LinkedInMariely Carrero

Mariely Carrero

Billing,Coding and Collections Manager Physician Partners Of America

Location
Tampa/St. Petersburg, Florida Area
Industry
Hospital & Health Care
Current
  1. Physician Partners of America
Previous
  1. Apollo Beach Family Medical Center,
  2. Everest University,
  3. Neuro Center Brandon
Education
  1. Everest University
Recommendations2 people have recommended Mariely
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Physician Partners of America

Physician Partners of America

Senior Collector

– Present

View full profile

Background

Summary

Seeking a challenging position with an organization that will utilize my billing and collection skills and experience

Specialties:Bilingual in Spanish; Experienced in handling A/R in excess of $1 million; Take initiative and demonstrate leadership abilities; Excellent problem solving skills; Capable of interpreting contracts and cross referencing payments made according to carrier and patient's benefits health plans. Extensive experience in IVIG claims; Proactive professional who can identify collection trends and solve them in a timely manner.

Experience

Senior Collector

Physician Partners of America
– Present (11 months)

Coordinator Insurance,Coding and Billing Department

Apollo Beach Family Medical Center
(1 year 4 months)Apollo Beach Florida

BS In Science, CPC

Everest University
(2 years 2 months)Brandon Fl

Obtained a degree

Externship

Neuro Center Brandon
(2 months)

Externship 160 Hours
· Obtained authorizations
· Scheduled patient appointments
· Corrected doctor's dictations prior to primary submission
· Verified patient health benefits
· Collected co-pay's, co-ins and deductibles
· Submitted appeals on short paid claims

Patient Financial Specialist

Ambient Healthcare Home Infusion
(1 year 4 months)Tampa Fl

• Handled all accounts receivableand all high volume accounts
• Collected and appealed from all third party payors
• Improved company profit margins with collections over $1,000,000 monthly
• Interpreted contracts and cross referenced to ensure proper payments were made

Patient Financial Specialist

Ambient Healthcare
(1 year 4 months)

· Handled all accounts receivable and all high volume accounts
· Collected and appealed from all third party payors
· Improved company profit margins with collections over $1,000,000 monthly
· Interpreted contracts and cross referenced to ensure proper payments were made

Collections Specialist

Surgery Partners
(2 years 5 months)Tampa, FL

•Responsible for all BCBS patient accounts within the 12 ambulatory surgery centers, including the pain management facility and anesthesia
•Handled all accounts receivable over 1 million dollars
•Set in place certain criteria's for submitting claims to BCBS for our participating providers as well as our non -participating providers in order to receive proper reimbursement in a timely manner
•Interpreted contracts and cross referenced to ensure proper payment was made according to patient's benefits health plan with BCBS
•Communicated with upper management and office managers for all ambulatory facilities
•Successfully handled all functions associated with outstanding account balances from third party payors
•Identified delinquent accounts, aging periods and payment sources and performed collection actions
•Evaluated patient financial status and established payment plans as appropriate
•Continuously met and exceeded assigned cash and productivity goals
•Obtained a relationship with BCBS payors and obtained a provider relations direct contact

BCBS Collections Specialist

Surgery Partners
(3 years 5 months)

· Responsible for all BCBS patient accounts within the 12 ambulatory surgery centers,
including the pain management facility and anesthesia
· Handled all accounts receivable over 1 million dollars
· Set in place certain criteria's for submitting claims to BCBS for our participating
providers as well as our non -participating providers in order to receive proper
reimbursement in a timely manner
· Interpreted contracts and cross referenced to ensure proper payment was made according
to patient's benefits health plan with BCBS
· Communicated with upper management and office managers for all ambulatory facilities
· Successfully handled all functions associated with outstanding account balances from
third party payors
· Identified delinquent accounts, aging periods and payment sources and performed
collection actions
· Evaluated patient financial status and established payment plans as appropriate
· Continuously met and exceeded assigned cash and productivity goals
· Obtained a relationship with BCBS payors and obtained a provider relations direct
contact

Collections Representative

Clifton Ambulatory Surgery Center
(1 year 9 months)Clifton New Jersey

•Responsible for an A/R of over $1 million dollars for various carriers- PIP, WORKERS COMP, HMO's, & PPO's
•Dealt with primary and secondary as well as third party payors for collections
•Worked off an aging report every month to address all 30 to 180 days past due accounts
•Identified and prepared adjustments and write offs as appropriate
•Negotiated with the attorney staff in regards to court settlements and arbitration accounts

Collections Representative

Clifton Ambulatory Surgery
(1 year 9 months)

· Responsible for an A/R of over $1 million dollars for various carriers- PIP, WORKERS
COMP, HMO's, & PPO's
· Dealt with primary and secondary as well as third party payors for collections
· Worked off an aging report every month to address all 30 to 180 days past due accounts
· Identified and prepared adjustments and write offs as appropriate
· Negotiated with the attorney staff in regards to court settlements and arbitration
accounts

Collections Representative PFSC

Coram Health Care Home Infusion
(3 years 5 months)Totowa, NJ

•Interpreted contracts with payors to ensure proper payments
•Specialized Oxford Healthcare, Tricare and MVP carriers in collections for the IGIV's
•Posted payments to accounts / Ensured all cash, adjustments and refunds were posted
•Worked off an aged trial balance to ensure at least a 30 day follow up on all patient accounts
•Worked with first, second and third party payors
•Follow up on daily correspondence (denials, low pays) to appropriately work patient accounts.
•Processed refunds, reinstatements and rejections of insurance claims
•Ran daily reports and invoices

Office Manager

Med Pay Associates
(9 years 10 months)Clifton NJ

•Accountable for coordinating all necessary steps to secure collections and billings were done properly in order to have reimbursement in a timely matter
•Trained staff of 18
•Worked on spreadsheets and graphs to keep track of new patients
•PIP 21-Day notification to the carriers for any medical treatment
•Obtained authorization for service for all patients

Courses

Everest University

  • ICD-9, Medical Term, CPT Coding, Physiology,Medical Records

Languages

  1. Spanish

Skills

  • Healthcare
  • Negotiation
  • Customer Service
  • Medical Billing
  • HIPAA
  • Microsoft Word
  • Medical Coding
  • Medicare
  • Hospitals
  • Outlook
  • Microsoft Office
  • Accounts Receivable
  • Invoicing
  • Leadership
  • Insurance

Education

Everest University

AS in Science, Associates in Science Medical Insurance Billing & Coding

Future Graduation January 2012, in additon I have also been a medical collector for the past 15 years.

Essex County Vocational & Tech H.S. Bloomfield N.J.

High School Diploma, Drafting

Everest University

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