Richard Alvarez

Experience

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  Tenet- Palmetto General Hospital

  Apr 1990 - Dec 1998

  Hospital Billing and Collections Associate - Patient Financial Representative/Counselor

  During that period, a major gap existed between the admissions/registration department's information gathering and the business office collections department. I played a pivotal role in illustrating to the administration that our collections were significantly impacted by errors and inconsistencies in gathering insurance information and documentation during the initial patient contact, whether in person or over the phone. Collaboratively, we implemented documentation policies and provided training. The downstream effect was remarkably positive, and I received substantial recognition for my proactive initiative in various ways. Advocated for and supported patients in navigating benefit applications under federal (SSI/SSD), State (HRS/DCF), and county programs. Key responsibilities encompassed managing collections, billing, screening, and coding for workers' compensations, as well as handling money adjustments, transfers, and postings. Show less

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  KINDRED HEALTH CARE

  Jan 1999 - Oct 1999

  Hospital Billing and Collections Associate/Financial Representative

  During my short time at Vencor Hospital, I made a substantial impact on their financial ledger, particularly in terms of account receivable days. The Long-term acute care claims ledger saw significant improvement due to my focused efforts in collections, going as far as personally visiting the insurance companies' claims processing centers within the state of Florida to expedite the collections. The role involves facilitating the efficient functioning of the business office, particularly in the timely collection of medical claims. Duties encompass generating on-demand and monthly reports, expediting reimbursement processes, managing collections, billing, screening, and coding for Advocated for and supported patients in navigating benefit applications under federal (SSI/SSD), State (HRS/DCF), and county programs. Key responsibilities encompassed managing collections, billing, screening, and coding for, long-term acute care as well as handling money adjustments, transfers, and postings.This includes the review, correction, and submission of claims to payers, as well as taking proactive measures for unpaid accounts. Meeting productivity and quality benchmarks, calculating write-offs and adjustments, offering general office support, and fulfilling other assigned responsibilities are integral aspects of the position. Show less

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  Humana

  Jan 2000 - Nov 2022

   Enthusiastic and proactive individual with more than two decades of experience in the Health Care Industry, driven by a strong sense of initiative.  Outstanding abilities in organization and customer service.  Exceptional focus on details. Proficient in identifying and communicating solutions to complex problems. Empathy, adaptable, contribute to excellence. Seasoned in medical terminology with complete fluency in both English and Spanish, bringing a heightened level of expertise to the table. Skilled in Microsoft Office applications with a proactive attitude toward acquiring new skills. Show less Stakeholders and Managed Care groups expressed concerns about errors in insurance payments, whether through the company’s portal or email. Employing tools such as the Claim Adjudication System and contract warehouse platform, along with analyzing the company's financial ledger, I crafted reports that identified service providers experiencing similar issues. This effort aimed to enhance and streamline our processes effectively. After looking into the root causes, we advised our teams and partners about what we found. We implemented modifications to the system where errors were identified, ensuring preventive measures for future issues. Together, we created ways to stop mistakes from happening again, including more associate training, claims processing edits, associate manual work-flows charts, emails and virtual meetings. We kept getting better by testing and regularly checking. To make things more efficient, we added extra details to our financial reporting, stopping problems with claims loading errors. Continuously helped the Stakeholders and Risk groups understand revenue risks better. As a team player, I actively helped create reports, and update workflow diagrams for future automation initiatives. I also worked hard to keep good relationships with Stakeholders in the Florida Market. By the aforementioned tasks, I played a big part in educating other departments about capitation leakage and executed plans to control Risk Partners' Capitation expenses. Stakeholders and Managed Care groups were happy with our work. They liked how we quickly responded, used tools, and found new ways to do better. Our focus on efficiency, improvement, and working together left a good impression. The reports and audits on claims have enhanced everyone’s understanding of revenue risk, facilitating informed decision-making and simplifying the process. Show less

  • Professional in Claims and Processing with a focus on Customer Service.

    Jan 2000 - Nov 2022

  • Contestations Payment Integrity Professional

    Jan 2000 - Nov 2022
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  MedSrv

  Aug 2024 - now

  CBO A/R Insurance

  Review unpaid, underpaid, denied, or unresolved insurance claims, ensuring accuracy, completeness, and timely submission. Rebill, appeal, and resolve errors to meet performance goals. Analyze EOBs, using CPT and ICD-10 codes, and utilize payer portals for claims statuses and eligibility. Handle authorization denials, follow-ups, and escalate coding issues as needed. Prepare reports and communicate denial trends to management. Maintain professionalism and consistently meet productivity standards.