Conduct comprehensive audits of payment records and insurance claims to ensure accuracy and compliance with contractual agreements and company policies. Analyze and resolve insurance denials by assessing coding accuracy, regulatory adherence, and policy terms, while preparing appeals with detailed documentation. Maintain accurate records of appeals, investigate discrepancies, and ensure coding aligns with ICD-10, CPT, and HCPCS standards, staying current on regulatory and reimbursement updates.

Provides consulting services to healthcare organizations, optimizing billing processes and revenue cycle management to enhance collections and reduce claim denials. Reviews and submits accurate claims, ensures compliant coding of medical and mental health diagnoses, and resolves discrepancies in accounts receivable. Conducts coding audits, delivers corrective action plans, and trains staff on industry standards to improve accuracy. Manages credentialing and re-credentialing for healthcare providers, ensuring adherence to regulatory requirements. Develops compliance policies, provides clients with performance metrics, and uses data insights to improve claim approvals and practice profitability for behavioral health organizations.

Promoted to Manager, leading revenue cycle operations across multiple clients and specialties, including account management, billing, collections, and client relations. Managed cross-functional teams, tracked KPIs, and implemented process improvements to reduce aged accounts and optimize cash flow. Partnered with executive leadership to provide strategic insights, preparing reports on AR reconciliation, aging trends, and key performance metrics. Supported system implementations, facilitated client meetings, and delivered presentations to drive decisions at the executive level.

Supervised revenue cycle management (RCM) staff, coordinating workflow, staffing, and performance goals. Conducted performance evaluations, managed disciplinary actions, and supported professional development for team members. Ensured department compliance with billing regulations and payer guidelines. Collaborated with management to identify continuous improvement opportunities, addressing revenue cycle issues and enhancing operational processes.

Assisted in overseeing daily operations, including collections, cash posting, and billing, while serving as a point of contact for team inquiries and support. Guided team members in handling billing discrepancies, denials, and claim appeals. Collaborated with other departments to streamline workflows and improve service quality. Conducted initial training sessions for new hires and provided ongoing support to team members.

Processed insurance claims, handled account management, and ensured accurate billing practices. Communicated with insurance companies for claim follow-up and payment resolution. Maintained current knowledge of commercial, government, and third-party payer billing regulations. Supported revenue cycle staff with cash posting and medical billing tasks as needed.

Processed and submitted primary, secondary, and tertiary medical claims, ensuring compliance with CMS regulations and accurate application of ICD-9/10 and CPT/HCPCS codes. Managed accounts receivable, escalated overdue accounts, and handled patient statements, refunds, and billing issues. Conducted benefits verifications, maintained HIPAA compliance, and resolved claims within strict timelines. Oversaw the monthly billing cycle, reconciled accounts, and updated electronic health records to ensure timely and accurate revenue cycle management.

Developed and monitored budgets for military projects, ensuring alignment with fiscal goals and collaborating with leadership on financial performance metrics. Managed confidential financial data and conducted daily reviews to address financial security concerns. Analyzed data to identify trends and informed decision-making on market and efficiency initiatives. Oversaw supplies and equipment logistics for large-scale deployments and maintained a comprehensive database of intelligence information. Provided briefings to senior personnel on operational efficiency, advised on payroll matters, processed paperwork for new employees, and conducted daily audits to ensure accuracy and resolve payroll issues.