Venessa Flores
San Tan Valley
Summary
Detail-oriented professional with focus on deadlines and skilled in handling medical billing without errors. Confident Medical Biller knowledgeable in data confidentiality and privacy practices when reviewing patient information.
Overview
13
13
years of professional experience
Work History
Medical Billing Specialist
Clinica La Familia
Mesa
03.2016 - 04.2020
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Liaised between patients, insurance companies, and billing office.
- Identified and resolved patient billing and payment issues.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Located errors and promptly refiled rejected claims.
- Precisely evaluated and verified benefits and eligibility.
- Trained new staff on billing procedures and software usage.
Medicare Biller
Good Health Financial
Tempe
09.2014 - 03.2016
- Maintained up-to-date knowledge of Medicare policies and procedures.
- Resolved discrepancies on Medicare claims with insurance carriers.
- Processed appeals to insurance companies related to denied or underpaid Medicare claims.
- Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under policies.
- Investigated, corrected, and updated patient records as needed.
- Utilized billing software to manage accounts and track payments.
- Monitored status of unpaid claims and submitted follow-up requests as necessary.
- Managed account receivables by contacting insurance companies regarding outstanding payments.
- Responded promptly to inquiries from customers or vendors concerning payment issues.
- Adhered to HIPAA regulations when handling confidential information regarding patients' health care plans.
- Communicated with patients regarding questions about their bills or statements.
- Conducted research to determine correct coding for services rendered by providers.
- Monitored past due accounts and pursued collections on outstanding invoices.
- Resolved billing issues by collaborating with internal teams.
- Performed data entry of patient information into medical billing system.
- Participated in workshops, seminars, and training classes to gain stronger education in industry updates and federal regulations.
Medical Billing Specialist
Ventec Group, LLC
Mesa
10.2007 - 09.2014
- Ensured compliance with healthcare laws and regulations during billing processes.
- Adhered to HIPAA regulations when handling confidential patient information.
- Maintained up-to-date knowledge of CPT and ICD-10 coding principles, government regulations, protocols, and third-party billing requirements to ensure compliance.
- Verified the accuracy of claim data prior to submission to insurance carriers.
- Recorded financial transactions for billing processes.
- Processed and submitted claims to various insurance providers.
- Reviewed rejected claims, identified errors, and corrected them before resubmission for payment.
- Submitted appeals using provider portals and phone communication.
- Monitored aging accounts receivable balances to facilitate timely resolution of outstanding balances.
- Trained new staff on billing procedures and software usage.
- Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.
- Updated patient accounts with information obtained from internal departments or external sources.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
- Provided customer service support to patients who had questions about their bills or payments due.
- Participated in workshops, seminars, and training classes to gain stronger education in industry updates and federal regulations.
Education
Medical Billing & Coding Certificate -
Apollo College
Mesa, AZ07-2007
Skills
- Medical Billing
- CPT modifiers
- ICD 9-10 Coding
- Billing Codes
- Claims Review
- CMS-1500 Billing Forms
- Medical Claims Submission
- Adjustment Posting
- Payments Posting
- Benefits Verification
- Diagnostic Codes
- Medical terminology
- Reviewing Patient Information
- HIPAA Compliance
- Time Management
- Customer Service
- Physician Interaction
- Active Listening
- Data Entry
- Statement Billings
- Claim requirements
- Medical Records Security
- Coding knowledge
- Medisoft
- eClinicalWorks
- Epic
- Change Healthcare clearinghouse
Timeline
Medical Billing Specialist
Clinica La Familia
03.2016 - 04.2020
Medicare Biller
Good Health Financial
09.2014 - 03.2016
Medical Billing Specialist
Ventec Group, LLC
10.2007 - 09.2014
Medical Billing & Coding Certificate -
Apollo College