Review AR for Top 5 credit balance payers. Submit corrected or voided claims for correct payment, submit refunds if outside of timely, or reach out to payer to request recoup and offset.Assist teams that are short staffed or having large payer issues. Determine how to utilize reporting to increase productivity and close gaps between billing and collections. Transfer and bill secondary claims.Verify EVV through CellTrack and Sandata for Therapy claims, making corrections in CellTrack when necessary.

Identify and prioritize outstanding debits and credits based on research and reports. Research the fee schedule and contract to make sure our rates and billing information are set up correctly.Responsible for the collection of Small Payer claims. Research and resolve open invoices and credits by utilizing company software and tools, provider manuals and contracts. Use these tools to determine billing addresses, HCPC codes, revenue codes, units/visits.Read and comprehend remittances, understand forwarding balances.Recognize and communicate trends in problematic accounts and payers to management. Request rules be set up in our clearing house for certain billing practices such as incidental code required modifiers, and down billing when necessary.Work all monthly-predetermined balances and credits through adjudication and resolution.Document all efforts to resolve balances and credits utilizing designated software and reports.Assist in training new and mentoring existing employees. Work on workflow with collectors. Train collectors to utilize Excel by running V-lookups and pivot tables.Communicate with other departments such as Patient Intake, Cash Posting, Billing, and Support Services.QA highest balance accounts by researching notes, call dates, action taken by collector. When necessary, call payers to get to root cause of issue. Train collectors on ways to improve their productivity.Review Denials Management to determine trending. Once trends are found, determine if it is a payer problem or billing error, and then correct any claims that need billing corrections or reach out to payers to bring awareness to underpayments.QA payers by auditing denials management trends and AR balances. Create training documentation for payer portals and collector process improvements.

Create initial, renewal, or change orders for DME supplies. Send DME orders to doctor’s offices and correspond to obtain everything necessary for prior authorization including proper diagnosis, letter of medical necessity for over allowables and current clinical documentation. Request prior authorizations in accordance to Texas Medicaid HP guidelines. Maintaining a portfolio of over 500 patients. Proficient with Brightree, Microsoft Excel, Word, & Outlook. Train and QA new hires, create training material.

Provide customer services such as patient check-in/out, answering phones, scheduling appointments, and verifying insurance.Support office management by receiving co-pays and deductibles, ensuring HIPAA compliance, records management, and efficiently utilizing Phreesia and Electronic Health Record computer systems. Support physicians, management, billing staff, nursing staff, and other team members.Train new front office team members.

Perform patient registration and insurance verification, answer customer service related questions, receive co-pays and deductibles, ensure HIPAA compliance, calculate estimates, and work with Meditech and Passport systems.Serve as “Pre-registrar” (the first at our facility) by registering patients over the phone for clinical, surgical, and sleep lab appointments, calculating and requesting estimates, and receiving payments over the phone.Support the financial counselor as the only backup by completing the deposit, visiting patients to go over insurance benefits, and receiving payment from patients.Provide coverage as needed to any location in the department: emergency room registration, Women's Imaging, Tuscan Imaging.Communicate with nurses in different departments to ensure access to their patient's account.Train new registration team members.

Provided customer services such as patient check-in/out, answering phones, scheduling appointments, and verifying insurance.Supported office management by posting charges, receiving co-pays and deductibles, ensuring HIPAA compliance, records management, and efficiently utilize Advanced MD computer system. Maintained a good working relationship and supported the duties of our doctors, management, billing team, nursing staff, and other receptions.Trained new reception team members.Coordinated multiple office visits for our patients within Medical City Dallas.