JOHN MILL GUELAS

Medical Billing & Revenue Cycle Management

• Verified patient insurance eligibility and benefits for commercial, Medicare, Medicaid, and HMO plans.
• Managed prior authorizations for medications, MRI, CT, PET scans, sleep studies, trigger point injections, and specialty procedures.
• Reviewed patient demographics and insurance information to ensure accurate claim submission.
• Assisted with claim follow-up and denial management by identifying billing errors and coordinating with insurance carriers.
• Monitored claim status, payment processing, and reimbursement activities.
• Worked closely with providers and clinical staff to obtain required documentation supporting authorization requests.
• Maintained compliance with HIPAA regulations and payer-specific requirements.
• Assisted patients with billing inquiries, insurance coverage questions, and payment responsibilities.

Insurance Verification & Authorization

• Performed comprehensive insurance verification to determine eligibility, benefits, copays, deductibles, coinsurance, and referral requirements.
• Obtained and managed referrals for specialty visits and diagnostic testing.
• Coordinated authorization requests with insurance companies, providers, and healthcare facilities.
• Tracked authorization approvals, denials, expirations, and renewals to prevent delays in patient care.

Patient & Provider Coordination

• Scheduled patient appointments and coordinated follow-up care.
• Communicated with patients regarding appointment preparation, authorization status, billing concerns, and treatment plans.
• Collaborated with physicians, nurses, and administrative staff to support efficient patient care and revenue cycle operations.
• Conducted patient outreach for infusion follow-ups, appointment reminders, and insurance updates.

Revenue Cycle Management (RCM)

• Supported front-end and back-end revenue cycle functions.
• Ensured accurate patient registration and insurance data collection.
• Assisted in reducing claim denials through proper documentation review and eligibility verification.
• Maintained authorization records and billing documentation to support timely reimbursement.
• Followed up on unpaid claims and resolved payer-related issues to improve collections.

• Respond to questions about health insurance coverage, claims, benefits, eligibility, and provider networks.
• Provide accurate information regarding medical claims, billing statements, and payment options.
• Help patients schedule, reschedule, or cancel appointments.
• Escalate complex medical, technical, or billing issues to the appropriate department.