Summary
Overview
Work History
Education
Skills
Languages
Timeline
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Karen Davalos

Chula Vista,NAY

Summary

Efficient billing professional with 9 years of experience. Productive and diligent with passion for resolving discrepancies through attention to detail and creative problem-solving. Passionate about perpetuating company values through impeccable work ethic and drive.

Overview

19
19
years of professional experience

Work History

Senior Medical Billing Specialist

Adapt Health
03.2017 - Current
  • Improved revenue cycle by managing and overseeing the entire medical billing process.
  • Streamlined billing procedures for increased efficiency and reduced errors.
  • Enhanced reimbursement rates by conducting regular audits of billing data.
  • Increased accuracy in claims submissions, resulting in higher reimbursement levels.
  • Implemented effective training programs for new hires to ensure consistent quality and performance standards.
  • Collaborated with cross-functional teams, optimizing the overall medical billing process.
  • Managed a team of billing specialists, ensuring accurate and timely submission of claims.
  • Developed strategies to reduce accounts receivable aging and improve cash flow.
  • Maintained compliance with industry regulations by staying current on changes in coding and billing practices.
  • Oversaw daily operations for efficient workflow and productivity within the medical billing department.
  • Provided excellent customer service to patients, resolving disputes or discrepancies regarding their bills.
  • Established strong relationships with insurance carriers to expedite claim processing times and improve reimbursements.
  • Analyzed financial reports to identify trends and areas for improvement in the overall revenue cycle process.
  • Implemented quality controls to prevent fraud or abuse in the medical billing system, safeguarding company resources and reputation.
  • Assisted management in budgeting, forecasting, and setting goals related to organizational growth within the medical billing sector.
  • Conducted thorough reviews of denied claims, identifying root causes and implementing corrective actions.
  • Ensured all electronic health records were accurately maintained according to established guidelines.
  • Effectively managed multiple priorities simultaneously while adhering to strict deadlines within a fast-paced environment.
  • Communicated with insurance providers to resolve denied claims and resubmitted.
  • Reviewed patient diagnosis codes to verify accuracy and completeness.
  • Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
  • Delivered timely and accurate charge submissions.
  • Adhered to established standards to safeguard patients' health information.
  • Liaised between patients, insurance companies, and billing office.
  • Reviewed patient records, identified medical codes, and created invoices for billing purposes.
  • Filed and updated patient information and medical records.
  • Collected payments and applied to patient accounts.
  • Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
  • Verified insurance of patients to determine eligibility.
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
  • Posted payments and collections on regular basis.
  • Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
  • Collaborated with customers to resolve disputes.
  • Audited and corrected billing and posting documents for accuracy.
  • Processed payment via telephone and in person with focus on accuracy and efficiency.
  • Maintained accurate records of customer payments.
  • Generated monthly billing and posting reports for management review.
  • Monitored outstanding invoices and performed collections duties.
  • Handled account payments and provided information regarding outstanding balances.
  • Created improved filing system to maintain secure client data.
  • Utilized various software programs to process customer payments.
  • Used data entry skills to accurately document and input statements.
  • Reconciled accounts receivable to general ledger.
  • Responded to customer concerns and questions on daily basis.
  • Kept vendor files accurate and up-to-date to expedite payment processing.
  • Generated accounts payable reports for management review to aid in financial and business decision making.

Lead Medical Biller

Life Care Solutions
02.2011 - 07.2013
  • Improved billing accuracy by diligently reviewing and updating patient information in the system.
  • Reduced errors in medical coding by cross-checking codes against diagnoses and procedures.
  • Streamlined claim submission processes for faster reimbursements, collaborating with insurance companies on a regular basis.
  • Enhanced revenue collection with consistent follow-ups on outstanding accounts and negotiating payment plans when necessary.
  • Led a team of billers, providing guidance and training to ensure timely completion of tasks.
  • Collaborated with healthcare providers to obtain necessary documentation for accurate billing submissions.
  • Conducted periodic audits of billing records, identifying discrepancies and implementing corrective measures promptly.
  • Developed efficient billing workflows to reduce turnaround time for processing claims.
  • Maintained compliance with industry regulations, ensuring accurate application of billing guidelines and policies.

Cashier

Monte De Piedad
04.2005 - 08.2009
  • Enhanced customer satisfaction by providing efficient and accurate cash transactions.
  • Streamlined checkout process for increased efficiency and reduced waiting times.
  • Maintained a balanced cash drawer, ensuring accurate accounting at the end of each shift.
  • Assisted customers with inquiries and provided exceptional service, resulting in positive feedback from shoppers.
  • Collaborated with team members to achieve sales targets and maintain a clean, well-stocked store environment.
  • Handled multiple payment methods securely, minimizing discrepancies and potential losses.
  • Resolved customer complaints professionally, leading to improved customer relations and loyalty.
  • Exceeded productivity goals through consistent attention to detail and organization during busy shifts.
  • Promoted store promotions and incentive programs to increase overall sales revenue.
  • Managed inventory levels effectively, reducing stock shortages and minimizing wastage.
  • Prevented loss by vigilantly monitoring potential theft or fraud situations instore.
  • Ensured compliance with company policies and procedures while processing transactions efficiently.
  • Mentored new employees on cashier duties and best practices, improving overall staff performance.
  • Contributed to store success by maintaining high standards of cleanliness throughout the facility.
  • Proactively addressed long lines by opening additional registers when necessary, enhancing customer experience.
  • Improved transaction speed without sacrificing accuracy by staying up-to-date on product pricing changes.
  • Supported management in implementing operational improvements such as updated training manuals or revised schedules.
  • Provided backup support for other departments when needed, showcasing versatility within the retail environment.
  • Greeted customers entering store and responded promptly to customer needs.
  • Built relationships with customers to encourage repeat business.
  • Operated cash register for cash, check, and credit card transactions with excellent accuracy levels.
  • Welcomed customers and helped determine their needs.
  • Helped customers complete purchases, locate items, and join reward programs.
  • Restocked and organized merchandise in front lanes.
  • Counted money in cash drawers at beginning and end of shifts to maintain accuracy.
  • Stocked, tagged and displayed merchandise as required.
  • Worked closely with shift manager to solve problems and handle customer concerns.
  • Tallied cash drawer at beginning and end of each work shift.
  • Upsold additional products and services to customers, increasing revenue.
  • Handled cash with high accuracy and took care to check bills for fraud.
  • Worked with floor team and managers to meet wide range of customer needs.
  • Responded promptly to requests for assistance, spills and customer inquiries.
  • Processed refunds and exchanges in accordance with company policy.
  • Reconciled cash drawer at start and end of each shift, accounting for errors, and resolving discrepancies.
  • Kept cash wrap stocked, products faced and shelving free of misplaced items or trash.
  • Set up new sales displays each week with fresh merchandise.
  • Conducted inventory counts by adding each item in stock and documenting in computer system.
  • Identified and resolved discrepancies and errors in customer accounts.

Education

Billing Specialist - Medical Billing & Coding

UEI
Chula Vista
03.2010

Skills

  • Revenue Cycle Management
  • Accounts receivable management
  • Team Collaboration Aptitude
  • HIPAA compliance awareness
  • Continuous learning mindset
  • CPT Coding Familiarity
  • Denial Management Strategies
  • Claims Processing Proficiency
  • Professionalism and Ethics
  • Payment Posting Accuracy
  • Medical terminology fluency
  • ICD-10 Knowledge
  • Third-Party Payer Guidelines
  • Healthcare Reimbursement Models
  • Patient Confidentiality Practices
  • Analytical Thinking Capabilities
  • HCPCS Level II Understanding
  • Electronic Health Records Experience
  • Medical Billing Software Mastery
  • Teamwork and Collaboration
  • Claims review
  • Commercial and Private Insurance
  • Claims Processing
  • Billing and Collection Procedures
  • Multitasking and Organization
  • HIPAA Compliance Certification
  • Records Management
  • Account Reconciliation
  • CMS-1500 Billing Forms
  • Collection calls
  • Insurance Verification
  • Medicare , Commercial plans
  • Worker's Compensation Knowledge
  • Claim submission
  • Data Entry
  • Mail Sorting
  • Financial Reporting
  • Medical Billing
  • Invoice Processing
  • Payer Contracts
  • Customer Service

Languages

English
Spanish

Timeline

Senior Medical Billing Specialist

Adapt Health
03.2017 - Current

Lead Medical Biller

Life Care Solutions
02.2011 - 07.2013

Cashier

Monte De Piedad
04.2005 - 08.2009

Billing Specialist - Medical Billing & Coding

UEI

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Karen Davalos