Darill Valencia

Experienced medical billing specialist with a comprehensive background in managing billing operations across multiple practice management (PM) systems. Expertise in resolving claim denials and handling payment posting with precision. Adept at utilizing various billing systems to ensure accurate and timely submissions, maximize reimbursements, and maintain compliance with healthcare regulations.

Committed to enhancing billing processes and improving revenue cycle efficiency through detailed analysis and problem-solving skills. Seeking to apply my extensive experience in medical billing to contribute to a high-performing healthcare team.

Medical Biller - SWIFTMDS

(2023-01 - 2026-12)

• Billing and Invoicing: Skilled in generating and managing medical bills and invoices, including itemizing services and charges accurately.
• Reporting: Capable of generating detailed reports on billing and reimbursement activities, helping identify trends and areas for improvement.
• Insurance Verification: Proficient in verifying patient insurance coverage and eligibility, ensuring accurate information for claims processing.
• Coding and Documentation: Adept at assigning appropriate medical codes (ICD-10, CPT, HCPCS) and maintaining meticulous documentation to support claims.
• Claims Submission: Expertise in preparing and submitting insurance claims electronically or via paper, adhering to payer-specific guidelines and deadlines.
• Claim Follow-up: Proven track record in monitoring the status of submitted claims, identifying and addressing discrepancies, and pursuing prompt reimbursement.
• Appeals and Denials: Proficiency in handling claim denials, analyzing reasons for rejections, and preparing appeals with supporting documentation.
• Communication: Exceptional communication skills demonstrated through clear and professional interactions with colleagues, clients, and patients. Proficient in conveying complex billing information in an understandable and empathetic manner, fostering positive relationships and ensuring smooth collaboration within the healthcare team.
• Problem-Solving: Demonstrated ability to identify billing errors, resolve complex billing issues, and optimize revenue cycle management.
• Submitting Medical Records: Experience in securely submitting medical records and documentation to support claims or appeals.
• Patient Support: Providing courteous and helpful assistance to patients regarding billing inquiries, explaining insurance coverage, and setting up payment plans when necessary.

Financial Account Specialist - Concentrix

(2019-01 - 2023-12)

• Fraud Detection: Proactively monitor financial transactions for signs of fraudulent activity, utilizing advanced fraud detection tools and methodologies.
• Transaction Analysis: Conduct in-depth analysis of suspicious transactions, assessing patterns and anomalies to identify potential fraud cases.
• Case Investigation: Initiate and manage fraud investigations, gathering evidence, and conducting interviews to determine the validity of fraud claims.
• Documentation: Maintain meticulous records of all fraud-related cases, including evidence, findings, and actions taken.
• Communication (Phone Skills): Effectively communicate with bank customers via phone, providing clear and empathetic assistance in addressing their fraud concerns and inquiries.
• Dispute Resolution: Handle customer disputes related to unauthorized transactions over the phone, demonstrating exceptional phone etiquette and problem-solving skills.
• Risk Assessment: Evaluate the financial impact of fraud cases and assess potential risks to the bank, making informed recommendations for risk mitigation while conveying this information clearly over the phone.
• Reporting: Generate regular reports on fraud trends, losses, and recovery efforts, assisting in the development of fraud prevention strategies and summarizing this information during phone discussions.
• Customer Education: Educate bank customers over the phone on fraud prevention measures, including safe banking practices and security measures.
• Compliance: Ensure strict adherence to regulatory requirements and industry standards, maintaining compliance with anti-fraud laws and regulations while communicating compliance-related information to customers over the phone.
• Team Collaboration: Collaborate with cross-functional teams, including compliance, legal, and IT, through phone discussions to enhance fraud prevention strategies and response protocols.
• Continuous Improvement: Participate in ongoing training and development programs to stay updated on the latest fraud detection techniques and technologies, occasionally sharing knowledge gained during phone interactions.
• Quality Assurance: Perform quality checks on dispute and fraud resolution processes, ensuring accuracy and efficiency, and conveying any necessary feedback professionally over the phone.
• Customer Support: Provide exceptional customer support over the phone, assisting customers with their fraud-related concerns, and guiding them through the resolution process with a focus on maintaining positive customer relationships.
• Documentation: Prepare comprehensive reports and documentation for internal and external stakeholders, ensuring transparency and accountability, and occasionally discussing the findings or recommendations over the phone.

Sales, Customer Service and Billing Specialist - IQOR

(2017-01 - 2019-12)

• Invoice Management: Utilized QuickBooks to generate and manage accurate monthly invoices, ensuring timely billing during the first week of each month.
• Customer Discounts: Reviewed customer accounts to apply appropriate discounts and promotions, enhancing customer satisfaction and retention.
• Payment Processing: Charged customer credit cards promptly and securely, monitoring transactions to ensure successful processing and resolving any payment issues.
• Late Payment Fees: Applied late payment fees to overdue accounts in accordance with company policies, ensuring adherence to payment terms and improving cash flow.
• Account Reconciliation: Conducted regular reconciliations of billing accounts and statements to identify and rectify discrepancies.
• Customer Communication: Communicated with customers to address billing inquiries, provide detailed account information, and resolve any discrepancies or issues.
• Escalation for Collection: Identified accounts with unresolved payment issues and escalated them to management for collection processes when necessary.
• Billing Records Maintenance: Maintained organized and up-to-date records of all invoices and payment transactions, ensuring compliance with company policies and financial regulations.
• Reporting and Analysis: Generated and reviewed billing reports to track revenue, outstanding invoices, and payment trends, contributing to financial forecasting and decision-making.
• Process Improvement: Identified opportunities to streamline billing procedures and enhance efficiency, collaborating with team members to implement improvements.
• Sales Support: Assisted in upselling and cross-selling additional services or products to existing customers, contributing to revenue growth and achieving sales targets.
• Customer Service Excellence: Provided high-quality customer service by addressing inquiries, resolving complaints, and offering solutions to enhance customer experience and satisfaction.
• Order Processing: Handled customer orders, ensuring accurate entry into the system and timely processing of sales transactions.
• Refund and Replacement Processing: Managed and processed customer requests for refunds or replacements, ensuring adherence to company policies and prompt resolution of issues.
• Order Tracking: Tracked and monitored customer orders through fulfillment stages, providing updates and resolving any issues related to order status or delivery.

Bachelor of Science - Computer Science - St. Peter College of Technology Tarlac (2014-06 - 2018-06)