Professional Portfolio

Dedicated Billing Manager with 12 years’ experience for a service provider of Therapists. Currently supervising Billing department for Holding Hands Pediatric Therapy and Diagnostics where 90% of business serves children and young adults diagnosed with Autism. Prior experience with large healthcare providers in Customer Service; Blue Cross of California, Premera Blue Cross of Washington, and Farmers Insurance.

Professional Experience

Company 1

Billing Manager (Feb 2006 – Present)

· Supervise billing staff Develop and implement billing process and procedures resulting in increased company efficiency and productivity.

· Supervise and monitor clients billing funded via Regional Center, School District and Insurance (PPO, HMO and Medical). Successfully resolve customer billing issues.

· Systematically increase office productivity by developing more efficient documentation system and customer database protocol by using NPA works/Code metro software.

· Oversee accounts receivable and unpaid claims.

· Review patient communications with billing staff. Resolve all issues related to patient balances and billing while maintaining a positive and professional attitude.

· Supervise all Insurance, Regional Centers and School Districts billing and rebilling and reimbursement processes to ensure account resolution.

· Train billing staff of 4 on insurance plans (PPO, HMO, and Medi-Cal) for full understanding of benefits, payment policies and procedures. Guide and monitor staff on benefit verification process and obtaining authorization on billing codes.

· Supervise, train, and mentor current staff of 230 therapists regarding billing procedures and policies.

· Conduct all new hire orientation sessions for all employees regarding billing procedures and polices.

· Review and approve payments processed by insurance companies for accuracy per patient benefit plans.

· Conduct weekly/monthly audits on rendered services, session notes and pay codes of employees.

· Monitor client’s authorizations for ABA (Applied Behavioral Analysis), Social Skills, and Adaptive Skills for accuracy of vendor numbers assigned per service by Regional Centers.

· Audit annual contracts for accuracy on all services through Regional Centers. Audit each contract for accuracy.

· Monitor and review client’s individual service agreements with school districts. Administer annual contracts with all school districts.

· Oversee therapist credentialing process (CAQH, NPI) with all insurance companies.

· Supervise the administration of insurance client’s e-billing and paper claims. Monitor CPT codes, modifiers, and diagnosis codes using NPA/Code metro and Kareo software. Knowledgeable of insurance guidelines, including HMO/PPO, Medicare and state medical plans. (LA Care, Care First & etc.)

· Monitor Coordinator’s duties concerning therapist billing hours for scheduling within authorized hours. Audit therapist’s payroll for pay code and billing accuracy.

· Problem solve on all IT related issues with billing software; NPA Works/Codemetro.

Company 2 (Oct 04 – Feb 06)

Patient Account Representative II:

· Provided regular updates of billing activities to Director.

· Coordinated and participated in regularly scheduled meetings with the physicians and operation staff.

· Assisted in the coordination of the registration of patients into the billing systems.

· Keyed charges, payments, adjustments, and balanced receivables to deposits.

· Reviewed accounts for collections procedures.

· Handled telephone inquiries from patients and insurance carriers.

· Accounts receivable, maintaining timely billing, running month end financial reports.

Company 3 (Sep 03 – Feb 04)

Customer Service Representative:

· Researched and resolved telephone and written inquiries regarding benefit claims adjudication with Calpers Members (State of CA Retirees) membership and billing.

· Assisted in achieving section and departmental goals in quantity and quality through individual and collaborative efforts.

Company 4 (Jul 02 – Jul 03)

Customer Service Representative:

· Researched and resolved telephone and written inquiries regarding benefits, claims adjudication and membership and billing.

· Assisted in achieving section and departmental goals in quantity and quality through individual and collaborative efforts.

Education

Argosy University (Graduating July, 2018)

Bachelor’s Degree in Psychology

Bellevue Community College (Bellevue, WA)

Multi-media

Associate’s Degree

Lake Washington Technical College (Seattle, WA)

Office Technology Core Program

Certificate