janice dela cruz

* Auditing, analyzing and collecting on patient accounts from claims submission to zero * Call Insurance payors on unpaid balances, making sure claims paid per Contracts * Correct and resubmit Hospital Claims * Review ERA's and process appeals to Insurance companies * Post adjustments as needed * Meet daily productivity goals and objectives as assigned by management * Answer calls and promptly assists with questions or problems

* Billing Professional Claims for Orthopedic, Physical Therapy, Chiropractic, Neurology and Sports Medicine * Entering Charges using Software Program and submitting claims to HMO, PPO and Govt companies for payment * Electronic Billing, Insurance Verifications and Authorizations * Insure accuracy of Insurance claims by verifying ICD-9 and CPT Codes for variety of specialists * Post deductibles, adjustments and payments per EOB details * Research and resolve incorrect payments, EOB rejections, and other issues with outstanding accounts * Monthly processing of patient statements

* Responsible for billing professional claims to Workers Compensation carriers * Follow up on unpaid accounts and files appeals on underpaid and denied claims * Contacts Insurance Companies, Defense Attorneys, Patient's Employers over the phone or in writing to negotiate bills/liens * Knowledge of preparing, filing and serving WC Liens and DOR's for Lien Conferences and Trials * Work with programs such as Eams, Edex and Lytec

* Identifies problem accounts with payors * Follow up on all claims from billing through final resolution. * Identify billing errors for correction, itemization for billing, inconsistencies, missed charges and resubmit * Follow up on payment errors, low reimbursement, denials, etc. * Review Insurance EOB’s and initiates appeals as necessary. * Prepares reports to identify and resolve accounts receivable and referral problems * Cleans all claim edits on electronic billing system * Makes any claim adjustments in the host system daily * Composes and types routine correspondence, memos, letters, etc.