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Experience : 12
Specialty : Anesthesiology,Optometry,Family Practice,Hospitalist Billing,Cardiology,Chiropractic,OB Gyn,Pediatrics,
Location : SandySprings,GA
Description :

SIMONE ROJAS is an experienced accounts receivable analyst with a deep knowledge of coding techniques and guidelines of medical coding and billing. With more than 12 years of experience and understanding the importance of operating a structured schedule, utilizing appropriate organizational and government standards. She has worked with a variety of specialties, government contracts, group sizes, new and established with success in retrieving payments on aged accounts while maintaining current accounts receivables. She welcomes the opportunity of learning more about your needs and applying her expertise to best assist your organization.


  • Staff Supervision/ Office Management Consulting and contracting Medical coding and Medical Billing   Implement and manage paperless office
  • Build and maintain Client Relations Full Revenue cycle review EXCEL and report analysis Electronic Systems Operations
  • Provider Enrollment/ Credentialing Accounts Receivable recovery Month-End-Closings/ Reconciliation EDI / Data Conversion




  • Managing team and day to day operations. Review productivity and report results to operational managers.
  • Coach team on improving processing and reaching goals.
  • Review and monitor timeliness reports, capture information and review trends. Gather timesheets transmit to payroll.
  • CMS-588 EFT, CMS-855I, CMS-855R, CMS-855B, CMS-460 Participations and CMS Opt-Out Affidavits.
  • Responsible for handling calls related to the provider enrollment revalidation project.
  • Assisted providers with excellent customer service and direction on completing forms CMS-588 EFT, CMS-855R, CMS-855I, CMS-855B, CMS-460 Participations and CMS Opt-Out affidavits.
  • Direct resource to management and staff for support in handling complicated provider issues, provider enrollment policies, internal and external procedures.
  • Train users on software applications at all levels of the organization. Responsible for group and individual training sessions to include technical training and delivery, coaching, training administration, assessment of competencies, documentation and instructional design.
  • Medical billing and Claim batch training and testing. Training delivery to all levels of the organization.
  • Troubleshoot with clients and function effectively in a fast paced, high volume support environment. Gather and document all information pertaining to the customer issue within company database.
  • Responsible for developing and implementing the practice's mission and strategic vision and for practice development, sales activities, and coding, billing, Charge entry, (Out pt/In pt/Office, multiple POS and SNF).
  • Credential providers- new and existing into healthcare plans and Hospitals.  Oversees the business and financial affairs of the practice and fiscal management in conjunction with the practice CPA.
  • Manages the billing and collection processes/department. Manage all practice managed care relationships, including monitoring of related reimbursement, negotiation with third party payers, provider credentialing, and maintenance of contracts.
  • Serves as liaison and channel of communication between the hospitals, health plans, insurance companies and regulatory bodies.
  • Ensure quality administrator of the Medicare Provider Enrollment program by assuring only qualified and eligible individuals, groups and organizations are enrolled into the program.
  • Reviews, evaluates and determines if the qualifications of healthcare practitioners, providers, groups, hospitals, organizations and entities qualify it for enrollment into the Medicare program facet it desires. In-depth skill level in areas of provider
  • Process all application types efficiently (New, Changes, Reassignments).
  • Work with forms CMS-588 EFT, CMS-855R, CMS-855I, CMS-855B, CMS-460 Participations and CMS Opt-Out Affidavits.
  • Identifying and analyzing areas of potential risk, which threatens timely reimbursement.
  • Devising overall strategy, proposing and implementing solutions to satisfy multiple office locations.
  • Coded procedures, diagnosis codes, payment posting, audits and charge entry. (Out pt/In pt/Office and SNF)
  • Worked complex accounts. Utilizing multiple databases, ICD 9, and CPT to obtain resourceful information.
  • Managed overall account function and employees on special projects. Maximized claim reimbursements.
  • Direct liaison to management and staff on difficult coding and billing issues.
  • Coded procedures, diagnosis codes audits, payment posting and charge entry. Managed heavy call volume, patient counseling, payment plans and all collection functions. Primarily responsible for working unresolved claims, appeals, contact person for insurance companies.
  • (Out pt/In pt/Office and SNF)
  • Utilized several websites, ICD 9, CPT, hospital and office databases.  Credited for identifying and clearing up major Kaiser (non- capitated) insurance issues, resulted in payment on aged accounts over 120 and continued to receive payments long after my employment.
  • Project management lead and operational management for all functions of a startup practice.
  •  Assisted in obtaining working license for practice location. Hired staff, worked with building contractor, managed construction and carpentry work, negotiated reduced rates with vendors and maintained working relationships.
  • Code procedures and set pricing formula for optical merchandise. Stocked office with optical wear, equipment, merchandise and displays. Marketing, advertising and contract development.
  • Responsible for monitoring accounts receivable for the practice. Coding/billing/ appeals/charge entry (Out pt/In pt/Office and SNF)
  •  Organized work schedules and distributed A/R reports. Meet with managing partners. Prepared financial analysis monthly and quarterly reports.
  • Develop reports and submit accounts to collection agency. Interacted directly with management. Backup with executive roles.
  • Assisted as a support team during a transition to a new system. Conducted training sessions with new and existing employees.
  • Managed large account receivable volume. Credential physicians, Obtained pre- authorizations, insurance verification and benefit review.
  • Hospital In- patient/ Out-patient/ and office Coding/Billing/Appeals/Charge entry.


  • Certificate of Achievement, Certificate of Promotions, and various Military Leadership Awards.

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