Mario A. M. Hermosa
3021 N. 47th Street
Phoenix, AZ  85018
Cell:  [Send email to request phone number] 20-4392


Objective:  To successfully accomplish the task necessary as a means of
achieving a goal, individually or as a team and with opportunity for advancement.
  


Qualification: Fifteen years in the healthcare insurance industry in the areas
of claims examining, customer service, and account follow-up.  Speak Spanish
fluently and have assisted the Hispanic community in problem areas of debt. 
Assisted patients to better understand their insurance plan for maximum benefit
utilization.  Knowledgeable in ICD-9-CM, HCPC’s, and CPT coding guidelines. 
Knowledgeable in Office 2000, Winterm, IDX, along with other healthcare billing
systems.  Knowledge of CMS guidelines.  Knowledge with health insurance such as
HMO, PPO, Indemnity, Medicare, Medicare Replacement plans, Indian Health, and
Arizona Medicaid (AHCCCS).  Customer service oriented, always trying to find a
solution to a customer’s problem in hopes of achieving their satisfaction. 
Research patient accounts for correct insurance payment and adjustment along with
correct posting of patient payment.  Assist with patient assistance through means
of hardship or through various healthcare or pharmaceutical companies with
patient assistant programs.  Assisted clients with employee enrollment and
terminations.  Have spoken publicly to new employer groups during open
enrollment.  Submitted group renewals to contracted brokers and agents.  

Education:  Associates in Business (Accounting), Chaparral College, Tucson, AZ.,
12/20/91

Relevant Experience:

3/09-6/09: AZ Reproductive Medicine Specialist, Phoenix, AZ; Billing
Coordinator.
	Posted insurance payments from explanaiton of payments on patient's accounts. 
Assisted patients with balance on their accounts.  Corrected patient's accounts
from patient calls as necessary.

11/07-3-09: Medical Management Southwest, Phoenix, AZ; Medical Collection
Specialist.
	Review medical accounts for any errors with CPT or ICD-9 coding.  Submitted
medical claims for various healthcare related insurances, both commercial and
government.  Appealed any denied claims as necessary.  Assisted patients with any
questions on their billing statement.  
 
10/06-07/07: Southwest Preferred Dental Organization, Phoenix, AZ; Account
Service Representative.
	Assisted brokers and agents with insurance packet request.  Attended open
enrollment meetings and spoke employer groups about their benefits in regards to
dental care.  Assisted in the process of new groups prior to fully policy
assembly and entering of members to IMPACT System.  Handled inbound calls from
clients, brokers and agents.  Left company to stay in medical billing.

11/00-10/06:  Arizona Oncology Associates, Tucson, AZ; Account Follow-up
Specialist II.
	Called various health insurances to follow up on HCFA 1500 claims submitted. 
Submitted appeal letters with any clinical records or studies on any denied
claims.  Took in-bound calls form patients wanting to set up payment arrangements
with any balances after insurance payments.  Worked with A/R over
$100,000.00/monthly.  

7/00-11/00:  EAI Healthcare Staffing Solutions, Inc., Tucson, AZ; Account
Follow-up Specialist I.
Assigned to Arizona Oncology Associates to follow up on HCFA 1500 claims
submitted to health insurances.  Called insurance for status of claims. Appealed
denied claims, attaching any documents to assist in claims payment.  Set up
payment arrangements with patients after insurance payment.  Hired on to AZ
Oncology Associates.

1/00-6/00:  Maryvale Hospital Medical Center, Phoenix, AZ; Account
Representative
	Received in-bound calls from patients willing to set up payment arrangements. 
Called health insurance on UB92 claims submitted.  Assisted with attorneys
requesting itemized statements on motor vehicle accident related issues. 
Appealed with health insurance on denied claims attaching any medical records for
justification of services rendered.  Left company to move to Tucson with family.


4/77-1/83: United States Air Force, Aircraft Maintenance Mechanic: Hydraulic and
Pneumatic Systems