Wendy Sandoval
Lake Elsinore,CA
Summary
Proven track record in the skilled nursing and healthcare industry. Extensive expertise in billing and collections, proficient in utilizing Microsoft Word and Excel for efficient administrative tasks. Comprehensive understanding of medical terminology, Medicare, and Medicare Advantage for effective navigation of complex healthcare systems. Strong supervisory skills ensuring smooth operations and maintaining a high level of professionalism.
Overview
17
17
years of professional experience
Work History
AR Consultant
Rockport healthcare
07.2024 - Current
- Review and analyze account receivable, aging and weekly cash flow reports
- Coordinates and monitors plans with facility staff
- Supports facility with resolving specific billing questions, problems and or difficult claims
- Coordinates routine account receivable management calls and or aging reviews no less than monthly with each facility
- Visits facility routinely throughout the month
- Notifies facility staff of schedule, completes a facility site visit report and monitors the plan for improvement for identified non-compliance
- Validates key systems are in place that are critical to cash collections such as, but not limited to, TARS, managed care authorization tracking, weekly ACS billing, Triple Check, certs and re- certifications, follow up systems for tracking outstanding claims, etc
- Reviews monthly accounts receivable balance sheet account issues and works with the facility to fix issues and improve cash posting process
- Reviews and approves refunds
- Reviews and approves facility month-end close files to confirm facility is balanced prior to closing
- Seeks support from the ARD if having issues
- Communicates timely if a facility will be closing late
- Reviews submitted request to write-off delinquent accounts
- Reviews collection efforts and returns write-off if opportunities to collect have not been pursued
- Approves write-off and submits for additional approval or to accounting per policy
- Reviews the resident trust reconciliation monthly and completes a quarterly resident trust audit
- Coordinates improvement plan with the facility
- Provides the facility Business Office staff with support in responding to audit requests including but not limited to cost reports denial reports, resident trust, reconciliation of bad debt, etc
- Provides assistance to Administration on special projects to the extent resources/priorities permit
- Participates in the interviewing of Business Office personnel
- Provides evaluation information as requested
- Makes staffing recommendations for facilities as warranted
- Coordinates Business Office employees training with available resources
- Provide both initial and ongoing training in all pertinent areas with particular emphasis on billing, collection and accounts receivable management procedures
- Respond to revenue questions from accounting during close
- Provides training to Admissions as needed related to insurance verification and set up in PCC
- Fosters and maintains a strong positive working relationship with fellow employees, including accounting, operations, marketing, human resources, etc
- Participates in the Quality Management process
- Supports development and implementation of improvement plans
- Travel as needed
- Follows all OSHA and safety standards, as applicable to the position and in the business location or workplace in accordance with state and federal regulations and policies and procedures
- Maintains safe and clean work area and adheres to safety standards for the healthcare professional
- Adheres to facility policy and procedures
- Adheres to established HIPAA confidentiality standards
- Provides leadership and support regarding timely reporting of financial operations compliance program concerns
- Cash Analysis review every month with ARD
Regional Business office
Rockport healthcare
11.2022 - 06.2024
- Supports facilities in all aspects of business office management and collections as assigned
- Review and analyze accounts receivables and collections for all assigned facilities
- Executes and monitors plans with RFC and ARD
- Participates in routine account receivable management calls and or aging reviews as assigned
- Provides on-site facility support as assigned
- Notifies facility staff of schedule
- Validates key systems are in place that are critical to cash collections
- Communicates system break down to the RFC and ARD
- Reviews and approves facility month-end close files as assigned
- Participates in Business Office employees training with available resources, as assigned
- Fosters and maintains a strong positive working relationship with fellow employees, including accounting, operations, marketing, human resources, etc
- Participates in the Quality Management process
- Supports development and implementation of improvement plans
- Travel as needed
- Follows all OSHA and safety standards, as applicable to the position and in the business location or workplace in accordance with state and federal regulations and policies and procedures
- Maintains safe and clean work area and adheres to safety standards for the healthcare professional
- Adheres to facility policy and procedures
- Adheres to established HIPAA confidentiality standards
- Performs other tasks or duties as assigned
AR Consultant
Cambridge Healthcare
02.2022 - 10.2022
- Overseeing four buildings 2 in Los Angeles area and 2 northern area
- Working closely with Business office managers
- Conduct semi-annual reviews resident trust accounts and admission packages
- Triple check meetings, training in Medicare A and B and all other insurances
- Trains BOM and BOA the technical knowledge and skills needed to succeed
- Teaches all aspects of billing, claims, banking, accounting and EMR software
- Teaches eligibility for all payers’ types, such as Medicaid, Medicare, commercial
- Teaches authorization process for all payers
- Teaches billing process for all payers
- Teaches follow-up process for all payers, including claim correction and appeals
- Teaches collection process for private accounts, including small claims court, collection agencies and any referrals
- Works with facility to improve billing processes, such as Triple Check and PPS
- Helps recruit and interview candidates for BOM and AOM positions
- Makes recommendations that are seriously considered regarding the hiring, performance management, and termination of Business Office personnel
- Works with BOM on how to lead, supervise and develop their ABOM
- Performs exit report with the Administrator after each visit
- Visits each facility on a monthly basis
- Attends Triple Check and PPS at each facility at least once per quarter
- Attends A-Z aging review with BOM and Administrator once per quarter
- Reviews 120+ day aging w/each BOM once per month
- Completes month-end close with each facility on a monthly basis
- Be able to have a general understanding of PNLs
- Able to travel locally and out of area as needed to support and consult with facilities, including overnight travel
- Follows all HIPAA regulations
AR BILLER
Renew Healthcare
05.2021 - 01.2022
- Billing Medicare, Medicaid, HMO, and Hospice
- Billing Co-insurance
- Ensure all invoices are submitted accurately and timely per policy guidelines
- Post all cash receipts
- Review aging reports and research outstanding money due from all Payers
- Review Medicaid Pending Logs, research status on pending claims
- Monitor the daily/monthly BOM census reconciliations
AR SUPERVISOR
Meridian Management Services
06.2017 - 05.2021
- Knowledge in California, Arizona and Nevada State SNF Billing
- Billing Medicare, Medicaid, HMO, Hospice and Private
- Billing Co-insurance
- Ensure all invoices are submitted accurately and timely per policy guidelines
- Post all cash receipts
- Review aging reports and research outstanding money due from all Payers
- Review aging reports and research Private Payer credit balances
- Review Medicaid Pending Logs, research status on pending claims
- Monitor the daily/monthly BOM census reconciliations
- Monitor the daily/monthly BOM A/R deposit journals and related activity for compliance with company policy and procedure
- Schedule monthly A/R Private Payer aging reviews with all assigned facilities
- Month-end close
- Perform all other duties as assigned
AR Supervisor/ Consultant
LTC Quick Recovery
03.2015 - 05.2017
- Managing critical deadlines and keen attention to detail
- Knowledge of Medicare, Medicaid, private insurance, HMOs and hospice billing
- Knowledge of verifying payer sources and posting payments to various systems AHT, PCC and NTT
- The ability to work across departments to achieve positive outcomes for residents and families
- Processed Medicare, Medicaid, and all other third-party billing, send private pay invoices on the first of every month
- Post all cash receipts
- Balance monthly Accounts Receivable aging’s to General Ledger
- Reviewed and balanced month end closing
- Maintain an accurate aging report and make collections calls
- Submit corrected claims, identify and execute necessary adjustments
- Verify medical eligibility, Research and resolve account discrepancies
- Ensure all invoices are submitted accurately and timely per policy guidelines
- Conduct triple check meeting
- Create excel census and balance to daily census and system
- Send updated census to vendors every Friday
- Run CWF verify Medicare eligibility / create MDS calendar sheets
- Input all HMO levels/rugs in system
- Itemized statements for patients
Admissions/Facility Billing Specialist
Skilled Nursing Pharmacy
09.2007 - 03.2015
- Obtaining and updating census for numerous LTC and board and care facilities
- Updating patient’s statuses from census, Medicare, HMO, VA and inpatient hospice days
- Run a report to check what is being billed to facility or guarantor
- Check for medications that are included or excluded, calculate IV days and charging IV per Diem
- Knowledge in facility contracts
- Customer Service dealing with customers for questions or problems
- Third party billing/ Prior Authorization
- Admitting new and readmit patients
- Collections to facility and customer accounts
Education
High School Diploma -
Washington High School
Los Angeles, CAHealth Claims Examiner/ Medical Billing Diploma -
American Career College
Los Angeles, CA09.2005
Skills
- Problem-Solving
- Attention to Detail
- Team Leadership & Development
- Client Relationships
References
Available upon request
Timeline
AR Consultant
Rockport healthcare
07.2024 - Current
Regional Business office
Rockport healthcare
11.2022 - 06.2024
AR Consultant
Cambridge Healthcare
02.2022 - 10.2022
AR BILLER
Renew Healthcare
05.2021 - 01.2022
AR SUPERVISOR
Meridian Management Services
06.2017 - 05.2021
AR Supervisor/ Consultant
LTC Quick Recovery
03.2015 - 05.2017
Admissions/Facility Billing Specialist
Skilled Nursing Pharmacy
09.2007 - 03.2015
Health Claims Examiner/ Medical Billing Diploma -
American Career College
High School Diploma -
Washington High School
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