Sonia Hermoso

With over 10 years in the healthcare industry, I have developed a comprehensive toolkit that includes medical billing, claims auditing, and team leadership. My career has been defined by a commitment to management roles, quality assurance and billing and collections, particularly within high-volume environments where precision is paramount. I am eager to transition my skills into a fully remote opportunity.

I am a self-motivated professional who thrives when working independently, whether I am deep in an Excel-based audit or mentoring a team to meet performance goals. I am highly adaptable to new systems and passionate about finding efficiencies that improve organizational workflows.

Medical Billing-Team Lead - Integrated Home Care Services - Miramar, FL

(2024-04 - 2026-07)

• Assist with New Hire Onboarding process
• Train on DME (Durable Medical Equipment) billing software such as Brightree, (EHR) NextGen systems and Microsoft Office Suite (Excel, Word), Medtrac systems
• Daily auditing & quality assurance reports
• Verified insurance eligibility and obtained prior authorizations to ensure coverage for equipment and supplies
• Prepare and submit appeal letters with supporting documentation (payer forms, medical records, prior authorization details, clinical justification)
• Oversee all claims for Medicare, Medicaid, and various commercial insurance plans
• Resolved billing inquiries, explained account balances, and managed claims processing
• Responsible for managing appeals to ensure proper reimbursement and avoid Timely filing
• Review denied claims and determine appropriate appeal strategy based on payer guidelines
• Collaborated with other management and other department team members to resolve complex issues or improve processes
• Managed the end-to-end billing cycle for durable medical equipment, including order confirmation, claim submission, payment posting, and denial management
• Responded to other departments (Collections, Posters, Accounting etc.) for patient billing inquiries
• Handle all billing inquiries, disputes, and appeals, ensuring timely and efficient resolution
• Analyzed claims payment to ensure accuracy and reconcile any discrepancies identified in Explanation of Benefits (EOBs)
• Obtains and maintains a basic understanding of third party billing requirements as assigned, including federal, state and commercial payers
• Responsible for account receivable, investigates and reviews claims based on the productivity standards set by management
• Process all HCFA-1500 claims through the related billing system, working the related claims scrubber in a timely and efficient manner; performs all associated duties in order to ensure the completeness and accuracy of all claim information, facilitating maximum reimbursement
• Reviewed medical records and patient documentation to ensure all required information was included before submitting claims
• Submitted electronic or paper claims to primary, secondary, and third-party payers
• Assist with escalation calls (Patients, Hospitals, Doctor's office, Case managers, Health plans)
• Manage complex denial resolution and appeal strategy across medical necessity, authorization, coordination of benefits, and timely filing, and drive denial trend analysis
• Work closely with the accounting department to ensure accurate financial records
• Processed orders, returns, and exchanges efficiently, maintaining accurate records in the company's CRM system. (DME, CPAP, Oxygen and Ostomy, Wound Care supplies)
• Analyze daily aging of insurance accounts via the billing system to determine appropriate follow up for non- payment and delayed payment accounts, as well as to ensure compliance with all Federal, state, insurance payer and St. Luke's Network policies
• Analyzes denied claims and investigates the reasons causing the denial and takes the necessary action to resolve the denial and/or resolution of the account
• Seeks resolution to problematic accounts and payment discrepancies with optimal goal of receiving accurate payments and maximum reimbursement
• Verified patient insurance coverage and benefits, updated patient records, and processed payments

Medical Biller - Integrated Home Care Services - Miramar, FL

(2019-06 - 2024-04)

Customer Service - Integrated Home Care Services - Miramar, FL

(2018-05 - 2019-06)

Case Manager - Change Healthcare - Weston, FL

(2017-04 - 2018-04)

• Acts as liaison between the member and our teams to promote effective communication
• Maintained close contact with the members throughout the entire process of enrollment in State Programs
• Conduct regular meetings with clients to review progress, mental health stability, appointments, and discharge readiness
• Access member's PHI to provide accurate information for assistance, in accessing member's account information and for enrollment purposes
• Ensures all documentation are accurate and compliant with GHS standards, Florida State and Federal Regulations
• Assists members with options for needed programs/services in their area (transportation, translations, prescriptions discounts, Medicare Savings Program and other (State Programs)
• Support clients with completing redetermination forms, SNAP applications, and other essential documents
• View all incoming documents requested for accuracy prior to submitting to State
• Coordinate and assist with referrals for medical care, entitlements, transportation, education, employment, legal assistance, and more

Supervisor-Medical Records - LaVan & Neidenberg Law office - Plantation, FL

(2013-05 - 2017-04)

• Manage and train a team of medical records employees, including medical coders and health information technicians. This involves assigning tasks, monitoring performance, and providing guidance
• Prepare reports and compile health statistics for upper management and administrators to assist with evaluating department performance
• Oversee all procedures to ensure the accuracy, confidentiality, and security of medical records, in compliance with laws like HIPAA
• Regularly audit records for accuracy, completeness, and proper storage
• Manage the organization, retrieval, and release of patient records, including responding to requests from third parties
• Work with healthcare providers and IT staff to ensure the proper flow of information and resolve any issues
• Collaborate with attorneys, paralegals, and other team members to ensure accurate and timely records reviewed
• Implement and enforce policies and procedures to ensure that all patient records are accurate, complete, and up to date. This includes performing regular audits
• Process requests for medical information from third parties, such as insurance companies, our attorneys, and patients, ensuring all procedures are followed correctly

Supervisor-Customer Service - EMP Medical - Coral Gables, FL

(2012-12 - 2013-04)

• Managed and developed a team of customer service agents/representatives
• Provided daily guidance, coaching, and performance feedback
• Delegating tasks, managing workload, scheduling, and ensuring efficient operations
• Conduct performance reviews, provide coaching and feedback
• Monitored performance metrics like customer satisfaction (CSAT) and average handling time
• Facilitated training sessions for new hires and provide ongoing professional development for existing staff
• Handled escalated customer issues, consistently achieving high resolution rates and maintaining a positive brand image
• Collaborated with other departments to address customers concerns and ensure seamless coordination
• Collaborated with other management and other departments to resolve complex issues or improve processes

Medical Billing/Coding - Florida Career College (2006-01)

High School Diploma - Miami Central Sr. High School (1994-06)