Alisha Vasquez
Riverside
Summary
I'm a self-motivated individual with 10+ years of medical administrator work experience. Yields an excellent work ethic with a wide range of experiences in different professional areas. Enjoys working on a team and independently to achieve a positive end goal. I thrive on challenges where I can utilize my motivation, experience and desire to benefit the company.
Overview
11
11
years of professional experience
Work History
Collection Specialist
Pediatrix Medical Group
09.2022 - 07.2023
- Review and prioritize the weekly Hospital Collection Excel report, color-coding items based on urgency, with a focus on accounts overdue by 30+ days.
- Send collection reminders using pre-made email templates to the Hospital AR department, tracking responses and updating the report accordingly.
- Escalate unresolved collections to Medical Directors and collaborate with Billing Specialists to clear credits from Hospital accounts as needed.
- Meet regularly with Regional Directors (monthly/quarterly) to discuss collection progress, address issues, and review new contracts or procedures.
Provider Enrollment Specialist
Pediatrix Medical Group
11.2017 - 09.2022
- Request and complete necessary forms for submission to health plan entities, ensuring all documentation is accurate and timely.
- Communicate with health plans to understand enrollment, credentialing, and re-credentialing processes, and maintain estimated effective dates for providers.
- Prepare check requests for application fees and document all tasks, communications, and updates in the enrollment database, including the CAQH system.
- Monitor and update provider licenses, stay informed on enrollment changes across managed care, government, and out-of-state health plans, and handle enrollments for providers in California, Washington, Oregon, Arizona, and Nevada.
Collector II
Pediatrix Medical Group
05.2016 - 11.2017
- Review and audit claims to ensure accurate processing and timely payment, addressing any underpayments or non-payments.
- Respond to patient inquiries regarding claim status in a clear, concise, and professional manner, ensuring a high level of customer service.
- Monitor the aging of claims to ensure timely follow-up and payment, collaborating with internal and external customers for efficient service.
- Maintain knowledge of CPT and ICD-10 codes, stay updated on healthcare laws and regulations, and document all actions taken on accounts in NextGen/GPMS.
Collections Specialist
Advanced Dermatology
05.2015 - 05.2016
- Manage the full collection process for all patient accounts, reviewing for overpayments and issuing necessary refunds.
- Monitor accounts receivable activity, meet with Physician Directors to review account status, and ensure timely follow-up actions.
- Address patient billing complaints in a consistent, timely manner, and coordinate all patient and insurance refunds.
- Oversee the collections process, including phone calls to accounts 60+ days past due, processing patient statements, reconciling cash transactions, and supervising billing and accounts receivable operations.
Medical Billing Specialist
Team Makena
03.2014 - 03.2015
- Possess knowledge of Worker’s Compensation, Medicare, and Third-Party billing processes, ensuring accurate submissions.
- Review patient accounts on RTB (Ready to Bill) lists to verify correct information and ensure all necessary documentation is included for insurance claims.
- Work with recall reports from Sales Representatives to attach documentation and ensure timely billing of services.
- Communicate with patients to obtain discharge dates for rental units and ensure HCPC codes match prescriptions to prevent denials, while staying updated on new product and documentation requirements.
Collections Specialist
CareNet Medical INC
12.2012 - 03.2014
- Manage a database of over 5,000 patients, ensuring clean claims are uploaded electronically to Medicare, Medi-Cal, Worker’s Comp, Commercial payers, and private insurance.
- Perform Aged Trial Balance (ATB) reports to follow up on claims, submit claims through PACWARE (Brightree) and FASTRACK (Mediware), and handle re-bills, 277, and 999 reports for denied claims.
- Communicate with Medicare to stay informed on policy changes and LCD rules, ensuring compliance and meeting client needs for DME equipment.
- Conduct audits, eligibility checks, and same/similar reviews, submit delinquent accounts to collections, post payments, and manage denials by reopening or appealing claims for payment. Provide client advocacy and exceptional service.
Education
GED -
Chaffey Adult School
Ontario, CA06-2010
Skills
- Data entry proficiency
- Strong negotiation skills
- Debt recovery expertise
- Microsoft Office Suite
- Action Oriented
- Drives Results
- Excellent Customer Service
- Optimizes Work Processes
- Situational Adaptability
- Manages Complexity
- Collaborates
Timeline
Collection Specialist
Pediatrix Medical Group
09.2022 - 07.2023
Provider Enrollment Specialist
Pediatrix Medical Group
11.2017 - 09.2022
Collector II
Pediatrix Medical Group
05.2016 - 11.2017
Collections Specialist
Advanced Dermatology
05.2015 - 05.2016
Medical Billing Specialist
Team Makena
03.2014 - 03.2015
Collections Specialist
CareNet Medical INC
12.2012 - 03.2014
GED -
Chaffey Adult School
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