Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Jessica Maldonado

San Diego

Summary

Dynamic Medical Biller with extensive experience at Rady’s Children’s Hospital, adept at processing insurance claims and resolving discrepancies. Proven ability to ensure compliance with HIPAA regulations while maintaining effective communication with patients and providers. Bilingual in English and Spanish, I excel in high-volume environments, demonstrating strong problem-solving and organizational skills.

Overview

6
6
years of professional experience
1
1
Certification

Work History

Medical Biller

San Diego Youth Services
San Diego
05.2022 - 11.2024
  • Performed follow up activities on unpaid claims with insurance companies or other third party payers by phone or written correspondence.
  • Researched discrepancies between billed charges and payments received from insurance companies or other third party payers.
  • Answered incoming calls regarding billing inquiries from patients and and or providers in a professional manner.
  • Ensured compliance with HIPAA guidelines when handling confidential patient information.
  • Performed daily reconciliation of accounts receivable with payment postings on the computer system.
  • Submitted electronic claims to Medi-Cal insurance carriers.
  • Assisted in auditing process by verifying accuracy of submitted claim forms against documentation provided by physicians' offices.
  • Reviewed claims for coding accuracy.
  • Completed and submitted appeals for denied claims.
  • Reviewed account information to confirm patient and insurance information is accurate and complete.

Account Analyst

Rady’s Children’s Hospital
San Diego
08.2021 - 06.2022
  • Submitted electronic claims in EPIC as well as paper claim forms via mail or fax according to regulations.
  • Collaborated with medical staff to ensure accurate coding of services rendered to patients.
  • Conducted regular audits of accounts receivable aging report ensuring accuracy.
  • Adhered to HIPAA guidelines regarding confidentiality of patient data at all times.
  • Processed appeals for denied insurance claims ensuring timely reimbursement from third-party payers.
  • Managed follow up on unpaid or rejected claims; contacted insurers as necessary for resolution.
  • Researched and resolved discrepancies in patient accounts, insurance claims, and billing records.
  • Prepared and processed invoices for payment by insurers according to established procedures.
  • Developed strong working relationships with internal departments and external stakeholders.
  • Verified accuracy of patient data including demographics, payer information, and coding.

Billing Specialist

Golden Hour
San Diego
03.2019 - 06.2021
  • Worked closely with patients to discuss payment arrangements when needed.
  • Resolved discrepancies between customers' remittances and invoices received.
  • Monitored accounts receivable activity to ensure timely payment of invoices.
  • Answered customer inquiries regarding billings, payments, account status.
  • Verified insurance coverage and identified third-party payers for billing purposes.
  • Reviewed medical records to ensure accuracy of billing information and patient data.
  • Maintained accurate records of collections, adjustments and denials in the system.
  • Performed data entry into patient portal
  • Performed accurate and fully compliant monthly closing processes, accruals and journal entries.
  • Submitted claims to insurance companies.
  • Assessed billing statements for correct diagnostic codes and identified problems with coding.

Education

Medical Office Administration Program -

San Diego, CA
08.2016

Concorde Career Institute
San Diego, CA

Skills

  • Medical Terminology
  • Familiar with HIPAA laws and regulations
  • CD9-10 and CPT Coding, and HCPCS
  • Medical Manager, Citrix, Epic, Cerner
  • Chart filing system
  • Type 45 wpm
  • BLS (Adult and Children)
  • Bilingual (English/Spanish)
  • High volume inbound/outbound phone calls
  • PowerPoint, Word, Excel
  • Processing Insurance Claims
  • Reconcile bank statements
  • Billing/Collecting Process
  • Multi-Task
  • Claim submission
  • Insurance verification
  • Discrepancy resolution
  • Problem solving
  • Attention to detail
  • Effective communication
  • Organizational skills
  • Insurance claims processing
  • Account follow-up

Certification

Certification, CPR, Concorde Career College San Diego, CA August 2016

Timeline

Medical Biller

San Diego Youth Services
05.2022 - 11.2024

Account Analyst

Rady’s Children’s Hospital
08.2021 - 06.2022

Billing Specialist

Golden Hour
03.2019 - 06.2021

Medical Office Administration Program -

Concorde Career Institute

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Jessica Maldonado