Oversee all aspects of medical billing including referrals, prior authorizations, billing claims, payment posting, working denials, reconsiderations, and appeals. Ensure billing and coding for all current and new medical service lines are accurate, consistent, and maximize revenue opportunities. Plan, implement, evaluate, and administer all Revenue Cycle strategies and processes, including authorization, eligibility and benefits verification, claims submission, payment posting for ERA’s, denial management, accounts receivable follow-up, reporting, and aged claims. Monitor, respond to, and communicate changes in billing requirements, regulations, and reimbursement rates, and maintain provider enrollments with payors.

Created both commercial and work comp claims for our pain management and anesthesia providers and forwarded claims to the appropriate payor via mail, fax and EDI. Worked all outstanding Accounts Receivable for 13+ groups, including 30+ providers. Posted all incoming payments and made any necessary adjustments accordingly. Processed reconsiderations and appeals using state reports, transcriptions, and explanation of benefits.Worked escalated claims, higher level appeals, and payor disputes or complaints. Identified and resolved any improper payments from payors as well as incorrect reimbursement issues. One-on-one communication with payors and patients with delinquent balances to collect on accounts. Processed all patient payments, including working the patient collections aspect and setting up payment plans.

Created medical claims and forwarded to the appropriate payor via mail, fax and EDI. Worked all outstanding AR daily, posted all incoming payments, and managed adjustments. Identified and corrected any billing errors. Processed reconsiderations and appeals, worked escalated claims, higher level appeals, and payor disputes.Identified and resolved any improper payments from payors as well as incorrect reimbursement issues. Worked directly with payors and patients with delinquent balances to collect on accounts. Processed all patient payments, verified the accuracy, and processed any and all refunds for patients and payors.

Utilized Aged Trial Balance reports to perform scheduled follow up on accounts. Interacted with payors and patients with delinquent balances to collect on accounts. Performed coverage research, handled re-considerations, first and second level appeals with insurance companies until final adjustment was reached. Processed escalated claims, higher level appeals and payor disputes or complaints.Located lost checks, researched recoupments, and filed refund appeals on improper refund requests. Ensured proper documentation of collection-related activity in the online system. Resolve third party payment issues resulting from claims processing errors. Conducted monthly follow-up on unresolved appeals. Processed patient payments, created financial agreements, and processed promissory notes.

Handled account resolution for 300+ clinics nationwide via communications with employers, patients, insurance companies, and attorneys. Collaborated with Urgent Care and Primary Care and assumed personal responsibility for handling all nationwide CHPT claims throughout the company. Generated and processed rebills and incoming correspondence for outstanding AR. Worked outstanding claims and resolved payment delays with insurance companies, employers, and patients. Identified improper payments from payors as well as incorrect reimbursement issues. Applied appropriate adjustments per contracts or state requirements. Processed reconsiderations with the appropriate state reports, transcription, and explanation of benefits. Maintained up to date EDI bills via electronic portals.

Responsible for all aspects of front office duties in a large Family Medicine practice. Duties included greeting patients, checking patients in and out, obtaining updated patient information/paperwork, collecting copays and balances, posting payments, answering phones and scheduling patient appointments. Solely responsible for creating and maintaining all financial agreements with patients with outstanding balances, resolving any monthly deposit summary discrepancy reports, processing all credit card refunds, and training newly hired employees. In charge of all Online Services, including Email Your Doctor memberships, appointment requests, demographic updates and new patient enrollment. Coordinator of all Pharmaceutical Representatives. Elected to participate in the company’s Patient Quality & Safety Committee.