Mario Hermosa

Performed full-cycle medical billing and follow-up from claim generation to payment resolution for multiple payers, ensuring accurate adjustments before patient balance assignment while working remotely.

Reviewed CPT and ICD-10 coding and submitted inpatient, outpatient, behavioral health, and dialysis claims to Medicare; corrected RTPs and submitted appeals to recover denied claims and ensure accurate patient accounts.

Managed collections and appeals across diverse payer types including Medicaid and Indian Health, educating patients on benefits and securing payments or appeal outcomes.

Assisted members and brokers with dental plan enrollment and renewals, delivered bilingual benefit presentations, and supported agent requests to maximize plan utilization.

Conducted insurance follow-up and appeals for oncology services, audited accounts for correct payments and adjustments, and coordinated patient assistance programs for financially-challenged patients.

Followed up with commercial payers for claim payment, arranged patient payment plans, and communicated with attorneys on motor vehicle–related claims.

Handled patient inquiries on billing discrepancies, coordinated cash posting adjustments, and supported medical billing and collections processes.

Billed Medicare professional charges and appealed rejected claims with physician documentation to secure appropriate reimbursement.

Contacted patients to arrange payments, managed collection correspondence, and maintained accounts receivable for past-due balances.

Contacted patients regarding >90-day balances after insurance payment and pursued resolution through payment arrangements or further processing.

Contacted insurers to obtain referrals and authorizations prior to patient procedures to ensure coverage and appointment readiness.

Performed insurance claim follow-up, verified contractual adjustments per EOBs, and arranged patient payments for remaining balances.

Processed outpatient claims for TPA and HMO products, verified authorizations, and ensured correct CPT/ICD-9 coding prior to adjudication while providing phone-based member service.

Trained and processed claims using CPT, HCPC, and ICD-9 coding to ensure accurate reimbursement to providers.

Completed an Associate of Science in Business with a focus on accounting, awarded December 1991.