Co-Director in overseeing and managing the revenue cycle and AR/denials management by establishing company revenue goals and setting strategic plans to increase revenue. Checks work for accuracy, efficiency, and uniformity, retrains managerial staff as needed, responds to managerial staff questions in a timely manner, ensures a full understanding of job requirements, ensures timely completion of assigned tasks, and provides necessary resources, Reports non-compliance and documented infractions to VP Executive, promotes teamwork and provides assistance to staff as needed, monitors Income, AR reports and productivity goals for AR/denials staff, utilizes data and AR Aging for strategic planning of workflow and staff assignments, utilizes denial tickler dashboard to identify trends and utilizes claim research, insurance guidelines and regulations to resolve ongoing claims issues, participates in Denial Management and Revenue Integrity Task Forces to improve denial rate and revenue collection debt ratio, guides AR managerial team on effective review of denied and unpaid claims, works with other departments to develop process improvements and prevent denials, Collaborates with peer-Directors, and VP Executive for workflow reorganization, and assists with related special projects as required by VP Executive, assumes other tasks, duties, and responsibilities as assigned

Overseeing company's organization and operations which included hiring, onboarding, training, and managing employees, as well as ensuring compliance with labor laws and regulations. Developed and implemented the HR department, created and improved current company policies and procedures, managed employee benefits and compensation, and handled employee relations issues with resolution. Developed and fostered in creating a positive work culture, and promoting engagement while also creating employee and leadership development programs. Developed and implemented HR strategies to attract, retain, and motivate employees, Conducted employee training and leadership development programs to enhance skills and increase productivity, Led recruitment efforts, including sourcing, screening, and interviewing candidates, Managed employee onboarding, benefits, and compensation programs.Maintained compliance with employment laws and regulations.Handled employee relations issues, including conflict resolution and disciplinary actions.Collaborated with VP Executive and management to create and implement policies and procedures.Oversaw HR administration, including record-keeping, reporting, and collaborating with the payroll team, Facilitated performance management processes, including goal setting and performance evaluations, Provided guidance and support to employees and management on HR-related matters.

Maintained relationships with clients as it relates to client questions/concerns, test pricing and fee schedules, and payer mix analysis for profitable and financial reporting. Collaborated with internal teams to ensure medical claims were billed, followed up on with current claim statuses, and worked with sales representatives to resolve missing information to bill claims for services provided by the lab. Managed multiple priorities, and identified opportunities to increase revenue. Developed and implemented client relations strategies to improve satisfaction and retention rates, Conducted audits of denied claims to identify trends and areas for improvement, and Collaborated with cross-functional teams to resolve client issues.Strived to deliver exceptional service to clients with billing inquiries and questions.Created and analyzed data to identify opportunities for process improvements and areas of profitability, Maintained accurate records and documentation of client interactions and claim denials, Created and implementation of company standard operating procedures in claim resolution, Led recruitment efforts, including sourcing, screening, and interviewing candidates, Managed, and trained a team of medical billing specialists to improve A/R and decrease denials, Collaborated with the Credentialing team to obtain contract negotiations with insurance companies.

Led denial/Aging team, ensured that medical billing claims were processed accurately and in a timely manner, communicated with patients and insurance providers to resolve any billing issues, developed and created Standard Operation Procedures to improve processes for denials management and to improve efficiency, reported aged claims and issues to billing director, and trained new team members. Developed and implemented strategies to reduce medical billing denials, Led a team of medical billing specialists in reviewing and appealing denied claims, along with hosting and leading team meetings, Conducted root cause analysis to identify trends in denials, and developed action plans to prevent future denials, Collaborated with insurance companies to resolve complex billing issues, Conducted training sessions for billing team members on best practices for denial management, Maintained accurate records and documentation of all denied claims and appeals, Analyzed billing data to identify opportunities for process improvement and increased revenue, Stayed up-to-date on industry regulations and changes to insurance policies to ensure compliance.

Provides services as it relates to reimbursement coding and billing questions, obtaining benefits and authorizations. Follows all necessary policies, procedures, processes and systems in place to support the maximum and most efficient reimbursement for the company products. Completes benefit and prior authorization requests expediently and accurately to ensure payer reimbursement of company products. Provides the health plan with all the pertinent patient and product information to assist in the authorization request. Contacts the Field Reimbursement Manager if additional information is required to proceed with the case. Enters complete information in the Salesforce/Alfresco system. Takes reimbursement calls and researches answers extensively to ensure the most accurate information is communicated to a physician’s office, health plan and sales team. Provides exceptional customer service to internal and external customers. Completes daily reports assigned. Follows HIPPA policies and procedures to ensure protected health information is secure and not accessible to others not authorized to view the information. Communicates procedures for physician office, hospital, outpatient facility and ambulatory care center billers to implement and ensure maximum efficiency and collection of their accounts receivable, including coding procedures and processes for denial and low payment. Reports reimbursement trends and global concerns to management to ensure corrective actions and mitigation of future occurrences. Troubleshoots national and local payer reimbursement and accounts receivable issues. Provides the most effective communication to health plans to ensure maximum level of reimbursement approval. Interacts with health plan personnel to educate and influence their decisions related to medical management recommendations for approval and reimbursement. Builds rapport with physicians office and sales team.

Charge entry and claims processing for Medicare, Medicaid, Commercial Insurance, and self-pay accounts. Bills claims according to insurance guidelines. Triage and code requisitions with medical records and lab reports. Work with other departments and physicians to ensure all information is accurate for billing claims. Ensures that all charges are accounted for, and billed to patient’s insurance each day to meet month-end closing deadlines. Works closely with peer billing specialist to make sure claims are billed according to updated insurance guidelines, which also include ICD 9/ICD 10 and CPT coding. Oversees and leads a team of 5 to make sure all data entry, verification, insurance charges, client charges, and payments are completed for the department at the end of each month, and HIPPA guidelines are being followed by staff members. Reports to Manager of charge entry and front-end issues/ideas. Serves as backup to Billing Manager and Front End Team including client billing, ICD 10, data entry, and insurance verification. Enters patient demographic, and verifies all insurances using electronic databases. Created encounters, and obtained required pre-authorizations for all patient accounts. Contacts clients for missing patient information and updates accounts once information is received. Scanned medical records into an electronic database and organized and stored all paper documents in the storage area. Assisted peer Billing specialists with printing and mailing secondary claims and patient statements, and charge entry.

Accurately input and maintain patient billing information using various software programs, Reviewed and verify patient insurance coverage, ensure adherence to billing regulations and policies, Communicated with patients and insurance companies regarding billing inquiries and disputes, Assisted in resolving billing discrepancies and errors to prevent payment delays, Maintained confidentiality of patient information and adhere to HIPAA regulations, Scanned medical records into the electronic database, Organized and stored documents and medical records, Printed and mailed paper claims and patient statements, Participated in training and education to stay current on billing policies and procedures, Assisted with charge entry and payments