Experience

Texas Pain Physicians

• United States
• Medical Practices
• 1 - 100 Employee

• Appeals Team Lead

  • Jun 2019 - Present

  • Monitors a billing team of 30+ appeals coordinators and billing representatives, reporting to Billing supervisor with monthly productivity and quality assurance reports • Identifies trends and patterns in denied claims and develops strategies and initiatives to prevent denials • Compiles medical records such as clinical reports, progress notes, operative reports, and lab reports to support appeals for denied claims • Performs accounts receivable duties including but not limited to invoicing, collections, and reconciliations for 25+ health facilities and 5000+ patients • Develops and delivers training programs for appeals coordinators and billing representatives Show less



AmeriPath

• Hospitals and Health Care
• 400 - 500 Employee

• Billing Coordinator

  • Nov 2018 - Jun 2019

  • Ensured continued claim accuracy by analyzing provider charges, dates of service, CPT / ICD-10 codes, level of care, places of service, patient identification, and provider signatures • Performed follow-up on denied or rejected claims and submitted appeals or reconsideration requests if necessary • Maintained an accurate aging accounts receivable report • Initiated collections on accounts past due and posted patient payments • Provided customer service to patients by answering billing inquiries and concerns • Maintained current working knowledge of all commercial, Medicare, and Medicaid billing requirements Show less



Aetna, a CVS Health Company

• United States
• Wellness and Fitness Services
• 700 & Above Employee

• Claims Specialist

  • Feb 2017 - Nov 2018

  • Processed 300+ medical and hospital claims per day to determine, review, or apply medical necessity, coverage benefits, and cost containment measures for adjudication • Conducted investigations to gather information to verify claim eligibility • Set a company record by exceeding production and quality standards within first three months of employment • Worked closely with department heads to review/enhance workflow processes • Processed 300+ medical and hospital claims per day to determine, review, or apply medical necessity, coverage benefits, and cost containment measures for adjudication • Conducted investigations to gather information to verify claim eligibility • Set a company record by exceeding production and quality standards within first three months of employment • Worked closely with department heads to review/enhance workflow processes