Summary
Overview
Work History
Education
Skills
Languages
Timeline
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Veronica Hernandez

Van Nuys,United States

Summary

Competent Behavioral Claims Specialist with 10 years of experience in handling wide variety of medical coding and billing tasks. Sophisticated and hardworking individual with excellent analytical and multitasking abilities. Coordinates with insurance companies and expedites claims processes. Expertise in accurately inputting procedure and diagnosis codes into billing software to generate invoices. Detail-oriented professional with focus on deadlines and skilled in handling medical billing without errors. Confident Medical Biller knowledgeable in data confidentiality and privacy practices when reviewing patient information.

Overview

15
15
years of professional experience

Work History

Medical Billing Specialist Behavioral Health

Virtue Recovery Center
05.2021 - 12.2024
  • Communicated with insurance providers to resolve denied claims and resubmitted.
  • Located errors and promptly refiled rejected claims.
  • Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
  • Identified and resolved patient billing and payment issues.
  • Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
  • Collected payments and applied to patient accounts.
  • Posted and adjusted payments from insurance companies.
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
  • Precisely evaluated and verified benefits and eligibility.
  • Precisely completed appropriate claims paperwork, documentation and system entry.
  • Filed and updated patient information and medical records.
  • Prepared billing correspondence and maintained database to organize billing information.
  • Communicated effectively and extensively with other departments to resolve claims issues.
  • Liaised between patients, insurance companies, and billing office.
  • Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts.
  • Printed and reviewed monthly patient aging report and solicited overdue payments.
  • Evaluated patients' financial status and established appropriate payment plans.
  • Maintained and updated collections tracking spreadsheet to help organize payment information.
  • Managed collections claims for unpaid bills against estates of debtors.
  • Verified insurance of patients to determine eligibility.
  • Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
  • Posted payments and collections on regular basis.
  • Reviewed patient diagnosis codes to verify accuracy and completeness.
  • Adhered to established standards to safeguard patients' health information.
  • Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
  • Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
  • Used data entry skills to accurately document and input statements.
  • Responded to customer concerns and questions on daily basis.
  • Audited and corrected billing and posting documents for accuracy.
  • Handled account payments and provided information regarding outstanding balances.
  • Monitored outstanding invoices and performed collections duties.
  • Collaborated with customers to resolve disputes.
  • Maintained accurate records of customer payments.
  • Utilized various software programs to process customer payments.
  • Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
  • Entered invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
  • Reconciled accounts receivable to general ledger.

Medical Billing Manager

Vogue Recovery Center
12.2017 - 04.2021
  • Worked with customers to develop payment plans and bring accounts current.
  • Reviewed billing problems, researched issues, and resolved concerns.
  • Managed monthly billing process to complete billings and returns to meet company revenue recognition policies.
  • Performed billing, collection, and reporting functions for office generating over $[Amount] annually.
  • Trained and mentored staff on procedures, compliance requirements, and collections techniques.
  • Conducted performance reviews and implemented improvement plans.
  • Performed testing for billing modules, enhancing new functionality and process improvements.
  • Established and checked coding procedures, monitored reports and updated internal files.
  • Developed strategic plans for day-to-day financial operations.
  • Supported financial director with special projects and additional job duties.
  • Evaluated and negotiated contracts to procure favorable financial terms.
  • Established internal audit procedures to validate and improve accuracy of financial reporting.
  • Reviewed historical records, current operational data and forecasting information to identify and capitalize on system enhancement opportunities.
  • Prepared internal and regulatory financial reports, balance sheets and income statements.
  • Utilized financial software to prepare consolidated financial statements.
  • Prepared cash flow projections, cost analysis and monthly, quarterly and annual reports.
  • Complied with established internal controls and policies.
  • Analyzed business processes to identify cost savings and operational efficiencies.
  • Checked payroll, vendor payments, commissions and other accounting disbursements for accuracy and compliance.
  • Improved overall financial reporting by streamlining control processes and reporting structures.
  • Processed payments and applied to customer balances.
  • Negotiated to collect balance in full.
  • Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.
  • Worked in call center environment handling manual and automatically dialed outbound calls.
  • Maintained high volume of calls and met demands of busy and productive group.
  • Negotiated re-payment plans by identifying causes of delinquent payments to assist in recovery of debt and meet realistic timeframes.
  • Researched accounts and completed due diligence to resolve collection problems.
  • Counseled debtors on payment options and arranged installment agreements.
  • Used probing techniques to determine debtors' reasons for delinquency.
  • Trained new team members on scripts, company services, and collection strategies.
  • Registered information of customers on database, collecting credit history, financial statements and personal details to preserve accurate records.
  • Responded to customer inquiries and provided detailed account information.
  • Maintained accurate records of customer accounts, payments and payment plans.
  • Entered client details and notes into system for interdepartmental access and review.
  • Located customers with overdue accounts and solicited payment in compliance with fair debt collection practices.
  • Processed debtor payments and updated accounts to reflect new balance.
  • Monitored customer accounts for payment delinquency and initiated collection efforts.
  • Analyzed customer financial records to determine appropriate payment plan.
  • Developed and documented collection procedures and policies to comply with government regulations.
  • Generated and distributed monthly customer statements.

Claims Processor

Malibu Beach Recovery Center
03.2013 - 12.2017
  • Utilized specialized software to process incoming claims, enter data and generate reports.
  • Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
  • Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes.
  • Managed workload and priorities to meet claims processing meet deadlines.
  • Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
  • Reviewed applications and supporting documents to verify claims eligibility and accuracy.
  • Followed up with customers on unresolved issues.
  • Developed and implemented quality assurance processes to check accuracy of claims processing.
  • Monitored claims processing trends to identify potential areas of improvement.
  • Established positive and trusting relationships with injured clients, administering efficient customer service and processing claims quickly.
  • Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes.
  • Tracked and reported on claims processing metrics to aid senior management in making informed decisions.
  • Verified client information by analyzing existing evidence on file.
  • Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Communicated effectively with staff members of operations, finance and clinical departments.
  • Generated, posted and attached information to claim files.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.
  • Processed and recorded new policies and claims.
  • Calculated adjustments, premiums and refunds.
  • Determined appropriateness of payers to protect organization and minimize risk.
  • Posted payments to accounts and maintained records.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Modified, updated and processed existing policies.
  • Notified insurance agents and accounting departments of policy cancellations and changes.
  • Coordinated with contracting department to resolve payer issues.
  • Collected premiums and issued accurate receipts.

Project Coordinator

AFX
05.2010 - 03.2013
  • Kept projects on schedule by managing deadlines and adjusting workflows.
  • Supervised multiple projects from project start through delivery by prioritizing needs and delegating assignments.
  • Liaised between departments to facilitate communication and keep appropriate parties updated on project developments.
  • Managed competing demands and professionally adapted to frequent change, delays and unexpected events.
  • Tracked hours and expenses to keep project on task and within budgetary parameters.
  • Created job files for each project and maintained current data in each file.
  • Kept corporate and client information confidential, adhering to data safety measures.
  • Prepared meeting agendas and minutes for distribution and record keeping.
  • Assisted with onboarding newly hired staff members and coached on task prioritization.
  • Responded to requests for information on materials to inquiring parties.
  • Provided input and feedback on departmental initiatives, directives and strategies to contribute to project success.
  • Arranged travel and accommodation for team members and project partners.
  • Coordinated venue and catering arrangements, speaker and attendee liaison and material distribution for meetings and events.
  • Reported regularly to managers on project budget, progress and technical problems.
  • Tracked project and team member performance closely to quickly intervene in mistakes or delays.
  • Developed and implemented project plans and budgets to ensure successful execution.
  • Recruited and oversaw personnel to achieve performance and quality targets.

Education

Medical Billing & Coding

Cal State LA
5151 State University Dr, Los Angeles, CA 90032

Skills

  • Bill Payment
  • Medicare and Medicaid Process
  • Accounts Payable
  • Adaptability
  • Electronic Health Records
  • Software Proficiency
  • Account Reconciliation
  • Attention to Detail
  • Problem Solving
  • Analytical Thinking
  • Collections Management
  • Claim Submission
  • Medical Terminology
  • Payment Posting
  • Data Entry Accuracy
  • Professionalism
  • CPT Knowledge
  • Team Collaboration
  • Critical Thinking
  • Conflict Resolution
  • Insurance Verification
  • HIPAA Compliance
  • Organizational Skills
  • Denial Management
  • Time Management
  • Patient Billing
  • Records Management
  • Commercial and Private Insurance
  • Billing and Collection Procedures
  • Teamwork and Collaboration
  • Claims Processing
  • Multitasking and Organization
  • Claims Review
  • Electronic Claims
  • Payer Contracts
  • Patient Collections
  • Accounts Receivable Management
  • Account Management
  • Insurance Claims Processing
  • Customer Service
  • Patient Account Analysis
  • Insurance Billing
  • Payment Processing

Languages

Spanish
Native or Bilingual

Timeline

Medical Billing Specialist Behavioral Health

Virtue Recovery Center
05.2021 - 12.2024

Medical Billing Manager

Vogue Recovery Center
12.2017 - 04.2021

Claims Processor

Malibu Beach Recovery Center
03.2013 - 12.2017

Project Coordinator

AFX
05.2010 - 03.2013

Medical Billing & Coding

Cal State LA

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