Monique Mejia
Tustin,CA
Summary
Medical billing professional with strong focus on accuracy and efficiency in processing healthcare claims. Demonstrates thorough understanding of insurance guidelines and billing procedures. A reliable team player who adapts to changing needs and is committed to achieving optimal results through collaboration and attention to detail.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Medical Biller
Providence
02.2022 - 06.2024
- Completed 75 claims per day
- Medical billing full revenue cycle for home health
- Audit claims prior to submission, follow up Medicare rejections in DDE and ability
- Follow up on denials and payment adjustments
- Verified accuracy of accounts payable payments, resulting in reduction in payment errors and check reissues.
- Submitted Appeals electronically
- Followed up on unpaid claims and underpaid claims
- Called Medicare to get status on batched denials to see if Medicare was having internal issues.
- Insurance verification and eligibility
Medical Biller /Collections Specialist
Radiology Partners
06.2019 - 11.2020
- Review claims before being submitted to insurance company to make sure claim is accurate prior to submitting to minimize denials
- Ensure patient information is accurate and complete
- Verify patient insurance coverage
- Research CPT and ICD codes in order to bill accurately
- Work insurance denials and appeals
- Identify denial trends and determine process changes to prevent future denials
- Follow up on all outstanding insurance claims
- Answer incoming patient account inquiry calls and as needed for all clients
- Process patient payments
- Contact insurance companies regarding denials and follow up, also utilizing insurance portals
- Work with other teams to address authorization, editing, coding and payment related issues
- Accurately document all research on individual patients accounts
Medical Biller/Collections Specialist
Clinical Practice Management
10.2017 - 06.2019
- Review claims for accuracy prior to submitting to insurance company
- Verify patients demographics are accurate
- Verify insurance coverage
- Confirm all CPT codes and ICD codes are valid and accurate
- Working Aging report
- Reviewing denials and getting a resolution, submitting appeals and reconsiderations
- Payment posting and customer service
Medical Biller/Full Revenue Cycle
Practice Management Plus
11.2016 - 10.2017
- Verify demographics and insurance for HMO, PPO, Medicare, Medicaid through CA.Gov / Medi Cal
- Worked with fee schedules such as Medicaid and Medicare
- Enter financial class, code accurately for submission of claims and entering charges
- Enter charges, CPT and ICD10
- Submit primary and secondary claims
- Follow up on zero nonpaid claims, insurance correspondence, internet research per online portals to follow up on EOB's
- Send statements to patients with unpaid balances
- Collections process, negotiates liens, Workers' Compensation cases and processed appeals
- Payment posting, amount allowed, amount expected, amount received, if under paid, sent appeal to insurance for review
Medical Billing Specialist
Ambry Genetics
05.2013 - 11.2016
- Audit claims prior to submission to insurance companies
- Verify CPT codes and ICD codes are being billed accurately
- Calling Insurance companies to follow up on unpaid claims, denials and appeals
- Processed 80 claim inquiry's daily
- Worked with Managed Care, Commercial Insurance, Medicare and Medicaid plans
- Utilized CPT Codes and ICD10 and ICD-9 Codes and HCPCs
- Required documentation which can include, LMN's, Clinical notes, Pedigree's
- Billed Genetic testing using Practice Ally
- Entering charges, submit claims and payment posting
- Appeals follow up unpaid claims, work ageing reports
- Collections process, negotiates liens, Workers' Compensation cases and processed appeals
Medical Collections Specialist
Hoag Hospital
03.2011 - 05.2013
- Follow up on unpaid claims
- Follow up on correspondence
- Check status on claims submitted over 30 days
- Submit Appeals
- Follow up on appeals
- Verify coverage
- Work closely with coding department with changes needed to rebill with updated CPT
- Add modifier if needed
- Resubmit corrected claims
- Call insurance companies and expedite claims to be send back for reprocessing
Medical Biller
Mission Viejo Regional Hospital
11.2010 - 03.2011
- Review claims before being submitted to insurance company to make sure claim is accurate prior to submitting to minimize denials
- Ensure patient information is accurate and complete
- Verify patient insurance coverage
- Research CPT and ICD codes in order to bill accurately
Specialty Registration Representative
CHOC Hospital
04.2008 - 11.2010
- Register X-Ray patients, verify HMO Insurance (Medical, Monarch, CCS, etc.)
- Obtained authorizations for services rendered at Choc in patients for 30 different specialty clinics
- Schedule any return appointments, check in lab patients
- Make sure insurance is verified and authorization is in place enter patient charges in system
- Assist all patients in signing forms, discharging patients in a timely manner
- Processed medical record request
Medical Administrative/Accounting/ Medical Records
South Coast Hematology Oncology
02.2006 - 04.2008
- Checked Patients in and out
- Appointment scheduling, insurance verification, billing and claims
- Obtained and processed authorization from primary care physicians
- Oversee Appeals and follow up with correspondence
- Follow up unpaid claims
- Actively follow up on all assigned accounts for collections
- Medical records processing and fulfilling request
- Payroll Accounting: Ensured accurate and timely processing of payroll updates including new hires, termination, and changes to pay rate, Attending to payroll inquiries from employees, and entered payroll information and maintaining payroll files
Education
Diploma -
Century High School
Skills
- Medical Billing
- Medical Collection
- ICD-10
- ICD-9
- Insurance Verification
- Authorizations
- Epic EMR
- EMR Systems
- Medical Receptionist
- Office Assistant
- Customer service
Certification
Medical Billing Certification
Assessments
Protecting patient privacy, Proficient, 11/21, Understanding privacy rules and regulations associated with patient records.
Accomplishments
- Documented and resolved Issues which led to results.
- Collaborated with team members in completed projects within deadlines.
Languages
Spanish
Timeline
Medical Biller
Providence
02.2022 - 06.2024
Medical Biller /Collections Specialist
Radiology Partners
06.2019 - 11.2020
Medical Biller/Collections Specialist
Clinical Practice Management
10.2017 - 06.2019
Medical Biller/Full Revenue Cycle
Practice Management Plus
11.2016 - 10.2017
Medical Billing Specialist
Ambry Genetics
05.2013 - 11.2016
Medical Collections Specialist
Hoag Hospital
03.2011 - 05.2013
Medical Biller
Mission Viejo Regional Hospital
11.2010 - 03.2011
Specialty Registration Representative
CHOC Hospital
04.2008 - 11.2010
Medical Administrative/Accounting/ Medical Records
South Coast Hematology Oncology
02.2006 - 04.2008
Medical Billing Certification
Diploma -
Century High School
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