Vivian Herrera
Sunrise
Summary
Experienced with managing patient billing and account reconciliation. Utilizes analytical skills and detailed knowledge of billing processes to ensure accurate and timely resolution of discrepancies. Track record of enhancing patient satisfaction through effective communication and problem-solving.
Overview
16
16
years of professional experience
Work History
Patient Accounting Spec III
Orlando Health
07.2024 - Current
- Resolves inaccurate payments with insurance carriers that are not in compliance with payer contracts or governmental agency rates on individual accounts.
- Utilizes specialized knowledge of contracts, regulatory or contractual billing guidelines to determine an account's ability to pay after initial rejection from payer.
- Coordinates duplicate billings, coordination of benefits, medical records and clinical documents as needed to expedite payment of insurance claims.
- Analyzes underpayments and overpayments to identify root causes and examines claims to ensure payers are complying with contractual agreements.
- Collaborates with payer contracting and other areas of the revenue cycle if necessary, to resolve issues pertaining to a claim payment.
- Communicates directly with payers to follow up on outstanding claims and resolve payment variances, responds to payer inquiries and concerns, and works to develop and maintain positive relationships with payers.
- Helps to work and resolve accounts from other staff members' workloads to prevent backlogs and fills in as needed for absent staff.
- Processes appeal letters for denied/unpaid claims
- Responsible for account follow-up for all assigned accounts.
Account Manager
Integrated Dermatology Group
05.2022 - Current
- Liaison between Central Business office (CBO) and the practice/clearinghouse
- Meets with practices staff for front end training, billing/reimbursement needs
- Meets with practice leadership on a monthly basis to review month end reports
- Proactively identifies, troubleshoots and resolves front end revenue related and claims issues
- Maintains accounts receivables
- Audit delinquent accounts considered to be uncollectible to ensure maximum efforts have been taken before assigning bad-debt status to account
- Processes appeal letters for denied/unpaid claims
- Insurance follow-up on delinquent commercial/government accounts
- Prepare and submit paper/electronic claims to various insurance companies
- Work aged reports
- Assisted patients with billing/collections inquires
- Work credit balances and initiate refund request
- SME (Subject Matter Expert) and assist collectors with resolution of accounts
Collector
HCA Healthcare –Ambulatory Surgical Division
08.2018 - 07.2024
- Maintained accounts receivables
- Processed appeal letters for denied/unpaid claims
- Insurance follow-up on delinquent commercial/government accounts
- Prepare and submit paper/electronic claims to various insurance companies
- Evaluate patient financial status and establish budget payment plans
- Negotiate settlements for legal cases
- Medical billing/rebilling
- Assisted patients with billing/collections inquires
- Work credit balances and initiate refund request
- Liaison between insurance agencies and provider
- Assist in the interviewing and hiring process of future Insurance Collectors
- Train new collectors and continue the development of existing Collectors, and continuation of implementation of department policies/procedures
Reimbursement Specialist II
Envision Healthcare
07.2017 - 08.2018
- Maintained accounts receivables
- Processed appeal letters for denied/unpaid claims
- Insurance follow-up on delinquent commercial/government accounts
- Prepare and submit paper/electronic claims to various insurance companies
- Evaluate patient financial status and establish budget payment plans
- Work aged reports
- Medical billing/rebilling
- Assisted patients with billing/collections inquires
- Work credit balances and initiate refund request
Payment Poster/ Collector
Digestive Care
07.2014 - 05.2017
- Maintained accounts receivables by working the aging report
- Processed appeal letters for denied/unpaid claims
- Insurance follow-up on delinquent commercial/government accounts
- Review all overpayments, requesting refunds if applicable or updating fee schedule profiles if claim was reimbursed accurately by the payer
- Submit corrected claims with the appropriate documentation per payer guidelines
- Prepare and submit paper/electronic claims to various insurance companies
- Review and correct all rejected claims via clearinghouse transmission report
- Assisted patients with billing/collections inquires
- Post all patient monies that come in via credit card, checks, and/or cash
- Post both paper and electronic payments, adjustments, and rejections from commercial, auto, and government payers
- Reviewed all explanation of benefits confirming all claims paid according to the fee schedule/contract
- Reviewed all submitted refund request for accuracy and posted in the system
- Perform the weekly close, and reconciliation for the group
- Confirming totals with finance department
- Assisted in adding new insurances, referring providers, and fee schedules into the system
- Complete tasks accurately, maintaining quality and productivity standards
Accounts Receivable Representative II
Orlando Health
11.2012 - 07.2014
- Maintained accounts receivables
- Processed appeal letters for denied/unpaid claims
- Insurance follow-up on delinquent commercial/government accounts
- Prepare and submit paper/electronic claims to various insurance companies
- Evaluate patient financial status and establish budget payment plans
- Work aged reports
- Medical billing/rebilling
- Assisted patients with billing/collections inquires
- Work credit balances and initiate refund request
Medical Biller and Collector
Digestive Care
08.2011 - 11.2012
- Maintained accounts receivables
- Processed appeal letters for denied/unpaid claims
- Insurance follow-up on delinquent commercial/government accounts
- Prepare and submit paper/electronic claims to various insurance companies
- Evaluate patient financial status and establish budget payment plans
- Work aged reports
- Medical billing/rebilling
- Assisted patients with billing/collections inquires
- Prepared, reviewed, and sent patient statements
Office Coordinator
Tenet Florida Physician Services
08.2008 - 08.2011
- Greeted patients and pharmaceutical representatives and directed all people to the appropriate location and services
- Respected and maintained privacy and confidentiality of patients
- Register patients according to procedure
- Determined the financial status of patients and their eligibility with their insurance carrier
- Assisted patients with completing appropriate forms, and document all information
- Scheduled appointments for patients, and deposition for the physician
- Collected and posted co-payments and balances
- Billing and collections
- Accurately applied charges and payments to patient accounts
- Researched and resolved incorrect payments, EOB rejections, and other issues with outstanding accounts
- Reviewed billing edits and provided insurance with corrected information
- Provided follow-up to ensure proper payments were fully corrected
- Check medical record charts (in and out) through computer system
- Prepared and balanced daily financial reports and submit all forms and fees to the appropriate department
- Maintained reports of provider’s accreditation, membership or facility privileges
- Assisted in maintenance of file systems within the department
- Verify insurance and obtain authorization for pain management procedures
Education
Technical Degree - Coding
Florida Career College
Pembroke Pines, FL10-2008
High School Diploma -
Western High
Davie, FL05-2004
Skills
- HIPAA compliance
- Insurance verification
- Medical billing
- Claims resolution
- Customer service
- Problem-solving
- Multitasking
- Microsoft office
- Task prioritization
- Billing and invoicing
- Account reconciliation
Timeline
Patient Accounting Spec III
Orlando Health
07.2024 - Current
Account Manager
Integrated Dermatology Group
05.2022 - Current
Collector
HCA Healthcare –Ambulatory Surgical Division
08.2018 - 07.2024
Reimbursement Specialist II
Envision Healthcare
07.2017 - 08.2018
Payment Poster/ Collector
Digestive Care
07.2014 - 05.2017
Accounts Receivable Representative II
Orlando Health
11.2012 - 07.2014
Medical Biller and Collector
Digestive Care
08.2011 - 11.2012
Office Coordinator
Tenet Florida Physician Services
08.2008 - 08.2011
Technical Degree - Coding
Florida Career College
High School Diploma -
Western High
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