Yvette Flores
San Antonio,TX
Summary
Efficient Medical Billing Manager known for productivity and completing tasks with precision. Excel in managing billing processes, coding accuracy, and claims management, ensuring streamlined operations. Possess strong skills in strategic planning, team leadership, and healthcare compliance which contribute to achieving financial objectives. Adapt quickly to new technologies and regulations, utilizing problem-solving and communication skills to navigate challenges effectively. Thrive on maximizing productivity and efficiency in task completion. Demonstrated ability to train staff on best practices for medical coding, claims processing, and billing procedures.
Overview
21
21
years of professional experience
Work History
Medical Billing Manager
Seven Oaks Womens center
San Antonio, TX
04.2024 - Current
- Prepared monthly financial statements detailing revenue generated by practice locations.
- Helped customers to bring accounts into good standing by implementing payment plans.
- Developed improved standard operating procedures to increase billing accuracy and ca
- Completed month-end and year-end closings, kept records audit-ready and monitored timely recording of accounting transactions.
- Managed and reviewed medical billing staff to ensure accuracy of patient accounts.
- Conducted regular audits of billing activities to ensure compliance with company policies and regulatory standards.
- Resolved issues related to denied or rejected payments from insurance companies.
- Conducted audits on claims submitted by medical billing staff, ensuring compliance with all applicable laws and regulations.
- Established clear billing policies and procedures, ensuring consistent application across all client accounts.
- Coordinated interdepartmental efforts to improve integration between billing and customer service functions.
- Developed training programs for new hires and existing staff in order to improve performance and efficiency.
- Created reports outlining trends in revenue cycle management, such as denials and rejections.
- Monitored accounts receivable aging reports and worked proactively to reduce outstanding balances due from patients or insurers.
- Identified areas of improvement within the medical billing process, implemented changes accordingly.
- Resolved billing issues by applying knowledge and completing in-depth research.
- Oversaw the preparation of monthly billing reports and analysis to track billing efficiency and accuracy.
- Reviewed appeals processes and assisted in preparing appeal letters when necessary.
- Conducted insurance verification and pre-authorization, coded medical procedures and managed patient charts.
- Assisted with customer requests and answered questions to improve satisfaction.
- Worked with cross-functional teams to achieve goals.
- Provided support and guidance to colleagues to maintain a collaborative work environment.
- Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Worked effectively in team environments to make the workplace more productive.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Identified needs of customers promptly and efficiently.
- Contributed innovative ideas and solutions to enhance team performance and outcomes.
Business Analyst
WellMed Medical Group
San Antonio, TX
10.2022 - Current
- Analyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers in regards to Prior Authorization changes and updates
- Identifies and interprets trends and patterns in datasets and provides feedback to various lines of business as well as stakeholders
- Manage issue/defect requests and resolution for service requests and projects
- Communicate with the business to ensure enhancements are reflected in internal or external training materials
- Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems
- Develop, build, and maintain reports and dashboards that contain actionable metrics to monitor growth, engagement, outcomes
- Managed requirements traceability information and tracked requirements status throughout the project.
- Synthesized current business intelligence or trend data to support recommendations for action.
- Delivered timely support by tracking issues and communicating resolutions to end users.
- Gathered and organized data to analyze current industry trends.
- Performed daily, weekly, and monthly reviews and analyses of current processes using operational metrics and reports.
- Identified needs of customers promptly and efficiently.
- Maintained or updated business intelligence tools, databases or dashboards.
- Evaluated business processes for improvement opportunities through automation or streamlining.
- Created, analyzed, and validated detailed functional specifications.
A/R Collections SUPERVISOR
WellMed Medical Group
San Antonio, TX
12.2018 - 10.2022
- Design and generate reports for analysis, trending, and subdivision of work to communicate with internal stakeholders
- Lead, develop and coach staff to assist with resolving posting issues, manage aged and denied claims and all correspondence in each of the EMR dashboards daily
- Monitor production and redistribute daily, weekly, and monthly workflows
- Audit team members and provide coaching/mentoring and providing performance information/feedback to associates to identify areas for efficiency/process improvements
- Act as a subject matter expert for internal customer support when needed
- Develops, implements, and maintains the Practice's revenue cycle training materials
- Conducts training of SOPs, systems, metrics, government regulations, and etc
- Communicate with the billing team and key stakeholders on changes in reimbursement and expectation of changes in insurance guidelines
- Oversee utilization, claims, remittance processing, and collection practices
- Notified customers of delinquent accounts by mail and telephone to obtain payment.
- Managed a high volume of incoming calls from customers inquiring about their past due accounts.
- Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
- Implemented departmental policies and standards in conjunction with management to streamline internal processes.
- Reviewed reports on employee attendance, productivity and effectiveness to evaluate performance.
- Recruited, interviewed and selected employees to fill vacant roles.
Provider relations specialist
Community First Health Plans
San Antonio, TX
08.2016 - 12.2018
- Fostering and maintaining proactive positive relationships with providers by communication through telephone, face-to-face visits, letters, faxes or emails
- A Liaison and primary contact for providers and/or provider groups, and physicians
- Effectively identifying, directing, and/or researching provider operational issues for timely resolutions
- Face-to-face orientations for new provider/physicians or groups
- Obtained and reviewed Texas Standardized Credentialing applications with supporting documentation to forward over to the Credentialing Department
- Assist, Identify issues, and provided resolution for claims and authorization issues by obtaining all required information and collaborated with appropriate departments for a resolution
- Participated in negotiations with external vendors concerning the terms of service agreements.
- Developed and maintained relationships with providers to ensure quality of care for patients.
- Resolved conflicts between providers and payers through effective communication strategies.
- Coordinated provider outreach activities such as seminars, conferences, workshops.
Utilization MANAGEMENT Care Coordinator
WellMed Medical Group
San Antonio, TX
09.2015 - 08.2016
Consumer benefits specialist ii
Center for Healthcare Services
San Antonio, TX
04.2013 - 08.2015
clinic supervisor
Everyone’s ENT & Sinus Center
San Antonio, TX
04.2009 - 04.2013
Admitting clerk/insurance verification specialist
Christus Santa Rosa Ambulatory
San Antonio, TX
01.2004 - 02.2009
Education
High School diploma -
Challenge HS
San Antonio, TX01.2003
Skills
- Team leadership qualities
- Proficient with Microsoft Office
- Insurance Knowledge (Medicare, Medicaid, Commercial & Medicare Advantage)
- Medical Collections/ Billing
- Exceptional Written & Verbal Communication
- EDI Rejections/Claims Review
- Develop Training Process and SOP’s
- Learn new systems and processes quickly
- Certified Medical Coder (PMI)
- Notary
- Speak, Read and Write Spanish
- Payment posting
- ICD-10
- Analytical thinking capacity
- Revenue cycle management
- Continuous improvement mindset
- Patient confidentiality practices
- Time management techniques
- Accounts receivable management
- Denial management strategies
- Electronic health records experience
- HIPAA compliance
- Financial reporting
- Effective communication
- Healthcare reimbursement principles
- Staff training and development
- Conflict resolution strategies
- Medicare and medicaid regulations
Timeline
Medical Billing Manager
Seven Oaks Womens center
04.2024 - Current
Business Analyst
WellMed Medical Group
10.2022 - Current
A/R Collections SUPERVISOR
WellMed Medical Group
12.2018 - 10.2022
Provider relations specialist
Community First Health Plans
08.2016 - 12.2018
Utilization MANAGEMENT Care Coordinator
WellMed Medical Group
09.2015 - 08.2016
Consumer benefits specialist ii
Center for Healthcare Services
04.2013 - 08.2015
clinic supervisor
Everyone’s ENT & Sinus Center
04.2009 - 04.2013
Admitting clerk/insurance verification specialist
Christus Santa Rosa Ambulatory
01.2004 - 02.2009
High School diploma -
Challenge HS
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