Edelmiro O.

Billing Denials Specialist @Sarahcare Home Care & Adult Day Care

Philadelphia, PA, US

Manage the full revenue cycle for Medicaid billing, ensuring accurate claim submission and prompt reimbursement.• Verify patient insurance eligibility, obtain necessary pre-authorizations, and ensure compliance with payer-specific guidelines.• Monitor denials and rejections, perform root cause analysis, and implement strategies to reduce reoccurrence.• Maintain electronic health records and ensure alignment with HIPAA and Medicaid regulations.• Conduct regular audits of billing data to ensure accuracy and reduce potential compliance risks.• Utilize systems such as HHA Exchange, NaviNet, PA Promise, UPMC, and PA Health & Wellness to streamline billing and improve efficiency.

Rutgers University–New Brunswick

Masters of Science, Healthcare Administration and Management

Temple University

Master of Business Administration - MBA, Accounting

Rutgers University–New Brunswick

Masters of Science, Health Information Management