Monica Ortiz
Delano
Summary
Professional medical billing expert with 15+ years experience prepared for leadership role. Expertise in optimizing billing processes, ensuring compliance, and managing claims. Strong focus on team collaboration, adaptability, and achieving efficient results. Skilled in coding, auditing, and revenue cycle management, with reputation for reliability and precision.
Overview
11
11
years of professional experience
Work History
Lead Medical Biller /Medical Office Manager's Assistant
Valley Imaging Medical Group
06.2014 - Current
- Secure timely reimbursements from insurers through persistent appeals of denied claims backed up with detailed evidence supporting each case made.
- Develop comprehensive training materials for new hires, facilitating their smooth transition into the medical billing team.
- Led a team of billers, providing guidance and training to ensure timely completion of tasks.
- Streamline claim submission processes for faster reimbursements, collaborating with insurance companies on a regular basis.
- Maintain compliance with industry regulations, ensuring accurate application of billing guidelines and policies.
- Manage electronic health record systems, ensuring data integrity and accessibility for authorized personnel.
- Monitor changes in insurance policies, keeping abreast of updates affecting medical billing procedures and informing staff accordingly.
- Developed efficient billing workflows to reduce turnaround time for processing claims.
- Implemented new software solutions that increased productivity within the department while reducing administrative burden on staff members.
- Collaborate with healthcare providers to obtain necessary documentation for accurate billing submissions.
- Enhanced revenue collection with consistent follow-ups on outstanding accounts and negotiating payment plans when necessary.
- Resolve complex billing issues by conducting thorough research, working closely with insurance providers to reach favorable outcomes for both parties involved.
- Assist patients in understanding their medical bills, addressing concerns and clarifying any confusion regarding charges or insurance coverage.
- Improve billing accuracy by diligently reviewing and updating patient information in the system.
- Conduct periodic audits of billing records, identifying discrepancies and implementing corrective measures promptly.
- Reduce errors in medical coding by cross-checking codes against diagnoses and procedures.
- Communicate with insurance providers to resolve denied claims and resubmitted.
- Verify insurance of patients to determine eligibility.
- Post payments and collections on regular basis.
- Collect payments and applied to patient accounts.
- Accurately enter patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
- File and update patient information and medical records.
- Analyze complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Liaise between patients, insurance companies, and billing office.
- Review patient records, identified medical codes, and created invoices for billing purposes.
- Deliver timely and accurate charge submissions.
- Prepar billing statements for patients and verified correct diagnostic coding.
- Review patient diagnosis codes to verify accuracy and completeness.
- Adhere to established standards to safeguard patients' health information.
- Respond to customer concerns and questions on daily basis.
- Use data entry skills to accurately document and input statements.
- Handle account payments and provided information regarding outstanding balances.
- Audit and corrected billing and posting documents for accuracy.
- Utilize various software programs to process customer payments.
- Maintain accurate records of customer payments.
- Generate monthly billing and posting reports for management review.
- Process payment via telephone and in person with focus on accuracy and efficiency.
- Produce and mailed monthly statements to customers and assisted with related requests for information and clarification.
- Enter invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
- Reconcile accounts receivable to general ledger.
- Maintain up-to-date knowledge of healthcare regulations and policies, ensuring the practice remained in compliance at all times.
- Developed close working relationships with front office and back office staff.
- Reduce overhead costs by identifying areas for improvement in supply management and negotiating contracts with vendors.
- Maintain high level of patient care by conducting regular audits of medical record accuracy.
Education
High School Diploma -
Delano High School
Delano, CASkills
- Claims processing
- Insurance verification
- Medical coding
- Revenue cycle management
- Billing compliance
- Patient billing
- Team leadership
- Data entry
- Payment posting
- Problem solving
- HIPAA compliance
- Claims processing proficiency
- Continuous learning mindset
- Training and mentoring
- Data entry efficiency
- Medical terminology fluency
- ICD-10
- CPT coding mastery
- Medical billing software
- Communication effectiveness
- Customer service
- Billing and collection procedures
- ICD-10 proficiency
- Claims review
- Insurance claims processing
- Critical thinking
- Claim submission
- Medical terminology
- Work prioritization
- Denial management
- Insurance billing
- Multitasking Abilities
- Excellent communication
- Staff training
- Scheduling and coordinating
- Professional and courteous
- Billing software
- Claims management
Languages
Spanish
Native or Bilingual
Timeline
Lead Medical Biller /Medical Office Manager's Assistant
Valley Imaging Medical Group
06.2014 - Current
High School Diploma -
Delano High School
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