Yvette Hernandez-Gonzalez
San Diego,CA
Summary
Dynamic professional with extensive experience at American Specialty Health Inc., excelling in claims processing and reconciliation. Proven track record in resolving discrepancies and ensuring compliance, leveraging strong attention to detail and interpersonal skills. Proficient in health insurance systems and coding, driving efficiency and accuracy in billing operations.
Overview
15
15
years of professional experience
Work History
Senior Reconciliation Representative
American Specialty Health Inc.
San Diego, CA
01.2018 - Current
- Reconciles and resolves discrepancies in ASO claim payments, ensuring accurate processing and timely reimbursement.
- Conduct systematic reconciliation of ASO claims payments from health plan payors to maintain financial accuracy.
- Contact health plans to verify payment status, investigate underpayments, and escalate issues as needed.
- Communicates with healthcare providers to provide payment updates and address concerns professionally.
- Documents all follow-up actions in the reconciliation system or communication log to ensure compliance and transparency.
Accounts Receivable Specialist
American Specialty Health Inc.
San Diego, CA
01.2017 - 01.2018
- Monitored accounts receivable and unapplied payments, reconciled patient and insurance payments.
- Reviewed customer account reconciliations, analyzing variances to ensure accurate billing and collections.
- Verifies cash receipt records to confirm alignment with daily deposit totals.
- Collaborated with account managers to resolve discrepancies between billed revenue and received payments.
- Researched and reconciled payment variances from insurance providers to ensure accurate claim processing.
- Supported revenue input and cash receipt processing to maintain efficient billing operations.
Compliance Analyst
American Specialty Health Inc.
San Diego, CA
01.2012 - 01.2017
- Reviewed and verified the accuracy of claim denials before processing patient and provider notifications.
- Processed claims pending denial resolution, ensuring compliance with audit and regulatory requirements.
- Collaborated with team members to support billing operations, claim adjustments, and special contract processing.
- Assisted in training new employees on billing procedures, claim reconciliation, and compliance protocols.
- Identified and escalated complex billing discrepancies or claim issues to the supervisor for timely resolution.
Claims Examiner
American Specialty Health Inc.
San Diego, CA
01.2011 - 01.2012
- Reviewed incoming medical claims to verify accuracy, completeness, and required documentation.
- Entered claim data into billing systems, ensuring timely and accurate processing.
- Maintained strict confidentiality of patient records, claims files, and financial data in compliance with HIPAA regulations.
- Processed claims following company policies, industry standards, and regulatory guidelines.
- Identified and resolved billing discrepancies to minimize denials and ensure proper reimbursement.
Skills
- Interpersonal skills
- Attention to detail
- Self-sufficient
- Organizational skills
- Reliability
- Time management
- Microsoft Office suite
- Health insurance systems
- CPT and DX coding
- HMO and PPO plans
- Medicare and Medicaid knowledge
- Explanation of benefits (EOBs)
Timeline
Senior Reconciliation Representative
American Specialty Health Inc.
01.2018 - Current
Accounts Receivable Specialist
American Specialty Health Inc.
01.2017 - 01.2018
Compliance Analyst
American Specialty Health Inc.
01.2012 - 01.2017
Claims Examiner
American Specialty Health Inc.
01.2011 - 01.2012
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