Jennifer P Poblete
San Diego
Summary
Bilingual Medical Biller and Coder, seeking to build my career with a company that can utilize my skills as a Certified Medical Billing and Coding Specialist through NHA, and other skills from customer oriented service experiences acquired from various businesses (dependable, responsible, and industrious with leadership qualifications).
Overview
35
35
years of professional experience
1
1
Certification
Work History
Medical Billing A/R specialist
MDRS Spine & Sport, INC
11.2021 - Current
- Medical Billing A/R specialist for Spine & Sport Physical Therapy.
- Uses RainTree as an EMR/EHR Software- Patient Demographics, insurance verification and Professional Claim Submission-CMS 1500. Gather Office Notes or Assessment notes for Office Visits/consultation, Diagnostic results, Authorizations, direct referrals, other medical records to assist with insurance correspondence and A/R for Insurance reconsideration for payment processing.
- Denial Management – Research and determine claim denials and take appropriate action for payment within federal, state, and payor guidelines.
- Trend Identification – Identify consistent payor or system trends that result in underpayments, denials, errors, etc.
- Appeals – Determine when an appeal, reopening, redetermination, etc. should be requested and the requirement of each insurance carrier. Take appropriate action to resolve the claim.
- Access insurance web portals for Claims status, EOB( explanation of benefits), RA( Remittance Advice) in capturing missed payments from payment posters. Also to verify coordination of benefits, if the health plan has an IPA or other insurance coverage
- Claim Status – Use available resources such as payor portals and clearinghouses to review unresolved accounts. Resubmits CMS1500 e-file charges/ hard claims for corrected claims per denial reason: example CO 252 Missing medical records, CO 197 Precertification absent, or CO 146 Invalid Diagnosis code.
- Unapplied Payments – Identify unapplied payments and take appropriate action to resolve accounts.
- Phone Calls - Call appropriate payors or patient to obtain the information necessary to resolve the claim
- Patient Service Representative- Answers calls for Patient Billing statement ledger review( patient balance due to Deductible/max out of pocket expense not met, copay or coinsurance amount due, post credit card payment over the phone, collecting updated insurance information and demographics, assisting patient with other inquiries such as scheduled visit summary, in reaching scheduling department or clinic. Also medical and billing records request.
Medical Billing A/R specialist
Medix Recruiting Services-Physource Solutions Billing Service
09.2017 - 02.2019
- Medical Billing A/R specialist for 3 Cardiologist at one Facility-
- Works with Epic as EMR from the Cardiologist Clinic to verify Patient Demographics & insurance, Gather Office Notes or Assessment notes for Office Visits/consultation, Diagnostic results, Authorizations, other medical records to assist with insurance correspondence and A/R for Insurance reconsideration for payment processing.
- Utilize Encoder for CCI Edits for procedure code billing guidelines and Noridian web portal or CMS.GOV for Active LCD to assist with Medically Necessity for Valid Dx Codes per procedural codes- for professional services.
- Utilizes excel spreadsheet for Billing Reconciliation log and Billing Records request from Law office.
- Process appeals for Timely Filing, No authorizations & Medical Records denials for reconsideration or dispute. Access insurance web portals for Claims status, EOB( explanation of benefits), RA( Remittance Advice) in capturing missed payments from payment posters. Also to verify coordination of benefits, if the health plan has an IPA or other insurance coverage
- Utilize Ebridge Scan for filing, uploading Charges/superbills for clinic and hospital billing- facesheets, copies of EOB’s, Payments, Medical Records, Insurance Correspondence, other scan documents for filing.
- Uses AdvanceMD as EHR+PM for charge reviews/claims acceptance on the clearing house, Aging reports, posting charges and payments per insurance. Adjusted payments accordingly per insurance eob and payments from patients. Submits e-file charges/ hard claims, corrected claims per denials-
- Patient Service Representative- Billing statement inquiry and posting payment, collecting updated insurance information and demographics
Pre Biller/Biller
Southern California Physicians Services
08.2017 - 09.2017
- Pre Biller/Biller for two Cardiologist with CMS1500 Form
- Registers Patient Demographics via Electronic Health Records
- Works with Prognosis and Practice Fusions as EMR from the Cardiologist Clinic to get Patient Demographics, progress notes, Direct referral, Authorization and Insurance providers.
- Verify patient’s Insurance eligibility and coverages.
- Post Bills for Out patient/In patient-clinics, hospitals also EA patients
- Utilizes excel spreadsheet to track received/completed DOS per clinics/hospital and Billing Reconciliation log.
- Follow up on corrected claims for claims acceptance on the clearing house, process appeals for denials. Access insurance web portals for Claims status, EOB( explanation of benefits) and RA( Remittance Advice) in capturing missed payments from payment posters.
- All documents scanned and filed- Shredded(HIPAA) once verified for legible imaging
- Currently assist on training new employees on registering patient demographic on EHR with insurance eligibility verification
- Reviews/updates Claims on Office Ally for any denials/errors-
- Make calls to follow up on Claims status(Aging Reports)
- Receive calls from patient billing statement inquiry and posting their payments.
Olympus Orthopedic & Southern Physicians Services
- Total of 200 hours of externship
- Trained on Practice Fusion-Electronic Health Record also MDSuite
- I opened new patient demographic account, updated accounts, process Appointment scheduling.
- MDSuite: I process Patient Registry for Clinics and Hospitals, verifying insurance eligibility and financial class. Also, EOB’s for Secondary Insurance payment claim.
- Observe Billing Transactions for the Primary insurance on MDSuite.
- Scanned and e-file documents per Providers and facilities.
Member Service Officer (MSO) and Member Service Advisor (MSA)
Financial Partners Credit Union, San Diego, CA
03.2006 - 02.2017
- Independently managed and operated a small financial office at the Naval Medical Center of San Diego
- My responsibilities included opening and closing membership accounts.
- Provided estimated quotes on loans for homes, credit cards, auto and personal by using the finance calculator software, then referred them to a specialist for the type of loan they are applying for.
- Processed loans for auto, credit card, personal, and line of credit.
- Provided financial transactions such as deposits and withdrawals from their personal account, IRA account, other share account-Money Market, CD’s. Also provided assistance for online and mobile banking.
- Other special duties given were Marketing strategies for the 3 Branches here in SD by creating a monthly promotional board with pictures, logos and catchy phrases for the products and services.
- Trained new hires on teller transactions and other duties to co-workers interested in growing within the company.
- Created weekly and monthly Staff Schedules.
Restaurant Manager
Restaurant Managements Corporations, San Diego, CA
09.1990 - 02.2006
- Over 16 years of experience in Customer service and management skills with MC Donalds Corporate and Franchise, Ghirardelli Chocolate Company, Boudin Bakery, and SD Medical Federal Credit Union
- As a manager was in charge of staffing, training, and crew development
- Assist in sales based on company locations products such as catering, retail gifts/souvenirs, and promotional strategies to increase sales and profit.
- Prepared weekly and monthly reports consisting of sales, variance, inventory, and labor analysis that results in Profit and Loss, gathered customer feedbacks, judge patterns, and trends Initiated specific action to continuously improve Total Customer Service Experience.
Education
Medical Billing and Coding Specialist -
Brightwood College
San Diego, CA01.2018
ROP for Medical Billing and Coding Specialist - undefined
Southwestern Community College
Chula Vista, CA07.1997
Skills
- HIPAA compliance
- Patient account management
- Customer service
- Revenue cycle management
- Medical billing and collections
- Claim submission-Professional CMS1500 Form
- Insurance verification
- Proactive and Self-motivated
- Attention to detail
- Adaptability and flexibility
- Teamwork and collaboration
- Multitasking Abilities
Certification
- National Healthcareer Association-Certification #E3B8A3X4 Jan.2018-Present
- Certified Billing and Coding Specialist Graduate
- Brightwood College, San Diego, CA Jan.2017 -Jan.2018
- ICD-10 CM,PCS, CPT, HCPCS, HIPAA, Microsoft Office, Electronic Health Record
Languages
Bilingual Tagalog - Filipino language and some Spanish
Timeline
Medical Billing A/R specialist
MDRS Spine & Sport, INC
11.2021 - Current
Medical Billing A/R specialist
Medix Recruiting Services-Physource Solutions Billing Service
09.2017 - 02.2019
Pre Biller/Biller
Southern California Physicians Services
08.2017 - 09.2017
Member Service Officer (MSO) and Member Service Advisor (MSA)
Financial Partners Credit Union, San Diego, CA
03.2006 - 02.2017
Restaurant Manager
Restaurant Managements Corporations, San Diego, CA
09.1990 - 02.2006
Olympus Orthopedic & Southern Physicians Services
ROP for Medical Billing and Coding Specialist - undefined
Southwestern Community College
Medical Billing and Coding Specialist -
Brightwood College
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