Experience

Southern California Orthopedic Institute
• United States
• Medical Practices
• 1 - 100 Employee
• Workers Compensation Coordinator

  • Dec 2020 - Present


Surgery Partners, Inc

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Medical Billing Collector

  • Jul 2020 - Dec 2020

  Reviewing of insurance payments for accuracy and compliance with contract discounts, reviewing of denials or partially paid claims and working with the involved parties to resolve the discrepancy including obtaining retro authorizations and submission of claim reconsideration requests as well as management of assigned accounts ensuring outstanding/pending claims are paid in a timely manner and contact appropriate parties to collect payment. Communicate daily with facility contacts patients, insurance claim representatives and other parties to clarify billing issues and facilitate timely payment. Perform a variety of administrative duties including but not limited to answering phones, reviewing and processing correspondence and other duties as needed. Show less



PRO-Spectus

• United States
• Pharmaceutical Manufacturing
• 1 - 100 Employee

• Case Manager

  • Oct 2019 - May 2020

  Single point of contact for the prescribing physicians of a DME product and patients well as the manufacturer's field team. Research of payer trends and which includes individual patient benefit verification including coordination of payer authorizations and management of patient treatment plans. Evaluate denied claims and prior authorizations, identifying payer’s appeals process in order to appeal denial coordinate appeal with external customers within the payer’s timelines. Research state regulations, federal regulations, and clinical information including peer reviewed articles and miscellaneous journal publications in order to formulate appropriate arguments to challenge payer’s determination. Specialty Pharmacy /servicing DME provider coordination which includes researching in network medical benefits and assisting family with order placement. Provided patient support by determining other potential forms of assistance for the insured, uninsured and underinsured including referrals to co-pay assistance. Show less

• Payer Specialist

  • Aug 2019 - Oct 2019



Lash Group

• United States
• Pharmaceutical Manufacturing
• 700 & Above Employee

• Sr. Reimbursement Consultant

  • Apr 2006 - Nov 2018

  Worked closely with patients, providers, and pharmaceutical representatives in providing patient assistance, drug replacement, and reimbursement support to a diverse patient population challenged by chronic disease states. Investigation of patient's insurance benefits, identifying network providers, provider restrictions, co-pays, requirements for prior auth and medical review process in the pursuit for product coverage. Interpreted Medicare and Medicaid guidelines, conducted alternate coverage research, and facilitated referrals to alternative coverage options as well as financial assistance programs for patients who are under insured or require co-pay assistance. Evaluated denied claims and prior auths; identifying payer’s appeals process in order to appeal denial coordinate appeal with external customers within the payer’s timelines. Researched state regulations, federal regulations, and clinical information including peer reviewed articles and miscellaneous journal publications in order to formulate appropriate arguments to challenge payer’s determination. Identify and track payer trends including reports to appropriate internal and external customers Show less

• Reimbursement Counselor / Region Lead

  • Apr 2007 - Aug 2011

  Work closely with patients, providers, and pharmaceutical representatives in providing patient assistance, drug replacement, and reimbursement support to a diverse patient population challenged by chronic disease states. Investigation of patient's insurance benefits, identifying network providers, provider restrictions, co-pays, requirements for prior auth and medical review process in the pursuit for product coverage. Interpret Medicare and Medicaid guidelines, conduct alternate coverage research, and facilitate referrals to alternative coverage options as well as financial assistance programs for patients who are under insured or require co-pay assistance. Evaluate denied claims and prior auths; identifying payer’s appeals process in order to appeal denial coordinate appeal with external customers within the payer’s timelines. Research state regulations, federal regulations, and clinical information including peer reviewed articles and miscellaneous journal publications in order to formulate appropriate arguments to challenge payer’s determination. Identify and track payer trends including reports to appropriate internal and external customers Show less

• Program Support Specialist

  • Apr 2006 - Apr 2007

  Provided support to reimbursement counseling and patient assistance teams by coordinating drug distribution systems with manufacturers, mail order pharmacies, and other vendors for programs that cover a variety of disease states. As well as process patient and physician requests to expedite urgent shipments of medication to patients, prioritize daily incoming program correspondence and fax transmissions, scan the documents into a document imaging system, and assigns the electronic images to patient cases and program counselors, allowing counselors to access program documentation directly from their desktop. As well as front desk reception and other duties as needed. Show less



Peninsula Dermatology Medical Group

• United States
• Medical Practices
• 1 - 100 Employee

• Billing Specialist/ Medical Records

  • Jul 2008 - Jan 2009

  Billing Specialist: completing superbills with fees and diagnosis, posting of mail payments, daily charges and payments for assigned physician along with others as needed, checking insurance claims for accuracy as well as following up w/insurance carrier to confirm that status, balancing of journals and deposits. Entering demographics and insurance information for each new patient as well as updating established patient information into the billing system and answering billing office phone calls. Medical records: filing of patient charts, maintaining of current patient charts, creating new patient charts, matching, and filing superbills according to appointment lists along with other duties as needed. Show less



Bright House Networks

• United States
• Telecommunications
• 700 & Above Employee

• Customer Service Representative

  • May 2001 - Apr 2006

  Included but were not limited to: handling of customers in all situations. Answering billing questions and technical troubleshooting and problem solving related to the division s high speed data and cable video services via phone. Answering customer phone calls in a prompt and professional manner (average 75-100 calls per an eight-hour workday.) Scheduling appropriate work orders when a customer requests new services, a change in service, disconnection of service or maintenance. Performing cashier duties in main lobby which includes the handling of cash and face to face contact with customers. Show less