Mirtha Baez Email & Phone Number

Fort Lauderdale, Fl, Us

Plantation, Florida, United States

• Credentialing Database (Cactus, Evips, EmWorks) are updated and accurate as well as provider profile in the share drive.• Monitor monthly expirables Excel report (Medical Provider & Mid-level Professionals); provide timely follow-up and obtain required documentation such as Boards but not limited to Board Eligibility and/or Grandfathered documentation, State Licenses, DEA Licenses, State Narcotic Registration, Occupational License, Driver's License, US Passport, ACLS, NRP, BLS, PALS Certification, TB Skin Test, TB Questionnaire, CXR, Flu Vaccine, TDAP, obtain any missing documentation for Covid Booster Vaccine.• Maintain professional communication as well as follow up with Medical Providers and Mid-level Professional via emails, text or phone.• Abstract and perform a thorough file scrubbing of the Internal Credentialing Application and CV into Credentialing System. • Process identifying, evaluating, interpreting and organizing data. It includes sorting through data to identify patterns and establish relationships for decision making.• Primary Source Verifications internal processing including start ups. (NPI, NPDB, OIG, TX OIG, FSMB, Boards, State Licenses, DEA Licenses, CDS, AMA, AOA, AANA, NCCPA, NCC, ACLS, NRP, BLS, PALS Certification. Background Verification, Time Gaps over 30 days.• Verification of Education (Medical, Residency, Internship, Fellowship, ECFMG) • Retrieve and upload all COI's , Malpractice claims, explanations if applicable onto Credentialing System as well as providers file in share drive.• Prefill of Initials and Reappointment Applications from various Hospital Credentialing System; upload required documents including malpractice claims documentation if applicable, peer references.• Upload CME's and Case Logs.• Collaborate with personnel in other departments and organizations.• Assist with various projects as requested.

As an Eligibility Representative, Patient Access, Accredo, I was part of a dedicated team which helps specialty pharmacy patients coordinate their medication needs and pharmacy insurance coverage for complex medical conditions such as HIV, Rheumatoid Arthritis and Cancer. This role is on the front lines with patients and doctors offices, responding to phone inquiries and addressing each with care, detail, and most importantly, empathy.Assisted patients in obtaining medications they are prescribed. Use the knowledge you gain from training, your problem-solving skills and support from your team to answer patient calls effectively. Coordinate and ensure services are covered under insurance coverage and talk to patients about their deductibles, co-payments, and authorizations.Interact directly with healthcare providers. Researched issues on benefits coverage with pharmacist and doctors’ office and provide guidance to our patients about medication coverage.

Spartanburg, Sc

• Plan, develop, organize, implement, direct and evaluate systems, processes, and payor-specific reimbursement mechanisms and billing requirements, contributing in the proactive identification of opportunities for revenue cycle improvement and enhancement.• Analyze prepared reports and data to identify trends related to denials and rejections; develop and execute plan to avoid, reduce, and resolve denials and rejections.• Serve as the subject matter expert for revenue cycle service excellence, maintaining an active understanding of current thinking and innovative intervention/programs regarding the patient revenue cycle experience• Coordinate special projects with payer representatives to resolve payer denials and trends.

Naples, Florida Area

• Coordinate the processing of all initial and reappointment provider applications in accordance with regulatory requirements including, JC, NCQA, federal and state regulations, CMS and other governmental payers, as well as Gundersen Health System Medical Staff Bylaws, to include the Medical Staff Bylaws, policies and procedures and obligations of the entities which contract with Credentialing Services.•Analyze and evaluate the primary source verification data and documents in accordance with CHS Health System and outside regulatory requirements and to determine quality and adequacy. Research and pursue additional information if necessary, to ensure good decision-making. • Manage data quality and integrity by maintaining an up-to-date database program to store and track information.• Assist with Ongoing Professional Practitioner Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) and Peer Review process for Medical and Allied Health Professionals.• Coordinate the electronic expiable management system to ensure renewal of all medical and associate staff applicable state licenses, DEA’s, malpractice insurance, certifications and other required expiable. Assist medical and associate staff in renewal process as needed. Responsible for accuracy of all required background checks and verifications, including, but not limited to: NPDB, State Medical Boards, medical licenses, DEA, AHCA, OIG, SAM, malpractice coverage, medical school, internship, residency, fellowships, board certification, red flag and all others as indicated based upon the applicant's history.• Analyze and evaluate privilege criteria data and documents. • Complete provider initial credentialing and re-credentialing applications; monitors applications and follows-up as needed for Medical and Allied Health professionals.• Sets up and maintains provider information on the MDStaff credentialing database and system.

Naples, Florida Area

•Serve as primary point of contact for and liaison between, patients, administrative staffs, physicians, technicians to facilitate proper lines of communication and expedient problem resolutions.•Responsible for day-to-day operations.•Provide diversified office support in areas of accounts receivables, probate claim filing.•Oversee, coordinate multiple office functions that focus on computerized scheduling, electronic billing, denial tracking, reimbursements, collections, account payable/receivable, patient records, data management and payment plans with a demonstrated knowledge of insurance carriers, manage care, medical terminology, and CPT/ICD9/ ICD10 codes.•Maintained current account receivables at 80% or higher, keeping all accounts current under 60 days. •Researched and resolved claims denials. Carrier A/R detailed reports are monitored monthly.•Ensure charges are entered and submitted within 48 hours of receipt.•Set up Practice Management Software for submission of electronic claims to clearinghouse. Work with web-based Practice Management Company to resolve file compatibility issues.•Retrieve Electronic Remittance Advice (ERA’s). Forward secondary claim upon processing primary claims. Knowledgeable with timely filing restrictions. Post and reconcile insurance and patient payments. •Research and resolve incorrect payments, EOB rejections and other issues with outstanding accounts. •Monthly processing of patient statements. Patient advocate when needed to answer and resolve patient billing issues. Keep up and maintain all credentialing contract for the physician with hospital, insurance carriers and CAQH Database. •Invoicing other Providers for Interpretation Services. Transcription Services.

Naples, Florida Area

Specialty: Urgent Care / Family Practice / Internal Medicine / Pulmonology / Cardiology / Radiology•Supervisor of four front of staff / 2 receptionist / 3 medical billers•Perform all necessary supervisory functions to effectively and efficiently manage the personnel assigned. Ensure employees have appropriate training and other resources to perform their job.•Create and maintain a cooperative and harmonious working climate conductive to maximize employee morale and productivity.•Physician Credentialing with Insurance Companies and CAQH database.•Maintain Physicians administrative meetings, files and professional services invoicing. •Prepare drafts/final correspondence review/revision for signature.•Attend all Corporate Staff meetings with President, Chief Operation Officer, Chief Financial Officer, Accountant, Director of Marketing, Computer Programmer and Administrative Assistant.•Produce daily/Weekly/Monthly reports to the COO and billing company.•File/Retrieve files data materials.•Data Entry, Customer Service, Patient Complaints. Gained in depth knowledge, experience and ability to recognize the trends and changing needs of the office practice. Capture all procedures and supplies based solely on documentation, to maintain the highest level of compliance with all state and federal guidelines.•An emphasis in complete cross training of all team members ensures the client a team of individuals equipped with the knowledge and capability to meet all of client’s billing needs. •Direct communication with Medical Director, Physician’s and insurance carriers to insure billing accuracy.•Insurance /Patient billing, all phases of collections, insurance verification of eligibility and benefits. •Claim audits / denial reviews / medical records. Data entry, scheduling. Insurance / patient billing, ICD-9 / ICD-10 and CPT coding. Maintain weekly/monthly reports.

Naples, Fl

Specialty: Physical Therapy •Assist Front office when needed. Phones, appointment scheduling, filing, creating new patient chart, collecting of copayments, authorizations.•Complete customized billing procedures.•Gained in depth knowledge, experience and ability to recognize the trends and changing needs of the office•Beginning-to-end responsibility and control of accounts.•Capture all procedures and supplies based solely on documentation, to maintain the highest level of compliance with all state and federal guidelines.•Posting insurance payments, EOB denials, patient / insurance billing / collections•ICD -9 and CPT coding

Miami, Fl

Specialty: Critical Care Services / Pulmonology / Diagnostics Imaging / Internal Medicine / Cardiology / Nephrology / Pediatrics / Opthalmology / Orthopedics / Physical Therapy•Supervisor•Complete customized billing procedures.•Gained in depth knowledge, experience and ability to recognize the trends and changing needs of the office practice.•Successfully negotiated with Chief Financial Officers to increase efficiency, boost productivity and reimbursement from specific familiarity with individual site problem payers.•Developed relationships with Insurance Executives for ongoing physician’s documentation feedback.•Responsible for providing notification, demographics, obtaining authorization for inpatient/outpatient admission and treatments.•Developed relationships with health insurance precertification nurse coordinators and daily follow-up with certifications to avoid denials.•Maintain reports on productivity.•Beginning-to-end responsibility and control of accounts.•Capture all procedures and supplies based solely on documentation, to maintain the highest level of compliance with all state and federal guidelines.•Responsible for reporting:Aged Trail Balance: A listing of all debit/credit accounts.Maintain Transaction Financial Reports, Procedure Summary, Charge Summary, Charge/Transaction Journal, Procedure Utilization, Patient Demographics and Collection Analysis. Diagnosis Code Usage Report: Breakdown of diagnosis utilization by code or patient.Customized Reports: Based on requested specifications by Medical Director.

Associate In Science, Computer & Network Engineer

Computer Installation And Repair Technology/Technician

High School Diploma