Experience

Decipher by Veracyte

• United States
• Biotechnology Research
• 1 - 100 Employee

• Medical Reimbursement Specialist

  • Jul 2016 - Oct 2017

  Greater San Diego Area GenomeDx Bioscience Corporation, San Diego, CA July 2016-October 2017 Medical Reimbursement Specialist / Customer Service • Processed Medicare, Medi-Cal, Medicaid, and all BCBS accounts (HMO and PPO) of the United States (billing, rebilling, appeals, claim status follow up, post payments • Resolved customer issues in the very first call • Provided information on all aspects of Plan products, premiums, benefits, policies and procedures and relevant CPT… Show more GenomeDx Bioscience Corporation, San Diego, CA July 2016-October 2017 Medical Reimbursement Specialist / Customer Service • Processed Medicare, Medi-Cal, Medicaid, and all BCBS accounts (HMO and PPO) of the United States (billing, rebilling, appeals, claim status follow up, post payments • Resolved customer issues in the very first call • Provided information on all aspects of Plan products, premiums, benefits, policies and procedures and relevant CPT codes • Adjusted balances to payment, follow accounts to zero balance, zero EOBs, refunds, overpayments) • Work primary and secondary accounts to patient responsibility or zero balance • Knowledge of HMO, PPO, and government payers. Knowledge of CPT and ICD-9-/10 codes and modifiers • Experience with rejected claims, denials, appeals, and collection procedures required for managing AR. Verified eligibility when necessary to bill the right insurance company • Created, reviewed and analyzed reports which allowed identification of coding errors and payer trends. • Resolved errors by resubmitting corrected or unacknowledged claims, medical records, appeals and other documentation required for timely payments. • Worked independently and as a team member. • Contacted insurance companies and third-party payors regarding errors and discrepancies • Assisted with cash application and billing at months and year ends when needed. Show less



AltheaDx

• United States
• Biotechnology
• 1 - 100 Employee

• Medical Reimbursement Specialist

  • Feb 2015 - Jul 2016

  Greater San Diego Area Medical Reimbursement Specialist / Customer Service • Processed BCBS accounts of the United States (billing, rebilling, appeals, claim status follow up, post payments, adjusted balances to payment, follow accounts to zero balance, zero EOBs, refunds, overpayments) • Provide customers with relevant, accurate information on products and services • Worked primary and secondary accounts to patient responsibility or zero balance • Knowledge of HMO, PPO, and government payers.… Show more Medical Reimbursement Specialist / Customer Service • Processed BCBS accounts of the United States (billing, rebilling, appeals, claim status follow up, post payments, adjusted balances to payment, follow accounts to zero balance, zero EOBs, refunds, overpayments) • Provide customers with relevant, accurate information on products and services • Worked primary and secondary accounts to patient responsibility or zero balance • Knowledge of HMO, PPO, and government payers. Knowledge of CPT and ICD-9-/10 codes and modifiers • Adjudication of appeals for various coverage issues and medical necessity denials for high dollar claims. • Daily transmission of electronic claims and follow-up of rejected claims including Analyzed and reviewed accounts receivable aging to report to senior management • Worked on aged receivables and identified improper payments, inappropriate claim denials, billing errors and discrepancies on all returned claims through final resolution • Tailored unique collections processes according to departmental guidelines • Performed reimbursement functions with focus on collections. Responsible for resolving returned, disputed or rejected claims from payors. Show less



San Diego Arthritis Medical Clinic

• Medical Practices
• 1 - 100 Employee

• Billing Representative

  • Feb 2011 - Apr 2014

  Greater San Diego Area • Serviced Sharp Community Medical Group and Vantage Medical Group accounts receivable (billed, rebilled, appeals, claim status follow up, post payments, adjusted balances to payment, follow accounts to zero balances, zero EOBs, refunds/overpayments • Obtained insurance authorization for all insurance companies whenever needed. Knowledge of HMO, PPO, and government payers • Experience with rejected claims, denials, appeals, and collection procedures required for managing accounts… Show more • Serviced Sharp Community Medical Group and Vantage Medical Group accounts receivable (billed, rebilled, appeals, claim status follow up, post payments, adjusted balances to payment, follow accounts to zero balances, zero EOBs, refunds/overpayments • Obtained insurance authorization for all insurance companies whenever needed. Knowledge of HMO, PPO, and government payers • Experience with rejected claims, denials, appeals, and collection procedures required for managing accounts receivable • Interpreted medical records to insure coverage based on established medical policies Show less



Superior DME Billing

• Data Entry/Order Processing

  • Jun 2010 - Aug 2010

  Greater San Diego Area • Initiated orders by data entry of all DME claim form information to be processed. Verified eligibility on all insurances • Assigned codes according to severity of diagnoses, per ICD-9 codes and HCPC codes Preparation of claims to be electronically filed to Medicare and other insurances • File management



San Diego County Office of Education

• United States
• Education Administration Programs
• 700 & Above Employee

• Claims Examiner

  • Mar 2009 - Jun 2009

  Greater San Diego Area • Performed a variety of claims and customer service related duties pertaining to the administration of the self-funded indemnity fringe benefit plans • Ensured claim files are properly documented and claims coding is correct. • Preserved confidentiality of all claims files, claims reports and claims-related issues. • Resolved complex and severe exposure claims using high service-oriented file handling



Dexcom

• United States
• Medical Equipment Manufacturing
• 700 & Above Employee

• Medical Reimbursement

  • Dec 2007 - Apr 2008

  Greater San Diego Area Patient Service Coordinator • Served as primary voice in Reimbursement Department • Provided customer service to all customers/patients and regional/national representatives • Provided claim status updates and benefit investigation for customers nationwide



Zotec Partners

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

• Patient Service Coordinator

  • Apr 2006 - Oct 2007

  Greater San Diego Area Performed account maintenance for billing, reconciliation reporting for HMO and PPO. Also performed customer service related activities, database maintenance and research tasks to support the contracts administration, cash control operations and assignment of medical record numbers. Confirmed eligibility and obtains retro-authorizations. Set up payment plans for cash pay patients. Direct contact with patients regarding accounts. Responsible for handling all follow up aspects for all payor… Show more Performed account maintenance for billing, reconciliation reporting for HMO and PPO. Also performed customer service related activities, database maintenance and research tasks to support the contracts administration, cash control operations and assignment of medical record numbers. Confirmed eligibility and obtains retro-authorizations. Set up payment plans for cash pay patients. Direct contact with patients regarding accounts. Responsible for handling all follow up aspects for all payor types. Specialized in P.E.T./P.E.T./C.T. scans performed for the company's second largest account. Adjusted charges depending on contractual agreement. Updated patient accounts and redemand statements and HCFA forms to bill insurance companies with required criteria. Appealed denied claims with 80% success rate. Provided customer service issues involving patients, providers, and insurance companies. Resolved any and all issues to increase the reimbursement rate of charges billed. Reduced A/R 45% by working aged reports. Demand/redemand (billed and rebilled) claims when need be to all insurance companies Show less



Imaging Healthcare Specialists

• United States
• Hospitals and Health Care
• 100 - 200 Employee

• Medical Transcriptionist/P.E.T. Center Coordinator

  • Sep 1998 - Apr 2006

  Greater San Diego Area Medical Transcriptionist • Transcribed all radiology reports, including ultrasounds, plain x-rays, and reports for outside facilities on a daily basis for Physicians Radiology • Transcribed all MRI, MRA, Dentascan, Bone Density, and CT reports for seven different locations within San Diego and Riverside Counties for Open Air P.E.T. Center Coordinator • Managed daily operations in this office • Scheduled appointments, customer service, bank deposits, obtained medical records,… Show more Medical Transcriptionist • Transcribed all radiology reports, including ultrasounds, plain x-rays, and reports for outside facilities on a daily basis for Physicians Radiology • Transcribed all MRI, MRA, Dentascan, Bone Density, and CT reports for seven different locations within San Diego and Riverside Counties for Open Air P.E.T. Center Coordinator • Managed daily operations in this office • Scheduled appointments, customer service, bank deposits, obtained medical records, pre-certification and insurance authorization, and transcription of P.E.T. reports on a daily basis • Handled correspondence, ingoing and outgoing. Handled cash control operations for the office. Ordered FDG for patient examinations on a daily basis from radiopharmaceutical company. • Managed Excel spreadsheets for Marketing • Worked as liaison between various site managers assisting with clients, physicians, and departments within the company for the San Diego Regional P.E.T Center • Utilized Vital Works Sentinel (Version H6340), RIS Transcription, WordPerfect 9.0, Dictaphone Transnet/Job Lister, Microsoft Word, and Excel Show less



Stephen M. Krant, M.D., Inc.

• Medical Transcriptionist

  • May 1997 - Nov 2002

  La Jolla, California Responsible for transcription of all plastic surgical operative reports and correspondence.