Fallon Valdes Email & Phone Number

Miami, Florida, United States

Miami, Florida, United States

Responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by commercial payers and MedicaidMaintain compliance with all regulatory and accrediting institutionsAssist Manager of Credentialing and Contracting and the Credentialing Team as needed tomeet department’s goal in timely submitting commercial and government payor applicationsMonitor staff credentials and licensesAdvise staff on renewal proceduresParticipate in the development of internal credentialing processesKeep records in licenses, credentials and insurance contractsAssist with special RCM or payor projects to capture revenue including the creation of ad hocreports as requestedAssists in researching pended and probated credentialing applications and resolvingdiscrepanciesUpdate and maintain Central Reach provider profiles’ Meta Data as per payorwelcome letters for assigned region(s)Conduct National Practitioner Data Bank and National Student Clearinghouse primesource verification for applicable providersRelease information to agencies and members of the public as required by law

United States

Lead of Medicaid teamAssist team members with any questions, problems and trainingMonthly/weekly billing and collections for 10+ skilled nursing facilities in multiple statesGenerate timely billing of assigned payers (Managed care/Medicaid/Insurance).Review agings weekly, follow up on all outstanding balances every 14 days.Review unbilled reports on daily basis.Adjust bill as needed.Bill all co-insurance as Medicare A & B; Remits are received.Call Medicaid/Insurance/Managed Care plans as needed to resolve issues on claims.Adhere to all established goals and procedures.Ability to work without direct supervision, take initiative, is flexible, adaptable and a problem solver.Maintain appropriate documentationAbility to prioritize work assignments during periods of stress and high work volumeMaintain compliance with all state, federal, and government agenciesAdhere to HIPPA requirements

Maitland, Florida

Generate timely billing of assigned payors.Review agings weekly, follow up on all outstanding balances every 14 days.Review unbilled reports on daily basis.Adjust bill as needed.Post daily cash receipts on Medicaid cash logs.Bill all co-insurance as Medicare A & B; Remits are received.Key Medicare Bad Debt.Post Remits as needed.Call Medicaid as needed to resolve issues on claims.Adhere to all established goals and procedures.Maintain compliance with all state, federal, and government agencies.

Sebastian, Florida

Billing for various specialties. Dermatologist, Podiatrist, Ophthalmologist, Plastic Surgeon, General Surgeon, and Neurologist. Prepares and submits claims to various insurance companies either electronically or by paper.Answers questions from patients by Identifying and resolving patient billing issuesPrepares, reviews and sends patient statementsEvaluates patient’s financial status and establishes budget payment plans. Follows and reports status of delinquent accounts. Patient/ insurance agingPrepare information for the collection agency.Performs various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payersMaintains strictest confidentiality; adheres to all HIPAA guidelines/regulationsPost payments

EMR experience with Amazing ChartsFront Desk duties including but not limited to: checking patients in and out, making appointments, collecting co-payments, answering phones, scanning and importing. Organizational skills and adept at multi-tasking and problem-solving.Managed all employees and schedule planningManaged and had control of all meetingsMade daily depositsOne on one with Doctor, PA and RepsManaged Doctor and Pas schedulePatient Education

Veterinary/Animal Health Technology/Technician And Veterinary Assistant

Education record