Karla Rodriguez
Lake Forest
Summary
Highly dedicated and organized professional with experience in medical insurance billing with understanding of coding, claims processing and patient account management. Expertise in policy evaluation, claims review, and data entry. Proven track record of accurately and efficiently processing high volumes of claims while adhering to strict company policies. Focused on providing superior customer service and maintaining positive customer relationships.
Overview
8
8
years of professional experience
Work History
Medical Insurance Biller
Pontine
San Leandro
09.2023 - Current
- Resolved denied or rejected claims by submitting appeals to the appropriate payer.
- Generated regular aging reports detailing accounts receivable balances due from various third party payers.
- Maintained up-to-date knowledge of third party payers' rules and regulations related to billing practices.
- Reviewed and processed medical claims for accuracy according to insurance guidelines.
- Investigated and responded to inquiries from providers regarding claim status, payments, denials.
- Submitted electronic and paper claims to insurance companies for payment.
- Verified patient information, such as demographics and insurance coverage, to ensure accuracy of claim submissions.
- Checked claims coding for accuracy with ICD-10 standards.
- Assessed billing statements for correct diagnostic codes and identified problems with coding.
Insurance Coordinator
Pure Pediatric therapy
Aliso Viejo
02.2017 - 05.2022
- Handle insurance verification of benefits and eligibility information.
- Request authorization visits or extension to all health insurance company.
- Plan and implement quality assurance claims.
- Prepares patient statements of accounts, collection of co-payments and deductibles.
- Gathered and compiled data for weekly and monthly reports pertaining to claims approvals, denials and pending claims.
- Prepared insurance claim forms and related documents and reviewed them for completeness.
- Performed detailed audits of client accounts to verify compliance with underwriting guidelines.
- Assisted clients with understanding insurance policies and coverage options by providing detailed explanations.
Education
Diploma - Medical Billing and insurance coding
UEI College
Anaheim06.2019
Certification - Medical Technology & Medical Assistance 1
Regional occupational program
San Juan Capistrano06.2007
Skills
- Bilingual
- Healthcare Terminology
- ICD-9 coding
- ICD-10 coding
- Procedural terminology coding
- Insurance guidelines
- HMO
- PPO
- Medicare
- Customer Service
- Accounts Payable
- Accounts Receivable
- Office Supplies
- Inventory
- Finance Operations
- Medical Billing
- Coding
- Payment Escalations
- Investigation Escalations
- Billing compliance
- Insurance verification
- Appeals management
- Electronic claims submission
- Problem solving
- Attention to detail
- HIPAA compliance awareness
- CPT coding
- Insurance appeals handling
- Medical claims submission
Timeline
Medical Insurance Biller
Pontine
09.2023 - Current
Insurance Coordinator
Pure Pediatric therapy
02.2017 - 05.2022
Diploma - Medical Billing and insurance coding
UEI College
Certification - Medical Technology & Medical Assistance 1
Regional occupational program