JIMEMA ADEZA GARALDA

• Responsible for providing instruction and training to employees in an organization on how to properly carry out their job duties and as a Quality analyst ensure the input worked by the employees should meet the quality standards set by the organization
• Audits Review on specific performance metrics Identifies the best way to evaluate performance by recognizing challenges and finding solutions to increase its effectiveness
• Stays up to date on Medical Billing Procedures and updates the Operations Team through splash & orientation
• Educate Medical Billers to ensure high QA scores through refreshers, coaching and training
• Shares best practices to help the business outperform competitors and optimize customer relations
• Provides additional assistance on production only when necessary
• Cross Trained to handle Operations (TL task as a POC) as necessary
• Works closely hand in hand with the support team on strategic plans for any process improvements
• Responsible for setting quality standards for the Medical Billing Department
• Performs other tasks assigned by the SQAE and/or Department Head
• Creates a customized dispute process
• Introduce and conduct training to new employees about the Account Receivable process
• Able to guide and explain the billing responsibilities and goals
• Teach the Healthcare 101, denials, US Insurances, Explanation of Benefits analysis, AR follow-up and AR protocols.

• Athena ER, HM and EDI ( Emergency, Hospitalist and Interface) Vibra Healthcare (Outpatient Care)

• PMBS - Micro MD Tool ( Bortolazzo Group, Dubuque Group, Washington Group)
• Athena ER and Hospitalist. Family Medicine.
• Tools used: Athena V2.0, Athena HealthOne, Waystar, EDI, Verinet, Wellsky, MyAbility, Emdeon.
• Insurance webportals: Both Government and Commercial Insurances.

SCOPE and TASK:

• Communicated with insurance payers to resolve denied claims and resubmitted.
• Implemented quality control measures to identify potential errors before submitting claims, reducing rejections significantly.
• Filed and updated patient information and medical records.
• Reviewed patient diagnosis codes to verify accuracy and completeness.
• Verified insurance of patients to determine eligibility.
• Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
• Process Appeals/dispute/ reconsideration.
• Calling or AR Follow up to the insurances.
• Post deductibles/coinsurance/ patients responsibilities.
• Data Entry and Charge posting.
• Process Prior Authorization.
• Sending Claims thru electronic or mail.

TRANSCOM ILOILO

• Receiving inbound calls to assist/ troubleshoot customers equipment (Comcast cable boxes)
• The duties of a technical support is to send cignal/ activate, troubleshooting, providing/ checking the outage in the area.

• Assisting managers/clients with the processing and troubleshooting of taxes via the IRS.

• Handling Triple Play account with Dish Network which shoulders Billing queries, receiving payments, process pay-per review and assisting customers with billing disputes.