• Denial Management, composed and submitted appeals and reconsiderations• Prepare legal documents, fulfilled attorney request for medical records and insurance audits • Effectively resolved problems • Reviewed payer contracts for reimbursement policies • Reviewed coding issues• Reviewed, verified and updated eligibility • Document all inbound and outbound calls• Reviewed accuracy of denials pre-certifications • Reimbursement under all medical specialties including Neurology and Orthopedics• Insurance follow up and collections• Posted payments and EOB contractual adjustments • Demonstrated knowledge of Medicare, Medicaid, managed care contracts advanced knowledge of third-party insurances in regards to plan types: HMO, PPO, POS, and Indemnity • Responsible for reviewing and editing rejected claims via Epic

• Review denials, compose and submit appeals and reconsiderations• Retrieve electronic medical records and paper chart records for reconsiderations and appeals• Utilized knowledge of full Revenue Cycle • Prepare legal documents, fulfilled attorney request for medical records and insurance audits • Effectively resolved problems • Create and test user case scenarios for a new GE Centricity billing system implementation clinic wide; designated as super user • Trained new employees • Reviewed payer contracts for reimbursement policies • Reviewed coding issues• Reviewed, verified and updated eligibility • Reviewed accuracy of denials pre-certifications • Instructed and provided feedback to reps related to appeal processes • Created A/R report• Documented all inbound and outbound calls• Tracked denial trends and developed collection strategies for trended denials • Corrected EDI rejections• Insurance follow up and collections• Documented all inbound and outbound calls• Posted payments and EOB contractual adjustments • Demonstrated knowledge of Medicare, Medicaid, managed care contracts advanced knowledge of third-party insurances in regards to plan types: HMO, PPO, POS, and Indemnity • Responsible for reviewing and editing rejected claims via Claim Logic• Performed quality assurance audits and performance evaluations for 35 team members on a monthly and quarterly basis including creating workflow aids and training material for teams up until the time of reorganization of the department in November 2015.

• A/R analysis• Responsible for collection of self-pay accounts • Reviewed of accounts to be forwarded to collections • Processed bankruptcy notifications • Negotiated settlements on self-pay accounts • Posted payments • Documented all inbound and outbound calls• Keyed adjustments on accounts as necessary• Worked as liaison for attorney’s office • Conducted account research and reconciliation

• Responsible for full revenue cycle• Insurance verification • Coding and Billing of Charges • Collections• Electronic claim submission, EDI process, rejection follow up• Insurance follow up • Obtain pre-certifications for procedures • Appeal submission• Payment posting • Reviewed Payer Contracts for viability and profitability• Correspondence • Prepare legal documents, fulfilled attorney request for medical records and insurance audits• Denial management • Account reconciliation and account research • Chart auditing • Patient billing• Contract negotiation • Credentialing

• Responsible for receivables for 2 clinic locations• A/R analysis• Performed electronic claims submissions • Corrected EDI rejections and contacted EDI clearinghouse with issues• Create and test use case scenarios for a new billing system implementation NextGen• Insurance follow up • Appeals submissions• Obtained pre-certifications• Documented all inbound and outbound calls• Added codes post radiation therapy codes not previously obtained • Account adjustments and account reconciliation • Prepare legal documents, fulfilled attorney request for medical records and insurance audits• Chart audits • Correspondence • Patient billing• Customer service • Payment posting, contractual adjustments and keyed rejections Employee training