Rachael Banda has over 25 years of experience in medical insurance and billing. She has expertise in areas such as patient services, account management, medical coding, insurance processing, billing, collections, and claims processing. She is proficient with billing systems like MS4, MediSoft, Mars, and MediFax. Banda has extensive experience in various roles, including as a billing manager, billing specialist, claims analyst, and medical billing contractor. She is skilled at negotiating with insurance companies, reducing accounts receivable, and ensuring proper billing and coding. Banda is seeking new opportunities where she can apply her strong work ethic and attention to detail.

1. Rachael Banda
13409 Chico Rd. N.E.
Albuquerque, NM 87123
480-386-4220
rachaz63@msn.com
 25 years in the Medical Insurance and Billing field performing: Patient Services, Account
Management, Medical Coding, Insurance Processing, Billing and Collections, Claims
processing, Implementation of Accounts for New and Renewal. Credentialing of
Providers to insurance companies and facilities.
 Exceptional communication, relationship with management, problem solving,
negotiating, multi-tasking as well as trending issues, organizational and project
management skills.
 Billing System Expertise: MS4, MediSoft, Mars, MediFax and PPM
 Knowledge of Medicare/Medicaid billing codes (CPT) commercial contracts, claims
processing and secondary billing, and appeals processes.
 Mature, reliable, goal oriented, detail focused and strong work ethic.
 Willing to relocate: Anywhere
WORK EXPERIENCE
R&B Consulting - Phoenix, AZ
Self Employed Contractor
Responsibilities
I have my own business consulting for various providers who need help with their AR, billing or
payment posting.
Accounting Principals April 2016 - Current
 Making collections calls and/or correspondence in a fast paced goal oriented collections
department
 Provide customer service regarding collection issues, process customer refunds, review
and process account adjustments
 Accountable for reducing delinquency for assigned accounts
 Establish and maintain effective and cooperative working relationships with all
departments as well peers
 Excellent customer service
 Collections experience
 Strong attention to detail
 Ability to prioritize and manage multiple responsibilities
 Commitment to providing excellent customer service
 15 years Collections experience

2.  Strong attention to detail
 Excellent communication skills, both written and verbal
 Ability to prioritize and manage multiple responsibilities
Gilbert Hospital January 2016 – February 2016
 Reduces account receivable by the timely follow up of unpaid accounts.
 Reviews all information to ensure account accuracy. Prorates billing cycle when
necessary, corrects demographic information, financial classification to name a few.
 Researches/Investigates assigned accounts to determine what additional steps must be
taken for accounts to be paid in full.
 Identifies system problems. Reports these problems to manager/vendor for resolution.
 Consults with claim processors at Third Party payer to determine denial reasons and
expedites resolution.
 Reviews remittance advice when necessary for no pays or short pays to verify proper
reimbursement and to make adjustments as necessary.
 Identifies coding and billing errors from the EOB and works to correct errors in a timely
manner.
 Able to work 50-100 accounts per day.
 Prioritizes workload to allow all accounts 30days or over to be worked.
 Notifies management of all payer issues that may impede the collection process.
 Maintains timely follow-up when working with other departments, vendors for pending
information.
 Performs all duties as assigned.
 Excellent communication and interpersonal skills in order to work effectively with
service partners.
 Strong problem solving/root cause analysis expertise.
Wayne Perry & Associates - Conifer Healthcare October 2015 – January 2016
Contractor
 Follow up on all A/R for balances that are due from either the patient and or insurance
companies
 Resubmitting claims that may have denied and or short paid. Work accounts that have
balances.
 Appeal any claim that was short paid on the account.
 Excellent communication and interpersonal skills in order to work effectively with
service partners.
 Strong problem solving/root cause analysis expertise.

3. Banner Health Care - Sonora Quest Labs January 2010 to May 2013
Billing Specialist Patient Accounts
Sonora Quest Responsibilities:
 Responsible for all patient account receivables, updating all bankruptcies and death
certificates and for adjusting any outstanding balances.
 Ensure all insurance information that patients have is updated and rebilled insurance
companies for proper payment.
 Assist upper management collect all data for patients that require financial help with their
accounts for the indigent program.
Set up payment plans for patient that are not able to pay in full at time of service or when
they receive their statements.
 Work several special projects for Supervisor to insure patient A/R is dropping.
 Banner Health Care Responsibilities:
 My duties include: Lead biller for all Western Region Commercial Contracts claims for
services rendered, collections of accounts that are current and past due.
 Make sure claims are processed and paid correctly as per our contract with the Insurance
Company in question. Ensure all claims have been billed out to Insurance companies.
 Make phone calls to Insurance companies for status of claims and or eligibility and
benefits for each patient seen in our facilities.
 Appeal any claim that is denied by the Insurance for any reason.
 Make sure that all claims are coded and diagnosed correctly.
 Cross collaboration to other Banner departments to ensure billing codes and charges are
valid.
San Tan Urgent Care Center April 2009 to January 2010
Billing Manager
 My duties include electronically submitting medical claims and filing paper claims to all
Insurance Companies.
 Reduced A/R from $285k to $125k by correcting past billing claims to the correct
contract reimbursement for 3-4 month period.
 Re-credential and re-negotiation the doctor's contracts for ALL Insurance Companies.
 Follow up on all A/R for balances that are due from either the patient and or insurance
company or workman's compensation claims.
 Post payments and EOB's to accounts. Coding claims all claims from doctor notes with
CPT codes and ICD-9 codes and post charges to their account for each patient that comes
through the Urgent Care.

4. Fresenius Medical Care December 2008 to October 2009
South- Medicaid Collector
 My main duties include billing Mississippi, Arkansas, Louisiana and Alabama Medicaid
for Kidney Dialysis
 Services rendered.
 Resubmitting claims that may have denied and or short paid. Work accounts that have
balances.
 Appeal any claim that was short paid on the account.
CIGNA Health Care June 2007 to December 2008
Small Market Implementation Manager
 Participate and facilitate the design, development, and implementation of new operational
controls, performance metrics, information management systems, and automated
processes.
 Compile and analyze results of services for identification of process improvement.
 Serve as a technical, procedural, or workflow resource for improvement teams, matrix
partners and management.
 Provide measurement and cost savings support (reporting) for management.
 Knowledge of CIGNA HealthCare products and procedures including state mandate and
legislation requirements.
 In-depth business knowledge of CIGNA Eligibility Systems and processes.
 Excellent communication and interpersonal skills in order to work effectively with
service partners.
 Strong problem solving/root cause analysis expertise.
 Work in a highly matrixed organization that requires developing relationships and
networking with internal team members at all levels of the organization.
 Facilitate and negotiate with matrix partners to meet client deliverables.
 Excellent organizational skills with the ability to prioritize and work on multiple
assignments simultaneously.
 Strong analytical and problem solving skills. Work independently.
 Ability to meet multiple/conflicting deadlines and proactively escalate/engage
management timely relative to project and deliverable risk.

5. Cornerstone Hospice February 2007 to June 2007
Billing Coordinator
Responsibilities Include:
 Prepare and file all claims to Medicare on a monthly basis for patients currently under
Hospice care.
 Receive and post all incoming payments to each account on a daily basis.
 Research all claims that remain unpaid and facilitate resolution with Medicare to ensure
timely response.
 Manage claims thru Medicare website to verify status of claims submitted. Provide any
additional information needed to ensure claims are processed accurately and timely.
 Manage incoming calls and file all paperwork for Nurses and Home Health Aides from
daily patient visits.
 Manage and prepare re-certifications for all patients that require additional hospice care
outside of the initial authorization. Maintain all patient charts ensuring all documents are
signed, dated, and filed in order to meet JACHO standards.
Oasis Anesthesia December 2005 to February 2007
Billing Manager
Responsibilities Include:
 Manage the ICD9 and CPT coding of all Superbills brought in by Anesthesiologists.
 Administer patient database to ensure demographic information is current for all patients.
 Implemented action plan to collect outstanding balances on delinquent accounts.
Managed all billing and collections for the office sending paper and electronic claims to
primary and secondary insurance carriers.
 Managed staff who worked the A/R reports for collection on delinquent accounts.
 Post all payments sent in by Insurance Carriers, Workman's Compensation, or self-pay
accounts.
Schaller Anderson March 2005 to November 2005
Claims Analyst
Responsibilities Include:
 Processed claims for Mercy Care medical claims in a production environment
consistently maintaining a high level of quality and production.
National Health Benefits Corporation November 2003 to March 2005
Claims Analyst
Responsibilities Include:
 Intake of medical claims. Reviewed and analyzed for re-pricing requirements on all
medical claims sent in from providers and insurance carriers.

6. Professional References
Professional: Dina Rubio-Mendoza, Ex Co-worker at Oasis Anesthesia.
Phone: 623-418-8392
Professional/Personal: Edna Yates, Ex Supervisor at Cigna Healthcare.
Phone: 505-236-9320
Professional/Personal: Michelle Carrillo, Ex-Office Manager at Oasis Anesthesia.
Phone: 602-570-3558
Education
Obtaining my Bachelors in Health Administration Management
Ashford University August 2010 - present