• Reviewing contracts and verifying if claims were paid accordingly. • Creating underpayment reports and initiating payer reprocessing of claims.• Recovered more than $150,000.00 in medical claims.• Identifying areas of weakness on the front end of the revenue cycle to help capture the necessary information vital to efficient clean claim adjudication the first time through.• Auditing claim collection work of the billing team to ensure claims were worked correctly to completion and all efforts exhausted.• Lead billing company training on Texas TDI claim dispute submission and Federal IDR portal claim submission in regard to the 2022 No Surprise Act law.

• Managing billing and coding revenue cycle for 20+ freestanding ER/micro hospital facilities across Texas, Oklahoma, Arizona, and New Mexico.• Creating and implementing protocols/workflows for 20+ collectors, billers, and posters.• Coaching team members to work their assigned payer(s) correctly.• Improved EHR/practice management software by collaborating with the EHR I.T. team. I’ve brought to their attention errors within the report software Tableau used by management and the aging claims reports buckets used daily by the collectors highlighting the needs of the revenue cycle team by coming up with ideas/reports to implement within the software to ensure efficient productivity. • Liaison between the facility administrators and Tyvan management.• Researching state insurance laws and commercial insurance payer policies to help aid in having claims reimbursed and paid correctly.• Responsible for reviewing monthly statistical claims data for trends and adjustments.• Creating monthly claims reports outlines delivered to partner facilities.

• Working with out-of-network claims for freestanding ER facilities across Texas.• Reviewing claims for coding and medical billing accuracy to assure maximum reimbursement.• Appealing denied and low allowable claims.• Knowledgeable in ICD 10, CPT, CPT II, HCPCS, and HEDIS.• Staying up to date with changing freestanding ER insurance policies and procedures through independent research via the internet and seminars.• Explaining statements and EOBs to patients, while answering their questions and concerns.• Collecting patient payments and setting up payment plans.• Assisting Spanish speaking patients and employers with account inquiries and payments, as I am the only team member who speaks Spanish.• Creating custom Microsoft Excel templates and spreadsheets, and Microsoft Word documents, templates, and letters to assist in claim revenue collecting.• Troubleshooting company computer/network issues.

• Implementing and training of provider and office staff on Medisoft and Medisoft Clinical EMR.• Creating Medisoft custom forms and templates to help maximize office time and efficiency.• Recovered more than $700,000.00 in medical claims.• Assisted in training office manager and staff on billing, coding, and revenue management cycle.• Created network folders that made office documents readily accessible by the provider and staff on their office computers throughout the practice.• Reviewed and enhanced office workflow.• Acted as the main intermediary between the practice and other medical partner associates.

Medical Billing/Coding Manager:- Insurance/Medicaid/Medicare billing and coding.- Extracting procedures and diagnosis from charts.- Processing claims within timely filing limits.- Knowledgeable in ICD 9, CPT, CPT II, HCPCS, and HEDIS.- Appealing denied claims for full reimbursement.- Posting insurance payments and reconciling balances.- Verifying insurance coverage and benefits.- Collecting overdue payments/balances from patients.- Reviewing chart notes to ensure they are compliant and match what is being billed.- Providing suggestions/feedback to doctors to make sure charts are compliant with coding guidelines.- Creating quarterly reports to track claim status and reimbursements.- Keeping up-to-date with current coding guidelines/information.- Helping patients understand their insurance bills and coverage.Information Technology (I.T.) Manager:- Evaluating/reviewing hardware/software products to be used by the physicians and staff.- Keeping computer hardware/software HIPAA compliant- Computer maintenance (Hardware and Software)- Troubleshoot and resolve computer issues.- Creating and integrating templates/procedures to help ease the gathering of health data into the EHR.- Responsible for contacting and communicating with EDI/IT departments for various insurance and health plans to resolve EHR and website problems.- Setting up and maintaining access to various healthcare related websites and e-mail addresses used in everyday office functions.Assistant Office Manager:- Coaching office and medical staff in office policy and procedures.- Improving efficiency in office workflow.- Handling and resolving patient concerns.- Main contact for the various health plan/insurance provider representatives.