Vinicia Adler
MEDICAL BILLER / AR
North Las Vegas,NV
Summary
- Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
- Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
- Advanced experience in: MS Word, MS Excel, Nasco System, Call Care Browser, ADS Software System, D-Thomas System, Mysis Tiger System, Encoder, RIMS, IDX, Facets 431 & 296 System. Familiar with Comcotec Pharmacy System, IDX Appointment & Referral System, Touch works Medical Records, Authorization & Referral System, Macess System Facets, Med I Soft/Lytec System & Touch work applications, ISG, Solution Central.
- To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
37
37
years of professional experience
Work History
Membership Rep II E&B, Individual Enrollment
Anthem
Las Vegas, NV
05.2018 - Current
- Monthly Maintenance for Subscribers & Dependents; researching membership to make sure all information is current & accurate
- Including the following information: Exchange ID, Exchange
- Subscriber ID, Exchange Member ID, Exchange QHP ID, Exchange APPL ID, Group number,
- Member Code, Address, phone number, DOB & SSN
- FFM Recon report / Maintenance updated for Subscribers & Dependents
- Cancel Stuck report Maintenance checking for subscribers information is correct to include billing is sent and current
- 820 Discrepancy report checking for accurate payment posting Applying payments that need to be updated also update incorrect invoices
- Working Peer to Peer audits
- Training of new Employees
- SME for fellow co-workers
- Created new step by step instructions on how to work various reports and to maneuver in the different programs.
Senior CSC Lead
Southwest Surgery Center / dba United Healthcare
Las Vegas, NV
05.2011 - 10.2017
- Managed backup, user account and helpdesk systems.
- Analyzed workflows and established priorities for daily operations.
- Provided company users with tech support for IT problems and account maintenance.
- Maintained knowledge of advances in information technology systems and applications.
- Met with users, vendors and technicians to determine computing requirements.
Senior Accounts Receivable Clerk
SouthwestMedical
Las Vegas, NV
01.2006 - 01.2011
- Responsible for day to day operations to include:
- Grievance & Appeals
- Reviewed Grievance & Appeals case by case to assure whether it was handled appropriately clinically or administrative for accurate payments and to avoid payment penalties and timely payments
- Customer Service
- Daily deposits, reporting cash flow to corporate
- Claim Processing
- Submission of electronic and hard copy claims
- Posting and coding surgery center charges to include: (Facility, Anesthesia & Physician charges)
- Investigate & researching claims issues, filing & following up on appeals
- Updating yearly ICD10 & CPT codes
- Applying insurance & patient payments, denials
- Assisting patients with concerns regarding claim, co-payments & deductible
- Perform quarterly and monthly Audits
- Manage MSO copay’s and transfers
- Missing charge reports for surgery center, physicians and completing charge corrections
- Research for over payments, submit refund requests
- Work and send monthly quality report
- Insurance web site set ups for claim status, eligibility, prior authorizations
- Inventory & ordering of supplies
- Handle Employee time off request, schedules
- New employee training including system task set up
- Implement changes made by upper management to team
- Advance experience with several computer programs including all Microsoft Office programs.
- Performed various accounts receivable functions, handled cash receipts posting, updated cash flow reports and researched chargebacks and write-offs.
- Monitored customer account details to minimize or rectify non-payments, delayed payments and other irregularities.
- Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
- Generated, mailed and monitored invoices.
Office Coordinator Supervisor
Capital MD
Las Vegas, NV
01.2001 - 01.2007
- Responsible for day to day operations to include:
- Grievance & Appeals
- Reviewed Grievance & Appeals case by case to assure whether it was handled appropriately clinically or administrative for accurate payments and to avoid payment penalties, and timely payments
- Customer Service
- Daily deposits, reporting cash flow
- Claim processing
- Submission of electronic and hard copy claims
- Investigate & Research claims issues, filing & following up on appeals
- Updating yearly ICD10 & CPT codes
- Applying insurance & patient payments, denials
- Assisting patients with concerns regarding claim, co-payments & deductible
- Perform quarterly and monthly audits
- Research for over payments, submit refunds
- Work and send monthly quality report
- Insurance web site set ups for claim status, eligibility, prior authorizations
- Inventory & ordering of supplies
- Handle Employee time off request, schedules
- New employee training including system task set up
- Implement changes made by Upper Management to team
- Advance experience with several computer programs including all Microsoft Office programs.
Medical Biller/Refund Specialists
American Medical Response
Las Vegas, NV
01.1997 - 01.1999
- Medical billing
- Responsible for daily deposits & payment posting
- Duties included working monthly credit reports
- Responsible for Medicare & Medicaid eligibility
- Duties included auditing patient accounts
- Responsible for working monthly refund reports
- Auditing and filing appeals, follow up on sent appeals
- Advance experience with several computer programs including all Microsoft Office programs.
Manager Accounts Receivable
Cal-Penn/Western Hand Center
Thousand Oaks, CA
01.1986 - 01.1997
- Responsible for day to day operation to include:
- Surgical Center charges and coding
- Submission of claims
- Monthly financial reports
- Employee payroll
- Daily deposits for the surgical centers
- Investigate & Research claims issues, filing & following up on appeals
- Monthly audits
- Applying insurance & patient payments, denials
- Staff hiring & training
- Staff scheduling
- Advance experience with several computer programs including all Microsoft Office programs.
Education
Medical Terminology I/II Certification, Claim processing, Medical Billing -
Learning Tree University
01.1989
Business Management -Certificate -
Learning Tree University
01.1988
Diploma - General Studies
Oxnard High School
01.1983
Skills
- Membership Documentation
- Staff Training and Development
- Member Service and Support
- Relationships and Rapport
Timeline
Membership Rep II E&B, Individual Enrollment
Anthem
05.2018 - Current
Senior CSC Lead
Southwest Surgery Center / dba United Healthcare
05.2011 - 10.2017
Senior Accounts Receivable Clerk
SouthwestMedical
01.2006 - 01.2011
Office Coordinator Supervisor
Capital MD
01.2001 - 01.2007
Medical Biller/Refund Specialists
American Medical Response
01.1997 - 01.1999
Manager Accounts Receivable
Cal-Penn/Western Hand Center
01.1986 - 01.1997
Medical Terminology I/II Certification, Claim processing, Medical Billing -
Learning Tree University
Business Management -Certificate -
Learning Tree University
Diploma - General Studies
Oxnard High School
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