Yesica Ruedas

• Rheumatology, Radiation Oncology, Hematology and Oncology coding and Billing.
• Review of chemotherapy flowsheet for coding and auditing purposes. Assigned diagnosis codes, modifiers to claims based on clinical findings.
• Conducted regular audits with Lab Consultant of billing records to ensure accuracy and completeness, enhancing overall financial performance for the practice.
• Provided excellent customer service, developing and maintaining client relationships.
• Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
• Provided in person Oncology billing training to Providers, staff and management.
• Monthly meetings alongside CEO, healthcare providers and management.
• Collaborated with healthcare providers & nurses, ensuring accurate documentation for seamless billing operations.
• Use CCI to check bundling issues, modifier appropriateness, and LCD/NCDs for medical necessity.
• Evaluated open accounts for past due balances and pursue collection strategies. Researched any chargebacks and write offs.
• Trained all new employees with payment posting, follow up with A/R, billing and coding.
• New client End to end Set up with billing software.
• Transition Healthcare provider to new billing software without cash flow interruption.
• Collaborated with setting up new providers with contracting.

• Managed end to end coding, billing, accounts receivable and payment process.
• Worked closely with Healthcare provider and Nurse to ensure all documentation was appropriately completed.
• Greeted, checked in, scheduled and responded to customer concerns and questions on daily basis.
• Verified insurance of patients to determine eligibility. Assisted patients in understanding insurance benefits, leading to a positive experience during their visit.
• Collected copay, deductibles and co insurances.
• Obtain authorization prior to chemotherapy treatment.
• Produced and mailed weekly statements to customers and assisted with related requests for information and clarification.
• Generated monthly billing and posting reports for management review.
• Liaised between patients, insurance companies, and billing office.
• Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.

Medical Billing & Coding Lead and Compliance Officer (2012-2014)

• Correctly coded and billed medical claims for various inpatient, outpatient & office facilities. Ex: Chiropractor, Radiation Oncology, Rheumatology and Hematology and Oncology.
• Report pending encounters to Healthcare providers and management on a weekly basis.
• Started and closed months. Weekly and month end reports to providers and Management.
• Yearly and Quarterly Fee schedule billing software updates
• Trained all new employees and mentored junior coders to support growth and development and apply high-quality coding practices. Addition, to payment posting, eligibility and authorizations.
• Educated staff on organizational mission and goals to help employees achieve success. Evaluated staff performance and provided coaching to address inefficiencies.
• Created job aid manuals for new employees.
• Attended training courses to build understanding of processes, techniques, and industry.
• Provided support with workflow issues and internal operational support.
• Helped meet changing demands by recommending improvements to business systems or procedures.
• Conducted various coding seminars in house and in Healthcare providers medical office.
• Verified signatures and checked medical charts for accuracy and completion. Followed up with medical staff/healthcare provider regarding missing information in patient records.
• Communicated effectively with staff, patients, and insurance companies by email and telephone.
• Monitored changes in coding regulations to provide recommendations for compliance.
• Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
• Generated reports to identify coding trends and discrepancies.
• Interacted with physicians and other healthcare staff to ask questions regarding patient services.
• Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability

Medical Biller & Coder July 2009-March 2012

• Medical Hematology & Oncology billing and Coding.
• Worked closely with Healthcare provider, lab, and nurse to ensure all codes billing and diagnosis were accurate.
• Trained new employees with administration,billing and coding responsibilities.

Medical Biller & Collector (March 2009- June 2009)

• Set up new client/healthcare provider (Rheumotology) in new billing system.
• Verified accuracy on superbills for diagnosis and CPT codes. Applied modifiers when needed.
• Worked closely with Healthcare provider staff ensure all billing was received.

Medical Billing Administrator (July 2008-February 2009)

• Processed all new patients by verifying patient benefits.
• Collected daily copays and patient balances.
• Responsible of getting all Authorizations for chemotherapy treatments..
• Initiate registration process for copay assistance programs.
• Sent out all electronic and paper secondary claims.
• Assisted in reconciling deposit and patient collections. Created and Deposit all manual checks to the bank. Payment posted all manual and EFT payments.
• Processed online and paper appeal/medical record submissions and refund requests.
• Optimized cash flow management by monitoring outstanding balances and initiating appropriate follow-up actions as needed.
• Cleared all claims from clearinghouse.
• Processed billing calls and answered questions from patients and third-party carriers.

• Honor Roll Recipient.
• 160 hours on the job training at Optimal Md Solutions, hired once internship was completed.