Experience

Virtual Business Office Associates
• United States
• Human Resources Services
• 100 - 200 Employee
• Team Lead

  • Jan 2023 - Present


Wipro

• India
• IT Services and IT Consulting
• 700 & Above Employee

• RCM Assistant Manager

  • Oct 2021 - Nov 2022

  Responsible for various projects geared towards increasing cash flow, managing growth, improving efficiency/quality, and optimizing workflows Be an integral part of the management team of the Billing Office managing the leaders of Revenue Cycle in functional areas Develop project plans, gather/analyze data, and make recommendations to leadership Work closely with practice managers/administrators, account managers, revenue cycle staff, vendors, managed care, credentialing, and medical center IT teams Monitor reports and work queues Train staff and clearly explain proper work procedures and methods and office policy Directly supervise billing employees, establish priorities, assign work, and follow up to ensure assignments are complete Resolve employee issues and address procedure and performance related issues Meet or exceed internal standards for accuracy and timeliness in charge documentation Compile statistical data as requested and reports data monthly to appropriate parties Review outstanding accounts receivable to maintain minimal level of open accounts Determine and establish the explanation to complex claims, issues, and questions not covered by specific instructions or common practice Identify denial trends and train staff accordingly to avoid in the future Ensure timely and accurate collection, preparation, and verification of billing information submitted to the outsourced billing service Review billing collection and denial reports from the vendor and identify trends Take initiative to teach and share new information and provide constructive feedback; Communicate delays and work queue issues to management daily Review practice Action Plans and/or reports on a timely basis Analyze issues to identify trends in denial rates to focus improvement initiatives Ensure staff meet CBO quality and productivity targets Review unbilled charge reports and follow up Interact with vendors as it relates to billing and collections Show less



Senior PsychCare

• Mental Health Care
• 1 - 100 Employee

• Medical Collections Specialist

  • Apr 2018 - Oct 2021

  responsible for maintaining industry standards for the A/R they are assigned to for all carriers in regard to aging, collection rates, appeals, rejections and claims with no activity, follow up on all outstanding insurance claims work the aging reports as directed by the A/R Manager Responsible for lowering A/R over 90 days to acceptable standards also responsible for timely follow-up with internal and external customers as well as third-party payers Supports and adheres to all policies and procedures Monitor payer rejects and denials to determine systemic or data entry issues and report irregularities to management Daily follow up on all outstanding assigned insurance claims Daily follow up on all claim reports generated based on rejections, appeals and denials by the insurance carriers Post contractual adjustments and transfer deductibles to patient accounts based of correspondence from the insurance carriers Assist with claim resubmission projects when necessary Work with supervisors to streamline billing procedures based on denial types Research and resolve unpaid claims Correcting errors on daily basis Review accounts that have partial or under payments Prepare spreadsheets on unpaid or partial pay claims for resubmission to payers Handle correspondence from insurance companies including denials, information requests or refund requests Handle incoming calls from patients and insurance companies regarding claims and patient balances Review accounts to determine if billed correctly Performs other related duties as assigned or described in Company policy Show less



EAST HOUSTON PHYSICIANS GROUP, PA

• United States
• Medical Practices
• 1 - 100 Employee

• Collector

  • Nov 2016 - Jul 2017

  Enter daily charges into billing system, based on requisitions for all wellness visits for Medicare and Lumeris exams for Texas Health springs, home health care with in Health fusion •Serves as the point of contract with all health plans to renew physician’s contracts, re credentialing of physicians. Established communication with all health plan provider representative to track trends and improve overall revenue •Communicating with patients to ensure timely resolution of balances, Resolve issues, set payment expectations, arrange payments and request information from patients. Complaints for billing issues (via phone, or in office interactions) •Reviewed A/R daily for trends reviewed all denials, Post and adjust payments and balances. Post Explanation of Benefits (EOB) •Submit claim balances to secondary insurance providers •Process insurance rejections and follow up on all appeals as well as ensuring entire insurance process is completed while assisting in the collections of monies due. Show less



PULMONARY RX

• United States
• Medical Equipment Manufacturing
• 1 - 100 Employee

• Bilingual Billing & Collections Specialist

  • Oct 2015 - Oct 2016

  Specialty Billing in NIOV (NON Invasive Open Ventilation)/ Diagnostic Sleep Medicine/ DME • Two million outstanding A/R collected 35% of productions • Billed claims for specialized Medicaid HMO program through United Healthcare for NIOV program per the provision of the contact set forth • Billed and collected in excess of 55 accounts per day • Posted A/R of excess of 250 accounts per day • Managed Billing of Diagnostic Sleep Lab: MPSG, Titration, MSLT, MSWT, and unattended home sleep studies, EEG Spike Monitoring • Update the most current Medicare and Medicaid billing policies, conducts insurance verification, appeals, and denials, out of network benefits • Billed for pap therapy/Nebulizer/NIOV/Oxygen • Brightree: Billing, invoicing, and adjustments • Trains other associates as needed within Brightree Show less



AeroCare Holdings, Inc.

• United States
• Medical Equipment Manufacturing
• 200 - 300 Employee

• Intake Coordinator

  • Oct 2013 - Oct 2014

  • Participates in obtaining and verifying insurance information, authorizations and physician's referrals• Serves as first line of contact for referral client care calls from physician's offices • Maintains referrals and receives and tracks information regarding changes in client status • Coordinates and schedules both equipment set-ups and follow-up appointments • Performs data entry, answers telephone and directs calls to the appropriate staff and performsclerical duties • Verified patient eligibility for replenishment supplies for CPAP/BIPAP/ST/VENT supply OXYGEN/POC,NEBULIZER/MEDS, TRACH/SUTION, BEND METAL, and ORAL NUTRITIONAL • Audits all components for billing, medical necessity and clean claims submissions • Assist with in office set ups of POC/ NEBULIZER'S/ BEND MENTAL • ON CALL representative assisting patients with any and all questions, troubleshooting equipment • Held sales report meetings monthly Show less

• Intake Coordinator

  • Oct 2013 - Oct 2014

  • Participates in obtaining and verifying insurance information, authorizations and physician's referrals• Serves as first line of contact for referral client care calls from physician's offices • Maintains referrals and receives and tracks information regarding changes in client status • Coordinates and schedules both equipment set-ups and follow-up appointments • Performs data entry, answers telephone and directs calls to the appropriate staff and performsclerical duties • Verified patient eligibility for replenishment supplies for CPAP/BIPAP/ST/VENT supply OXYGEN/POC,NEBULIZER/MEDS, TRACH/SUTION, BEND METAL, and ORAL NUTRITIONAL • Audits all components for billing, medical necessity and clean claims submissions • Assist with in office set ups of POC/ NEBULIZER'S/ BEND MENTAL • ON CALL representative assisting patients with any and all questions, troubleshooting equipment • Held sales report meetings monthly Show less