Mike Hinojosa
Chaska
Summary
I bring over 15 years of dynamic professionalism in a Leadership Role. I have extensive experience in Medicare and other government payers plus commercial payers. I excel in organization, interpersonal relations, and communication skills. I have a wide array of skills and expertise in Physician/Hospital Revenue Cycle Management. I am a Certified Professional Coder (CPC). I have worked in EPIC since 2012 in all aspects.
Overview
16
16
years of professional experience
Work History
Supervisor A/R
Conifer Health Solutions/Revenue Cycle Management
10.2021 - Current
- Responsible for all aspects of the day-to-day supervision and leadership of Patient Account Representatives, including but not limited to the Performance Management metrics of collections, productivity, quality and aging. Interview candidates and make hiring recommendations and decisions. Complete monthly quality evaluations. Monitor staff scheduling and adherence to time and attendance protocol. Responsible for all aspects of A/R Management, including but not limited to maintaining workload balance, ensuring maximum efficiency, eliminating rework, and reducing cost. Promptly identify issues and develop action plans to mitigate or resolve. Train, develop, motivate and assist subordinates in reaching new levels of skills, knowledge and attitude. Effectively maintain a work environment which stimulates and motivates the morale, engagement and growth of subordinates. Identify performance deficiencies and opportunities and implement action plans as needed. Review and respond timely to requests, including emails, telephone calls, issues, account research and resolution as needed by staff, management and clients. Timely completion of accounts referred to the Supervisory Desk by staff or management. Effectively communicate and interact with subordinates, management and clients. Conduct, attend and participate in meetings, conference calls and training sessions, including Management Meetings, Team Meetings, as well as one-on-one monthly meetings with subordinates to provide consistent performance feedback. Complete the mid-year and year end Performance Management review.
Clinic Billing Supervisor
Ridgeview Medical Center
12.2019 - 09.2021
- Responsible for all aspects of follow up and collections, including making telephone calls, accessing payer websites for Medicare, MN Medicaid, Tricare, UCare and other government payers. Identify issues or trending and provide suggestions for resolution. Accurately and thoroughly documents the pertinent collection activity performed. Review the account information and necessary system applications to determine the next appropriate work activity. Verify claims adjudication utilizing appropriate resources and applications. Initiate telephone or letter contact to patients to obtain additional information as needed. Perform appropriate billing functions, including manual re-bills as well as electronic submission to payers. Edit claims to meet and satisfy billing compliance guidelines for electronic submission. Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory. Participate and attend meetings, training seminars and in-services to develop job knowledge. Participate in the monthly, quarterly and annual performance evaluation process with the clinic billers. Respond timely to emails and telephone messages as appropriate. Initiate one on one with each clinic biller to address any issues or trends in denials. Also perform quality reviews each month which includes productivity. Communicate issues to leadership, including payer, system or escalated account issues. Train new hires in the clinic billing department in billing systems plus grant access to payer websites and support the new staff to transition on their own. Update training manuals/documents and share with the staff if needed.
Patient Account Representative
Conifer Health Solutions/Revenue Cycle Management
03.2017 - 11.2019
- Responsible for all aspects of follow up and collections, including making payer phone calls and accessing payer websites. Accurately and thoroughly document the pertinent collection activity performed. Review the account information and necessary system applications to determine the next appropriate work activity. Verify claims adjudication utilizing appropriate resources and applications. Initiate telephone contact to patients to obtain additional information as needed. Perform appropriate billing functions, including manual re-bills as well as electronic submission to payers. Edit claims to meet and satisfy billing compliance guidelines for electronic submission. Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory. Participate and attend meetings, training seminars and in-services to develop job knowledge. Participate in the monthly, quarterly and annual performance evaluation process with the supervisor. Respond timely to emails and telephone messages as appropriate. Communicate issues to management, including payer, system or escalated account issues.
Medical Reimbursement Specialist
Assurex Health
06.2016 - 02.2017
- Populate and maintain Standard Operating Procedures, including payer specific date for the management of claims. Monitor status of claims in collections system. Investigate error notifications, respond to denials, resubmit and/or appeal as appropriate. Assembled appeal packets with appropriate documents/medical records and mailed to the proper payer. Worked patient accounts thru spreadsheets until the claims were paid by the payer. Monitor and report standardized metrics on claims status/progress for Medicare Advantage. Establish contact points/relationships with payers to optimize claims/appeals process. When claim/appeals process exhausted (according to policy), hand off to Customer Service to initiate collections from patients.
Medical Billing Specialist
Physician Focus
11.2015 - 05.2016
- Worked two accounts: Cardiology and Gastroenterology. Data entry-Verifying eligibility with insurance companies, patient demographics. Work monthly insurance aging reports for Medicare, Blue Cross, etc. Filed appeals to insurance companies including the attachment of medical records for denied claims and follow ups. Answer any patient questions regarding monthly statements. EPIC billing software for cardiology and Intergy billing software for gastroenterology. Entered office charges for gastroenterology providers and procedure charges (endoscopies, colonoscopies) thru physician’s reports from emails. Work monthly patient aging reports and work monthly statements. Posting of insurance payments to accounts (balance by day’s end) and patient payments.
Medical Billing Specialist
California Cardiovascular Consultants
04.2012 - 11.2015
- Data entry-patient registration and insurance verification. Entered office charges, hospital and procedure charges (LHC, Stents, etc) for three cardiologists including coding the procedures and assigning the appropriate diagnosis. Posting of insurance payments to accounts (balance by day’s end) and patient payments. Worked the monthly aging report for unpaid claims. Filed appeals to insurance companies including attaching of medical records and follow ups with the payers thru payer websites and phone calls. Compiled monthly figures from Medicare payments for the CEO. Worked patient collections by calling patients and sending them correspondence, worked with the collection company for assistance of patient accounts. Attended monthly meetings within our billing office with the manager regarding updates to Medicare, changes in policies and procedures.
Medical Billing Specialist
Advantage Billing Network
02.2009 - 04.2011
- Data entry-patient registration and insurance verification thru payer websites and payer phone calls. Entered office charges for several providers including procedure codes/diagnosis codes. Posting of insurance payments to accounts (balance by day’s end) and posting patient payments. Worked the monthly aging report for unpaid claims and appealing claims with the necessary forms and medical records. Worked with all insurance companies such as Medicare Part B, UHC, Blue Cross/Blue Shield, Aetna, Medicaid, HMOs/PPOs.
Skills
- Government Payers
- Commercial Payers
- Working Accounts Receivable/Follow Up/Denials: Leading my team in getting a resolution for denied claims by getting them paid including generating appeals and following up on those appeals
- Billing Systems: EPIC (10 Years), Intergy, Xifin, MS4, DDE, EBO Pro, ACE, Allscripts
- Billing Editors: Epremis, Relay/Assurance, Change Healthcare
- Direct Data Entry (DDE): Novitas and Noridian
- Coding in Cardiology, Gastroenterology, Office Visits, etc from Provider Orders/Medical Notes/Records
Timeline
Supervisor A/R
Conifer Health Solutions/Revenue Cycle Management
10.2021 - Current
Clinic Billing Supervisor
Ridgeview Medical Center
12.2019 - 09.2021
Patient Account Representative
Conifer Health Solutions/Revenue Cycle Management
03.2017 - 11.2019
Medical Reimbursement Specialist
Assurex Health
06.2016 - 02.2017
Medical Billing Specialist
Physician Focus
11.2015 - 05.2016
Medical Billing Specialist
California Cardiovascular Consultants
04.2012 - 11.2015
Medical Billing Specialist
Advantage Billing Network
02.2009 - 04.2011
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