Destiny Santa Cruz
Fontana
Summary
Accomplished Medical Billing Specialist with over four years of experience in insurance billing and claims management. Demonstrated success in resolving billing discrepancies and enhancing collections processes. Committed to delivering accurate and timely billing solutions that exceed client expectations.
Overview
9
9
years of professional experience
Work History
Medical Billing Specialist
Concentra Medical Center
Rancho Cucamonga, CA
04.2023 - Current
- Managed case files for injured employees, ensuring compliance with regulatory requirements and internal policies.
- Processed daily occupational medicine and employer service original billing. This includes EDI, paper, spreadsheet, and client invoicing, as well as any approved exception billing requests for customers.
- Monitor trading partner portals for missing attachments, rejections or denied claims to identify root causes, fix and bill both timely and accurately
- Processed routine rebill cycles for central business office
- Provided solutions to resolve billing questions for clients and respond to client communication promptly and efficiently
- Issue customer/payer invoices and send to clients/partners through various channels (mail, email, etc.). Manage the status of client accounts and identify inconsistencies
- Provided support in training new employees and assisting peers
- Facilitated communication between healthcare providers and insurance carriers to expedite claims processing.
- Analyzed claim data to identify trends and recommend process improvements for efficiency gains.
- Developed training materials on workers compensation policies and procedures.
- Reviewed and verified medical documentation to ensure accuracy in claims adjudication.
- Implemented software solutions to enhance tracking of workers compensation cases and reporting metrics.
- Examined claims forms and other records to determine insurance coverage.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Followed up on potentially fraudulent claims initiated by claims representatives.
Medical Billing Specialist
Arrowhead Regional Medical Center
Colton, CA
09.2022 - 04.2023
- Processed medical claims utilizing advanced billing software to ensure timely reimbursements.
- Reviewed patient accounts for accuracy, resolving discrepancies efficiently to maintain compliance.
- Collaborated with healthcare providers to verify patient information and eligibility for services.
- Implemented streamlined billing procedures, resulting in improved claim approval rates.
- Coordinated with other departments to address any discrepancies or concerns related to charge capture or data entry accuracy.
- Prepared billing correspondence and maintained database to organize billing information.
- Generated monthly billing and posting reports for management review.
Medical Billing Specialist and Front Desk
Team Nurses Home Health
San Bernardino, CA
02.2020 - 08.2022
- Prepare and submit accurate medical billing claims to insurance companies and government payers
- Communicate with healthcare providers to clarify any discrepancies in documentation.
- Collaborate with front desk staff to review and verify patients insurance information
- Apply appropriate medical coding systems, including ICD-10 to ensure accurate billing
- Monitor and follow up on unpaid claims, including managing the medical collections process
- Manage accounts receivable, including medical collections and payment posting.
- Maintain thorough and organized records of billing activities and communications
- Utilize medical billing software systems effectively to streamline processes.
- Stay informed on updates in medical billing regulations and coding standards
- Assist in internal and external audits related to billing and reimbursement
- Answer phones, schedule appointments, and collect payments
- Manage patient and doctor requests efficiently
- Schedule new and follow-up appointments for existing patients
- Help maintain patient flow and keep the office on schedule
- Performed filing and maintain organized records
- Maintain a clean, sanitized, and tidy lobby and treatment areas
- Follow instructions and work collaboratively as part of a team
Cashier
Hometown Buffett
Rialto, CA
06.2017 - 10.2018
- Processed customer transactions accurately and efficiently using point-of-sale systems.
- Provided exceptional customer service, addressing inquiries and resolving issues promptly.
- Maintained clean and organized checkout area to enhance customer experience.
- Assisted in training new cashiers on operational procedures and company policies.
Education
Medical Billing And Coding Certificate -
Pomona Adult School
Pomona, CA04-2019
High School Diploma -
Jurupa Hills High School
Fontana, CA05-2016
Skills
- HIPAA compliance
- Payment posting
- Claim submission
- Insurance verification
- Collections management
- Data entry
- Insurance billing
- Medical billing
- ICD-10
- Insurance claims
- Critical thinking
Languages
English
Spanish
Native or Bilingual
Timeline
Medical Billing Specialist
Concentra Medical Center
04.2023 - Current
Medical Billing Specialist
Arrowhead Regional Medical Center
09.2022 - 04.2023
Medical Billing Specialist and Front Desk
Team Nurses Home Health
02.2020 - 08.2022
Cashier
Hometown Buffett
06.2017 - 10.2018
Medical Billing And Coding Certificate -
Pomona Adult School
High School Diploma -
Jurupa Hills High School