrics to meet the goals of this initiative
- Actively pursuing the top 20+ aged A/R providers per region
- Updating and aggressively reducing dollars on the provider suspend reports
- Maintaining positive provider relationships
- Documenting and sharing improvement opportunities with leadership for action to be taken to resolve drivers permanently
- Committing to take action with our findings, while continuing to pursue the overpayments
- Create and modify Power Point presentations
- Creating & maintaining documents within Microsoft Word
- Strong organizational skills: working with Microsoft Excel & pivot tables to be able to analyze large amounts of date & inventory.
Sr. Recovery Resolution Analyst (RAM)
Optum
11.2014 - 01.2018
- Work closely with provider onsite staff to process refunds in a timely manner, as well as follow up and ensure timely paid claims to meet/exceed daily and monthly goals & metrics
- Investigate, review, and provided clinical and/or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review
- Interpretation of state and federal mandates applicable benefit language, medical and reimbursement policies, and consideration of relevant clinical information
- Perform clinical coverage review of post-service, pre-payment claims, which requires medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims with overbilling patterns
- Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing
- Identify over billing patterns and trends, waste, and error, and recommends providers to be flagged for review
- Maintain and manage daily case review assignments, with a high emphasis on quality
- Provide clinical support and expertise to the other investigative and analytical areas
- Participates in provider/client/network meetings, which may include provider education through written communication
- Participate in training of new staff and serve as a clinical resource to other areas within the clinical investigative team
- Reviewed & analyzed hospital billing trends that would cause on-going overpayments for specific payers
- Assisted provider with detailed analysis of incorrect billing trends in order to eliminate ongoing inaccurate claims billing.
Contact Service Representative
Internal Revenue Service
11.2013 - 11.2014
- Conduct telephone interviews such as: third party representatives, e.g., Certified Professional Accountants (CPAs), practitioners, and attorneys, who possess a professional understanding
- Provides full explanations to specific inquiries involving: A body of law and regulations that covers Employee Plans, Exempt Organizations, Indian Tribal, local, state or Federal Government entity filings, each having different conditions, reporting requirements, or other regulatory provisions that significantly affect and complicate the specific obligation involved
- Regulations and policies subject to frequent legislative changes or administrative determinations, amendments or precedent decisions that affect specific conditions
- Responds to in-person, telephone, or written inquiries from taxpayers and/or their representatives and/or the public regarding Employee Plans or Exempt Organization status
- Review individual circumstances and goals and advises on the most advantageous methods of handling them
- Applies Revenue Rulings to appropriate situations
- Elicit sensitive and financial information or draws out information the individual may attempt to withhold to ensure compliance with reporting and disclosure requirements
- Resolve exempt status inquiries and respond orally or in writing to taxpayer inquiries on a variety of exemption-related issues
- Provides information on how to request abatement and update good exempt status
- Place a hold on accounts while penalty is being considered for abatement.
A/R Representative II
Central California Faculty MG
02.2011 - 02.2014
- Assigned to billing, coding & collections for Oncology & Infusion department since January 2013
- Consistently increased revenue from $500,000/month to an average of $1 million+ per month 4 months in row
- Familiar with billing and collecting for multiple Silos and co-payment assistance programs for infusion & oncology patients
- Knowledge in billing infusion codes to all payers such as: Medicare, Medi-cal, HMOs, PPOs, etc
- Experience with billing & collections for multiple specialties: (Plastic Surgeons, Facility, Psychiatry, Internal Medicine, GI, Cardiology, Rheumatology, Neurology, Neurosurgery)
- Knowledge with billing both facility and professional claims
- Experience with UB-04 and CMS1500 form
- Data entry: keying in all demographics & charges
- Post payments and take proper adjustments based on correct contracted reimbursement rates
- Knowledge working with DSG (electronic clearing house) to submit and reprocess any rejected claims, as well as EPIC & EMR (Electronic Medical Records)
- Contacting insurances to follow up on unpaid claims and ensure timely payment/s
- Meeting with insurance representatives to resolve problematic claims processing issues
- Contacting patients to follow up on balances after all insurance payments have been collected
- Knowledge with preparing & coding both professional and facility charges to be keyed into system.
Medical Billing Manager
Abeo Corp.
02.1998 - 02.2010
- 12 years of anesthesia & pain management billing & collections experience
- Processed and prepped physician face sheets to prepare them for billing to appropriate insurances/patients
- Billing and follow-up for multiple insurances such as: Medicare, Medi-cal, Work Comp, HMO, PPO, Self-pay, trauma funds, Tricare, etc
- Over 5 years of supervisory and office management experience
- Responsible for overseeing a 35-physician medical group that staffed about seven individuals to work account
- Managed Orange County office where I was responsible for making sure all billing, collections, personnel, and IT issues were running efficiently
- Responsible for hiring office staff
- Training new employees on in-house medical program and billing & collections processes
- Created several spreadsheets and cheat sheets for Medi-cal, CCS, Anesthesia & Pain management billing workshops
- Supervised Pain Management program & scheduling dept
- Overseeing the timeliness of physician credentialing
- Assisted the COO of Allied Anesthesia with contracting, where I kept up to date spreadsheets and records of multiple contract rates that needed to be increased
- Providing data analysis of all billing and collection criteria to the COO for purposes of re-negotiating contracts for higher reimbursement rates
- Reviewing, correcting, and billing CPT, ICD-9, Anesthesia Modifiers & Time unit calculations, etc
- Running monthly distribution reports for our group's income and account status'
- Assisted & accompanied President of company to executive meetings as one of the primary billing representatives & liaison for Allied Anesthesia Medical Group
- Primary contact & liaison for physician group and patients
- Managing billing & collections for a group of five Anesthesia doctors in the Chula Vista, CA area
- Set-up to work from home-office and responsible for all aspects of medical billing processes and daily office functions
- Supervise one employee that assisted me in the data entry of group face sheets.
Education
Graphic Design
Brooks College
Long Beach, CA01.1998
Criminology
University of La Verne
La Verne, CA01.1997
Skills
- Excellent Communication & Writing skills
- Bilingual: Spanish
- Advanced knowledge with Microsoft office: Word, Excel, Outlook, Power Point
- Knowledge with use & repair of fax machines, Lexmarks, Neopost, scanners
- Advanced computer skills & familiar with multiple billing software & operating systems: Microsoft Office 1997-2011, Medsuite, Onbase, DSG, Advanced MD, Practice Fusion, EPIC, Practice Suite
- Knowledge with multiple billing and UHC system platforms: ODAR, UNET, Cosmos, CPW, CSP & RV Facets, NICE, OPM, ORMS, Oxford WebCSA, EDSS, IDRS, ISET, Lockbox, TRACR, Document Viewer, CDB, Mobius, Bottomline, Enterprise NOW, Direct Connect
- Clerical Support
- Account Reconciliation
- HIPAA Compliance Certification
- Records Management
References
- George W. Kanaly, Ph.D., Executive VP for Allied Anesthesia, (951) 830-9816
- Cesar DeLucio, Field Director for Optum, (323) 997-3881
- Jonathan Fredericks, Client Services Manager for Optum, (615) 293-6302
Languages
Spanish
Full Professional
Timeline
Medical Biller - Behavioral Health Therapist
Self-Employed
02.2022 - Current
Service Account Manager
Optum
11.2018 - 07.2021
Sr. Recovery Specialist
Optum
01.2018 - 11.2018
Sr. Recovery Resolution Analyst (RAM)
Optum
11.2014 - 01.2018
Contact Service Representative
Internal Revenue Service
11.2013 - 11.2014
A/R Representative II
Central California Faculty MG
02.2011 - 02.2014
Medical Billing Manager
Abeo Corp.
02.1998 - 02.2010
Graphic Design
Brooks College
Criminology
University of La Verne
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