Daniel Balmaceda Email & Phone Number

Miami, Florida, United States

● Manage day-to-day operations, and provide practice management services for 3 + medical providers. ● Mentor, motivate, and oversee 25+ staff members, maximize coaching opportunities, and deliver feedback to improve employee engagement, retention, and morale. ● Analyze the operations of 3+ practices, integrate technology solutions, and develop/implement process improvements that streamline workflow and increase efficiency and productivity. ● Administer medical coding audits for group providers and run quarterly analysis reports detailing provider gross profits to identify growth opportunities.● Effectively manage utilization management processes, resulting in a 73% reduction in unnecessary medical procedures and associated costs.● Research and analyze denied claims to identify errors or missing information, leading to successful appeal outcomes by applying a strong understanding of insurance policies and regulations.● Coordinate Contract Development with HMO, PPO, and Local Marketplace Lines of Business to expand healthcare provider participation. ● Conducting compliance reviews to ensure medical practice, physicians, and employees are adhering to CMS guidelines as well as meeting state health code regulations. ● Perform detailed analysis on assigned projects, recommend potential business solutions, and assist with implementation.

Miami, Florida, United States

● Operated as a subject-matter expert and processed 120+ medical, hospital, and Medicare/Medicaid claims daily in a deadline-driven environment and was named Processor of the Year for exceeding expectations.● Trained and oversaw the performance of 30+ junior processors, delegated claims, and conducted quarterly reviews to provide actionable feedback and improve service levels.● Processed medical claims and performed claim quality control analysis to identifying and resolving discrepancies to ensure proper reimbursement for healthcare providers.● Conducted thorough investigations into suspicious medical claims, identifying patterns of fraudulent activity and saving the company $50,000 in potential losses monthly.

Miami, Florida, United States

● Maintained the confidentiality of sensitive information, reviewed patient records, and created billing invoices.● Prepared billing statements, verified diagnostic and procedural coding and coordination of benefits, submitting claims, and resolved issues by serving as a liaison between patients, insurance companies, and the billing offices. ● Performed thorough audits of medical claims to ensure accuracy and compliance with industry regulations.● Oversaw the credentialing process for 15 healthcare providers, ensuring compliance with regulatory standards.

Miami, Florida, United States

● Assisted 80+ clients daily, promptly resolved benefits authorizations and member claims issues in a time-sensitive environment, and won the Employee of the Month award in June 2017.● Advocated for members and applied knowledge and experience to resolve complex calls.● Streamlined workflow by creating a knowledge base by documenting and categorizing call classifications, which increased the efficiency of the member services department by 43%● Prioritized tasks, handled competing objectives, and multitasked effectively by utilizing 7+ computer applications simultaneously.

Bachelor'S Degree, Health/Health Care Administration/Management, 3.89

Licentiate Degree, Medical Insurance Coding Specialist/Coder

Activities and Societies: NCCT Licensed in insurance medical billing and coding