WALESKA ROBLEDO

• Applied HIPAA privacy and security regulations while handling patient information.
• Addressed and responded to staff and client inquiries regarding CPT and diagnosis codes.
• Reviewed claims for coding accuracy.
• Contacted insurance providers to verify insurance information and obtain billing authorization.
• Reviewed account information to confirm patient and insurance information is accurate and complete.
• Oversaw medical coding, charge entry, claims, pharmacy communications and other day-to-day operations of billing department.
• Kept accounts current with facility-approved reporting and analysis strategies.
• Submitted and accurately processed insurance claims with related medical code verifications and assessments.
• Handled billing for full complement of practice providers.
• Used various health record indexes and storage retrieval systems to manage medical billing.

· Authorizations for four Doctors, prepared charts for over 100 patients a week in a timely manner

· Oversaw all the billing, made corrections with authorizations CPT and ICD-9 codes, handled claims and appeals for four office locations

· Efficiently managed a high volume of surgery billing as well as submitted CCS referrals if needed for all four doctors and two hospital locations

· Consistently reached hospital goals

· Matched fee tickets with authorization and eligibility paperwork, added proper HCPCS,

· CPT or ICD-9-CM codes

· Retro authorizations for proper reimbursement

· Submitted modifications and pending authorizations

· Status retro authorizations for hospital procedures

· Knowledge of global period and Modifiers use

· Obtained authorizations for hospital consultations

· Performed abstracting while sorting the correct CPT and ICD-9 codes

· Daily account updates with late charges and DNB, charge review for charge error/warning, claim editing (all user error), analyzed mistakes and fixed prior to billing

· Sent/received e-mails from clinics to resolve authorization and eligibility issues

· Handled patient financial advice for those with a large deductible or cash patients

· Eligibility advisor for new or established patients

· Decision maker towards retro authorizations for x-ray

· Systems used: Epic, Argus, Tempus, Keene, ADV WEB,Chart MAXX

· Processed daily claims w/1500 and UB04 forms, Differentials, every woman counts claims