Rosario Mendoza-Marrufo
Anthony
Summary
Experienced billing professional with a strong background in financial management and a track record of maintaining high levels of billing accuracy. Recognized for enhancing billing procedures and efficiently resolving discrepancies. Reliable team collaborator dedicated to achieving results and adept at adapting to changing needs. Keen eye for detail and strong problem-solving skills ensure the highest level of accuracy and efficiency in all billing processes.
Overview
10
10
years of professional experience
Work History
Billing Specialist
Medix Staffing
06.2024 - Current
- Researched and resolved billing discrepancies to enable accurate billing.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Worked with multiple departments to check proper billing information.
- Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
- Prepared itemized statements, bills, or invoices and recorded amounts due for items purchased or services rendered.
- Reduced errors in financial records by conducting regular audits of billed accounts.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Posted and adjusted payments from insurance companies.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Located errors and promptly refiled rejected claims.
- Developed a comprehensive understanding of ICD-10-CM, CPT, and HCPCS codes to ensure proper use in medical coding assignments.
Refund Specialist
AmSurg
03.2023 - 06.2024
- Run credit balance report for the center chosen to research, write up, and process the true refunds
- Gather documents for true refunds in a packet form
- This consist of a top cover sheet with the patient information for patient refunds (patient name, account number, date of service) or the insurance information (insurance name and address, account number, date of service, patient name), the transaction screen, the balance control, copy of patient payment(s), insurance EOB(s), the refund request letter from the insurance (if received), a generic letter to the insurance company explaining why a refund if due (if needed)
- Note the account when a refund has been written up for approval
- Work returned mail, correspondence, emails, and tasks regarding refund requests daily
- Respond to emails with 24 hours
- Work tasks within 48 hours
- Log into Five9 on their specific day of the week to answer inbound calls and return voicemails left by patient/insurance
- Email the specific department representative regarding adjustment issues for corrections, if you are unable to do so, that is causing an untrue credit on the account and note the account
- When we bill for the facility and the anesthesia group, if the patient has a credit on one account and a balance on the other, they will contact the patient for permission to move the credit
- An email will be sent to the payment poster requesting the move
- If there is a credit remaining after the balance is covered then a refund will be issued
- Work the CBO Tracking stale dated refund spreadsheet sent by accounting
- This consists of contacting the patient for the correct address, reverse the refund posting for re-issuing, or sending the account to unclaimed if the refund has been issued twice and are unable to reach the patient to obtain the correct address
- Once complete the spreadsheet is sent back to accounting
- To reverse the refund posting so the credit will be applied back to the account, click on the 'Posting' icon, right click, and create a batch new
- After batch is created double click on your batch and enter the encounter number
- Select the insurance or patient name
- The adjust code will either be Refund-Patient or Refund Insurance
- Under 'Refund' put a negative in front of the amount
- Go back to 'Posting' icon, right click on your batch and select 'Post'
- Sending an account to unclaimed includes the refund amount, patient name, and the last known address, date of birth, social security number, original refund check, original refund check date, re-issued check number, and re-issued check date
- You do not reverse the refund posting
- The account should have a zero balance
- Each team member is to export their approved Nextgen center refunds through Refund Manager the day before the check cycle date and log their total dollar amount on the Refund Tracker on the v-drive (each time)
AMBULATORY BILLING & Coding
MIDLAND MEMORIAL
10.2022 - 03.2023
- Assign appropriate CPT surgical codes and modifiers
- Perform regularly scheduled quality reviews and audits per departmental policies and procedures
- Perform ad hoc quality reviews and audits as requested by management
- Assist team members with coding questions and provide resolution guidance
- Complete special projects as assigned by management
- Reviews patient encounters for accurate code assignment(s) of all relevant diagnosis, procedures, and/or modifiers
- Responsible for reviewing, correcting, and releasing e-Clinical Works charges
- Processing, monitoring, and collecting of Medicare, Medicaid and other commercial insurance claims in accordance with payor requirements
- Verifying accuracy of billing data and revising any errors
- Importing/posting payments from all payor types
- Creating and distributing various financial reports as needed
- Timely resolution of all claims including appeals
- Following up on accounts for billing and on overdue accounts for collections via phone calls, resubmissions and adjustments for billing errors
- Midland Memorial is a healthcare provider in Midland, TX
Billing Specialist/Office Manager
Pedi Cardio of west Texas
08.2018 - 02.2023
- Provider or Pro fee medical coding, Cardio E/M visits (OP & IP), ECHO, Stress tests, Cardiology/EP surgeries (pacemaker placements), Cardio-thoracic surgeries
- Resolve related coding issues in all phases: production, coding scrub, and coding denial resolution
- Maintain consistent quality using the established coding guidelines provided you by the immediate supervisor
- Performs ongoing prospective coding and documentation chart reviews for physician services to ensure that the coding supports the services billed
- Identifies issues and patterns related to coding
- Selects and assigns the appropriate ICD-10 CPT codes, based on chart review documentation
- Participates in on-going mandatory compliance training
- Stays up-to-date with compliance on federal, state health care laws, regulations, and rules
- Reports any differentiation from institutional or departmental procedures
- Strong critical thinking and problem-solving skills with proven ability to apply creative approaches to complicated questions
Precertification Specialist
El Paso Orthopedic Group
09.2017 - 08.2018
- My responsibility was to call the insurance and if the patient was active, as well to see if the surgery schedule needs Precertification with the CPT codes given buy the doctor or also if the MRI, CT SCAN also need Authorization and if so to initiate the authorization and send clinical to the insurance to get them approved
- If the authorization was denied will call the patient to advice need to cancel surgery and make an appointment
- Answered phone calls and messages for physician medical facility, scheduling appointments, and handling patient inquiries.
Front Desk Receptionist
Texas Tech
04.2017 - 09.2017
- My responsibility were to great the patient with a simile, I would register the patient for their appointment, collect a copay if necessary, also if they had to sing some form will give them so they could sing them
- I would call the patient and remind them about the appointment they had with the rd
- Next day of if need to reschedule I would
- I would also check to see if the authorization were obtain if not send a message to the Pre-cert them to obtain the authorization
- Maintained organized and clean front office area to create professional and welcoming environment for visitors and employees.
- Collected room deposits, fees, and payments.
- Managed high-volume phone calls, directing inquiries to appropriate personnel for prompt resolution.
Billing Specialist
El Paso Center
08.2015 - 01.2017
- My responsibilities is to call the insurance and verify to see if patient is active and to see if they have coverage for the medical procedure
- I also call the patient and give them the instructions for the procedure he/ she are going to have and give payment if they have a payment for the procedure
- I also did front Desk just to cover the other ones that they were absence or on maternity leave
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Prepared itemized statements, bills, or invoices and recorded amounts due for items purchased or services rendered.
- Researched and resolved billing discrepancies to enable accurate billing.
Education
Bachelor of Applied Science - Health Administration
Southwest University at El Paso
El Paso, TX12.2016
Associate's - Medical Billing & Coding
AAPC
Remote03.2025
Skills
- Reception Management
- Accounts Receivable Processing
- Financial Accounting
- Medical Claims Processing
- Insurance Eligibility Verification
- Medical Billing Coding
- Medical Records
- Human Resources
- Fluent In Spanish and English
- Insurance verification
- Invoice processing
- Denial management
- Accurate Payment Posting
Languages
English
Spanish
Personal Information
Willing To Relocate: any part
Timeline
Billing Specialist
Medix Staffing
06.2024 - Current
Refund Specialist
AmSurg
03.2023 - 06.2024
AMBULATORY BILLING & Coding
MIDLAND MEMORIAL
10.2022 - 03.2023
Billing Specialist/Office Manager
Pedi Cardio of west Texas
08.2018 - 02.2023
Precertification Specialist
El Paso Orthopedic Group
09.2017 - 08.2018
Front Desk Receptionist
Texas Tech
04.2017 - 09.2017
Billing Specialist
El Paso Center
08.2015 - 01.2017
Bachelor of Applied Science - Health Administration
Southwest University at El Paso
Associate's - Medical Billing & Coding
AAPC
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