Experience

Oncure Medical Corp

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Appeals Coordinator

  • Dec 2012 - Present

  Implemented process for identifying under paid claims using Medical Present Value and other available tools. Answer and review pertinent insurance correspondence to insure completed and accurate reimbursement for medical claims. Appealed underpaid claims for government and third party payers for the states of California, Florida and Indiana. Report to Revenue Cycle Director impacting revenue related issues and provided resolution. Responsible for claims process of difficult claims. Assist in training new staff handle difficult claims. Support staff with any question and issues that may arise. Review requested refunds made out to insurance companies and patients. Training coordinator. Encouraged team approach which increased productivity and department morale. Show less

• Collections Specialist

  • Dec 2008 - Present

  Accounts receivable follow up on accounts in collection module including appeals, follow up phone calls to insurance companies and patients. Ran, daily, weekly and monthly reports, decreased DSO. Reviewed claim tracker for rejected claims at the payer level thru Emdeon, balanced unbalanced MSP claims. Experience with split billing professional and technical for Skill nursing facility and Hospice patients. Request and review refund overpayments to insurance companies and when applicable effectively dispute requests. Transfer money from one account to another when insurance has paid for another patients account thru a recoupment. Train new employees on Charge posting, payment posting, and collections on Intergy Billing Software. Relied on heavily to provide suggestions and solutions to ensure that collectors met their daily productivity goal. Translated documents for compliance department for our Spanish Speaking patients. Show less



Arbormed

• Collection Specialist Lead for Internal Medicine, OB-GYN, Radiology team

  • Jan 2005 - Nov 2008

  Responsibilities included training employees, on Medical Manager Software.Account receivable follow up, wrote appeals, knowledge of Medi-Cal, Medicare and commercial insurances. Review of EOB's for accuracy of payments as well as insurance correspondence.Provide excellent customer service to both inter and external customers. Assisted the department in all areas on an as needed basis.

• collector

  • 2001 - 2006



South Coast Family Medicine

• Santa Ana, CA.

• Medical Office Manager

  • Jan 2004 - Dec 2004

  Promoted new Family Practice at health fairs, met with insurance company representatives for office inspection of new practice. Made office emergency plan, medication log. Responsibilities included appointment scheduling, patient billing, third party billing to private insurances, HMO’s, Medicare, and Medi-Cal. Training of all new employees. Actively involved in setting up contracted payer in-services and staff training. Registration of new patients, verification of insurance eligibility and benefits and obtaining authorization for specialist. Show less



Women's Health Clinic Sachiiko Terajima MD

• Irvine & Torrance, CA.

• Medical Office Manager

  • Jan 1997 - Jan 2004

  Responsibilities included keeping doctors credentials up to date, trained new employees and managed four employees workflow of scheduling, check-in, and check-out processes to ensure timely and accurate completion of tasks. Met with Laboratory representatives to negotiate the best fee schedules for our self-pay patients. Appointment scheduling, insurance verification for benefits and eligibility. Met with patients to explain cost of treatment or delivery, insurance coverage, and patient financial responsibility. Responsible for monitoring and collecting the financial balances owed by our patients during their course of treatment. Assisted patients with questions regarding billing and insurance payments. Obtained authorizations for surgery, Scheduled patient’s Deliveries and Surgical procedures at Irvine Medical Center and Torrance Memorial, filed medical records, purchased supplies and equipment for Doctor’s office. Prepared daily bank deposits and Payroll for 3 employees. Assisted the Doctor in office procedures. Ensured that all accounts were correctly coded and followed up on in a timely manner, and in compliance with state regulations prior to claim submission using Advantage Medical Software. Review patient’s statements before mailing statements to patients. Drive doctor to scheduled personal appointments and airport. Show less