Wendy Reyes
(Remote) Katy,TX
Summary
Billing Specialist with 7+ years of experience in revenue cycle and healthcare. Proven track record of accuracy and efficiency in processing invoices, handling customer inquiries, reconciling accounts and appealing denials in order to maximize collecting outstanding balances.
Overview
7
7
years of professional experience
Work History
Insurance Collector
Tanyr
07.2023 - Current
- Review accounts for billing accuracy in order to maximize reimbursement
- Initiate collection follow-up on all unpaid or denied claims with appropriate insurance carriers
- Research, appeal, and resolve unpaid insurance claims
- Respond to correspondence from insurance carriers
- Followed-up on claims status Appeal, and re-bill or forward claims for recalculation and/or adjudication as necessary
Support Service Representative II
Acclara
06.2019 - 06.2023
- Research payer eligibility via payer websites or call payers to gather needed information for billing
- Revise EOB's, Identify rejections for hospital and physician claims (missing demographic information, coding error, etc.), make appropriate corrections
- Work aged accounts on assigned payers prioritizing accounts that are approaching timely filing denial
- Fix errors and re-bill accordingly
- Review and send medical records as needed
- Communicate with providers and/or patients, resubmitting claims for approval and payment from the payers
- Review and responds to insurance/patient correspondence
Customer Service Representative III
Acclara
11.2017 - 06.2019
- Deliver a high-quality patient experience thought inbound and outbound customer service calls
- Ask appropriate questions and listen actively to identify specific concerns or issues while documenting all required information in computer systems
- Explain billing processes, insurance coverage, and payment options to patients in a clear and concise manner
- Address patient inquiries, resolving billing discrepancies, and answering questions regarding insurance benefits and claim status
- Assist with Payment Plan, No Statement, Special Handling, Expired, and Bankruptcy tickler queues designated for follow up, taking appropriate action
- Effectively navigate several computer applications during and after phone calls, document all actions taken in appropriate company and/or client systems
- Assist team lead when unavailable for the team with any escalations and task that need to be completed of High priority.
Member Services Representative Contractor
Community Health Choice
02.2017 - 10.2017
- Answer and call track incoming calls related to member eligibility
- Assist with explaining detailed information regarding CHC benefit plans
- Assisting member's with question and concerns over provider invoices such as claims, premium invoices, processing payments/setting up recurring payments, assigning primary care physicians, providing a listing of providers per member specialty request
- Offering excellent customer service
Education
Medical Assistant Certificate -
Pima Medical Institute
Houston, TX01.2014
High School Diploma -
Katy High School
Katy, TX01.2010
Skills
- Knowledge of EOB's, CPT and ICD- 9&10 codes
- Microsoft Office, Excel
- EPIC (7 years experience)
- CPR (1 year experience)
- HCN 360 (1 year experience)
- Revenue Cycle Specialist
- Billing experience with PPO, EPO, HMO, Medicare, Medicaid, Worker's Compensation
- Waystar/Availity/ Insurance provider portals
- Billing and Collection Procedures
- Account Reconciliation
- Insurance Verification
- Medical billing experience
- Claims Processing
- Electronic Claims
- HIPAA Compliance
- Spanish fluency
Timeline
Insurance Collector
Tanyr
07.2023 - Current
Support Service Representative II
Acclara
06.2019 - 06.2023
Customer Service Representative III
Acclara
11.2017 - 06.2019
Member Services Representative Contractor
Community Health Choice
02.2017 - 10.2017
Medical Assistant Certificate -
Pima Medical Institute
High School Diploma -
Katy High School
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