David Herrera Email & Phone Number

United States

let's do this

Houston, Texas, United States

Houston, Texas Area

Utilized GE Centricity to follow up on outstanding balances in the Accounts Receivable queue for the Revenue Cycle Management Department regarding various denialsFollowed up with various insurance carriers by phone and internet to initiate appeals and reconcile outstanding balances pertaining to various professional claims denials for Orthopedic Specialties and surgeries in order to obtain correct reimbursements according to provider fee schedules and contractsWorked with the Revenue Cycle Management department as reimbursement specialist in collections department in order to follow up on outstanding balances in the Accounts Receivable queue, and ensured outstanding balances were rectified accordingly for various patient accounts by utilizing knowledge of government, commercial and managed care payer guidelines

Houston, Texas Area

Utilized knowledge of Value Based Pricing methodologies and protocol, contractual agreements with various payers for cardiovascular services/ surgeries rendered by professional providers, and multiple procedure discounts pertinent to various payersReviewed claims corrections/ billing and coding errors, as well as payment posting discrepancies, outstanding balances, credits and contractual adjustments in AXIA Accounts Receiveable; distributed payments accordingly utilizing Claim MD Filed appeals with various insurance carriers- United Healthcare, BCBS, and Optum Transplant by obtaining, downloading and reviewing Medical Records using OnBase and various provider portals or payer websites such as Methodist, St. Lukes, Athena Health, United Healthcare, Optum, Availity and UMR Followed up with insurance payers regarding outstanding balances; reviewed patient policies for stipulations and submitted possible appeals for appropriate reimbursementReviewed and reconciled various provider relation requests or disputes regarding unpaid balances on professional claims per HCFA-1500 billing guidelines

Houston, Texas Area

Utilized BBVA/ HCRS daily to review and pull lockbox totals and lockbox files for teamReconciled unfinished files with missing ERA's using various insurance website accesses so payments could be posted accordinglyAs team lead in Payment Operations, served as backup for other team leads' responsibilities while they were out of officePerformed monthly audits of two subordinates at 7 random accounts per employeeReviewed employee time sheets to ensure accuracyAudited various work queues in EPIC by age of account regarding charge corrections, credits and follow- upReconciled EFT payments/ splitters using WinSCP accessBalanced and reported infusion payments to Healix bi-monthlyBalanced and reported Global Healthcare payments to MCRP Global received in Baylor lockbox for appropriate reconciliationReviewed, posted and balanced payments weekly to CardioVascular Care Provider files in EPICAnswered any queries that the team may have had regarding various accounts and assisted with any issues or problems on the teamSelf-Pay Collections/ Payment PostingBalanced Remote Deposits utilizing OnBase

Houston, Texas Area

As a floater, assisted with filing, scanning and posting payments in EPIC from various payers for their respective departmentsLearned the logistics of posting/adjusting/removing various payments to ensure all accounts are balanced accordinglyUtilized BBVA to view insurance remits/ check details onlineTrained in various aspects of the scheduling process

Houston, Texas Area

Collected payments by telephone or mail and initiated payment plans for patients, also advised them of balances in collectionsCommunicated with law firms and doctor's offices as well as insurance carriers regarding receipt of payments or denialsUpdated spreadsheets and patient demographics/ updated insurance information on behalf of patientFollowed HIPAA regulations in disclosing pertinent information.

Houston, Texas Area

Successfully trained staff of 4 employees in all office systems and databases, policies and procedures while focusing on minimizing errors and generating superior resultsManaged weekly audits for each team memberDeveloped a strong knowledge of hardware and software while keeping abreast of insurance carrier protocols, and utilized the Internet for claims processing and verification that increased efficiency and productivity for management and clientsCooperated with Medicare, Medicaid and private insurance providers to establish relationships and resolve billing issues between the INOVA hospital system using third party payer protocolsCorresponded with patients by phone and correspondence (in English and Spanish) to update insurance information and forward any payment issues to the hospital directlyInvestigated and analyzed client complaints to identify and resolve issues for small balance clients with various hospital billing issuesEnsured smooth operations by supporting team while Manager was out of officeServed as team lead, answering any questions or concerns with various insurance carriers and their billing/ coding procedures.