Minnie Silva
Youngtown
Summary
Dynamic Appeals Analyst with extensive experience at Southwest Service Administrators, excelling in claims processing and management. Proven track record in optimizing revenue cycles and resolving complex appeals. Skilled in ICD-10 coding and adept at multi-tasking, ensuring compliance and enhancing operational efficiency. Committed to delivering exceptional results in fast-paced environments.
Overview
21
21
years of professional experience
Work History
Appeals Analyst, Stoploss Analyst, TPL Reviewer
Southwest Service Administrators
Phoenix
09.2020 - Current
- Review, analyze, and process member and provider appeals at the 1st and 2nd levels, ensuring compliance with policy guidelines and plan provisions
- Resolve cases by applying plan limitations and preparing responses for Board of Trustees review
- Obtain prior authorizations as needed and coordinate medical necessity reviews
- Facilitate peer-to-peer reviews between healthcare providers for appeal resolution
- Manage stop-loss claims by tracking accumulation and ensuring timely filing and processing
- Analyze claims and financial data to support employer benefit clients in renewal processes
- Model and assess financial risk, ensuring compliance with established guidelines
- Conduct case file reviews to identify responsible third-party entities and recover costs
- Manage the recovery of cash and medical assistance (MA) claims from insurers, attorneys, and liable parties
Medical Biller
QCMB
Phoenix
10.2018 - 03.2020
- Reviewed aging reports, denials, and appeals across multiple specialty practices (Physical Therapy, Behavioral Health, ENT)
- Performed charge posting and insurance follow-ups for accurate reimbursements
- Assisted front desk operations, patient inquiries, and insurance verifications
Medical Biller
Family Practice Internal Medicine
Avondale
04.2017 - 01.2018
- Led denial management and appeals, including credentialing and incentive plan discussions
- Assisted patients with billing inquiries and coordinated insurance verification
- Managed aging reports to optimize revenue cycle performance
Medical Biller
ARS
Phoenix
07.2016 - 04.2017
- Processed high-dollar claims for Out-of-Network facilities, surgery centers, and anesthesia services
- Generated UB04 and HCFA claims and maintained thorough medical documentation
Ward Clerk
Rolling Plains Clinic
Texas
04.2004 - 03.2006
- Coordinated insurance authorizations, referral scheduling, and medical records management
- Supported providers with refill requests, multi-line phone handling, and interdepartmental communication
Education
Associate Degree - Graphic & Digital Imaging and Design
Texas State Technical College
Abilene, TX01.2008
Certificate - Medical Coding & Transcription
Texas State Technical College - West Texas
Abilene, TX01.2004
Skills
- ICD-10 and CPT coding
- Claims processing and management
- Charge posting and denials
- Prior authorizations and stop-loss claims
- Third-party liability review
- WebPT, Kareo, and Greenway Intergy
- AdvancedMD and EZClaim
- Therabill expertise
- Front desk operations and scheduling
- Insurance verification and credentialing
- Attention to detail
- Multi-tasking and adaptability
Timeline
Appeals Analyst, Stoploss Analyst, TPL Reviewer
Southwest Service Administrators
09.2020 - Current
Medical Biller
QCMB
10.2018 - 03.2020
Medical Biller
Family Practice Internal Medicine
04.2017 - 01.2018
Medical Biller
ARS
07.2016 - 04.2017
Ward Clerk
Rolling Plains Clinic
04.2004 - 03.2006
Associate Degree - Graphic & Digital Imaging and Design
Texas State Technical College
Certificate - Medical Coding & Transcription
Texas State Technical College - West Texas
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