Responsible for the day to day functions of an Ophthalmology practice. Post insurance payments, balance end of day transactions & prepare bank deposits. Ordersupplies and office equipment. Manage employee payroll. Hiring of new staff anddevelpment of existing staff. Audit payments from various insurance co's to make certainwe are paid by contract, negotiate new contracts as necessary. Keep physicianscredentialing information up to date and accurate for various insurance / hospitalfacilities.

Develop and maintain professional relationshipswith physician offices in the West Central region as well as select bordering counties. Make certain offices are aware of claims policies and procedures for the AnthemPartnership plan. Assist the office staff with any coverage or claims questions, educateoffices of the proper way to bill, follow up on and proper reimbursement of medicalclaims. Assist offices in becoming participating and facilitating the process with otherinternal departments. Recruite and maintain physician network for West Centralterritories.

Hired as a Contractor to work claims settlement betweenKAA and UHC. Successfully researched and resolved historical claims over/underpaymentswhich resulted in KAA not owing a refund as UHC was demanding. Research and resolve allaged claims for all clients over 60 days. Played a key role in developing andincorporating plan for follow-up on accounts receivable to ensure claims are handledpromptly. This process makes certain all claims are followed up on and monitored no lessthan every 60 days resulting in more timely payments and appeal resolution. As a result,we consistently exceed industry standard/benchmark for accounts receivable aging.Benchmark is 30.59% over 60 days, KAA accounts are currently @ 7.54%. Act as a liaisonbetween KAMS and collection agency for all collection accounts for KAA as well as otherphysician groups. Make certain new physicians that utilize our billing services arecredentialed with various insurance companies. Act as a liason for physicians and thebilling company. Handle customer complaints as well as work with groups regarding anyconcerns with the billing comany, ie: cash flow, accounts receivable.

Managed the day to day operations of a multi facetedmedical facility including: Pain Clinic; Recruitment of all newemployees. Oversee receptionists and staff for Podiatry and Family Practice Departments.Back up manager for all other departments when primary manager was unavailable. Credentialing for all physicians joining the practice as well as those utilizing ouroutpatient surgery center. Handle the contracting relationships with the variousinsurance companies. Oversaw the building maintenance and contracts with variouscontractors i.e.: plumbing, cleaning contracts, electrical contracts, HVAC contracts,Phone services etc. Assisted in a successful three- year accreditation through AAAHC(Accreditation Associated for Ambulatory Health Care, Inc.)

Responsible for creating and maintaining professional relationshipswith physician and hospital providers. Trained physician office staff on UHC policies andprocedures pertaining to claims filing and reimbursement. Contracting with localphysicians: Anesthesiologists, ER Physicians, Surgeons, Pathologists, and Hospital basedphysicians for both the Cincinnati and Dayton Networks. Maintained current demographicfiles on all groups. Negotiate new contract rates for reimbursement.Auditor - Responsible to audit contract set up for hospital contracts to ascertain claimspaid according to system set up and provider contract set up. Responsible to report anysystem set- up errors. Process settlement checks or have claims reprocessed for repaymentof improperly paid claims. Supervisor Customer Service - Responsible for hiring, training, managing customer servicestaff. Monitored staff and provided feed-back for improvement on a daily basis. Liaisonbetween customer service and claims department to resolve payment processing issuesreported to department by customers including patients and physician groups. Responsiblefor audit telephone quality on all in coming customer service phone calls and councilstaff as needed.Trainer, Customer Service - Responsible for development and implementation of customerservice training program for local and national sites.