Perform work in Epic.Appeal complex denials through review of payer policies, coding guidelines ( CPT ICD-10 ), contracts, and medical records. Assist department supervisor on special projects and staff training.Responsible for assisting the professional billing staff within the CBO with difficult and escalated issues.Participate in workgroups and meetings. Attend all required training classes. Escalate issues to management as needed. Maintain confidentiality. Read and apply policies and procedures to make appropriate decisions.Coordinate functions and work cooperatively with others. Explain processes and procedures to others; performs other related duties as assigned.Communicate with providers, patients, coders, or other responsible persons to ensure that claims are correctly processed by third party payers.Review reports to identify revenue opportunities and unpaid claims.Utilize CBO Pathways as guide for determining actions needed to resolve unpaid or incorrectly paid claims and/or for authorizing procedures in assigned workqueue(s) using payer websites, billing system information and training within expected timeframe.Identify payer, provider credentialing, and/or coding issues and address them with management.Provide input on system edits, processes, policies, and billing procedures to ensure maximization of revenues.

Accurately apply payments to patient accountsPost and reconcile insurance and patient payments. Research and resolve incorrect payments, EOBrejections, and other issues with outstanding accountsEnsure accuracy of ICD-10 and CPT codes on insurance claimsRetrieve Electronic Remittance Advice (ERA’s)Send secondary claims upon processing of primary insuranceMonthly processing of Patient statements. Answer and resolve patient billing inquiriesFollow up on Insurance and patient Aging. Re-Submit insurance claims as needed. Knowledgeable intimely filing restrictionsCorrected ClaimsERA Denials

Supervise the competency and performance of allergy departmentCreate and implement an allergy training checklist including emergency protocolCoordinate staffing coverage for all locationsInterview candidates for allergy service in house. Coordinate and conduct effective training of new allergy medical assistantsTravel to sister locations to ensure allergy staff are performing adequately and efficientlyInventory for all locations and order supplies in a timely mannerCoordinate with biller for contracted insurances to ensure reimbursement for servicesTrain on billing/coding for allergy claim submissionTrain staff on insurance verification for allergy servicesAging reportsCoach providers on positioning allergy test to patients or speak to patients directly to obtain consent for testing and treatmentQuantify patients tested weeklyCustomize allergy panel and result sheet to patient populationQuickbooks

Verify insurance for allergy benefits. Prepare testing and treatment supplies. Discuss and obtain consent from patient for allergy testing and treatment. Scribe noteInput ICD codes, CPT codes and appropriate modifiersCoordinate with billers for proper billingTrain allergy staffAdminister immunotherapy injectionsRx Epipens and refill meds PRN. Follow up on patients PRN. Associates MD Clinical Manager Davie office - (January 2015-July 2019)Responsibilities: Create and implement new policies to make the office run efficiently. Increased revenue by increasing patient returns after labs/procedures. Educate providers and staff on procedures, workflow, and protocols for the office. Manage patient complaints and documentation. Perform vitals, process holter monitors, sleep studies, allergy injections, phlebotomy, and assist with stress tests.