+ Supervised the medical billing service line department including Medicare HH and Hospice, Commercial Contracts and Payers, DOL, and Worker's Comp Programs.+ Provided leadership and direction in all billing and collection processes. General management of 15 direct reports with a billing staff of over 1500. + Provided ongoing training to billing staff related to software and regulatory changes, payor requirements, compliance, and department policies.+ Ensured all federal, state, and payor-specific regulations and guidelines are adhered to.+ Developed and implemented controls and measures to ensure accurate and timely billing and collections in accordance with established internal and third-party payor requirements (Medicaid, Medicare, MCO, Commercial payors). This included the cycle from submitting claims to collection and denial management.+ Responsible for denials management of claims and performs root cause analysis to determine trends for denials and addresses the underlying issues on a timely basis including following third-party payor specific requirements for disputes, appeals, and reconsiderations. Utilized clearinghouse reports ensuring denials are addressed in a timely manner by the team.+ Secured maintained and organized managed care contracts including monitoring the terms and reimbursement criteria. + Reviewed and analyzed contracts routinely for financial profitability and to ensure the best interest of St. Thomas Health care.+ Developed, managed, and sustained relationships with third-party payor representatives to communicate concerns and identify solutions. + Coordinated with other internal operations including Credentialing, Clinical Support Team, Finance and Accounting, and Information Technology to ensure effective processes.+ Reported on A/R aging at the weekly meeting including identifying issues that may need escalation. Provided monthly A/R aging summary for our CEO (Dr. Chris Low)..

+ Oversaw the medical billing operations and financial performance of identified physicians, advanced practitioners, and other contracted providers of St. Thomas Health care.+ Prepared reports to reflect the performance of relevant medical billing activities, including volume, financial billing performance, and staff productivity. + Worked collaboratively with all entities involved with billing for Urgent Care Extra providers to facilitate the onboarding of providers, including contracting and credentialing.+ Managed applicable quality programs including the submission of data.+ Implemented annual goals for revenue cycle performance consistent with national benchmarks.+ Worked with others to assure coding was appropriate to maximize revenue while maintaining compliance. + Reviewed data and continually educates providers on coding trends and opportunities.+ Monitored reporting from billing vendors and evaluated key performance metrics. Met with vendors to review metrics on a periodic basis and works to assure both accountability and data transparency. Quickly and proactively responded to revenue cycle issues to promote maximized reimbursement.+ Assessed billing models and billing options for all practitioners to determine the best overall structure.+ Developed session leases for hospital space and resources in accordance with regulatory standards.

+ Trained new team members on company policies and procedures, including HIPAA regulations .+ Reviewed claims to ensure that they were accurate and were completed, and approved them for payment.+ Prepared reports on data related to claims processing, including claims denial rates and turnaround times for different types of claims+ Communicated with patients, physicians, insurance companies, and third party administrators on billing issues+ Ensured that all documentation were accurate and up to date, including patient records, insurance claims, and physician orders+ Managed and oversaw all aspects of the billing department, including hiring staff and overseeing their performance+ Ensured timely and accurate payment of claims to providers by submitting them to insurance companies for approval+ Communicated with patients about their account status and explained any discrepancies or denials in their bills+ Cooperated with other departments within the organization to ensure that billing operations run smoothly

+ Retrieved and collected physician background info from various resources for reporting.+ Prepared summaries and assigned the appropriate codes that apply. Complied with medical coding guidelines and policies.+ Reviewed claims to formulate a synopsis of facts and collaborated with claims examiners regarding the synopsis as needed+ Made corrections to draft reports sent for physician review and submit approved reports to management in a timely fashion.+ Interacted with claims staff, attorneys, and physicians regarding reports on an as-needed basis+ Make sure that codes were assigned correctly and sequenced appropriately as per government and insurance regulations+ Received and reviewed patients’ charts and documents for verification and accuracy Followed up and clarified any information that was not clear to other staff members+ Collected information made by the Physicians from different sources to prepare monthly reports. + Examined medical malpractice that had been reported by analyzing and identifying the medical procedures, diagnoses or events that lead to the negligence