o Hire, interview all new employees, evaluate employee performance, provide promotions, discipline, termination and salary increase. o Administer the processing of payroll, health insurance and benefits.o Maintain all personnel files in accordance to company and state policies.o Communicate regularly with physicians, office managers and surgery center administration to address ongoing strategies and concerns. o Attend to all disputes with insurance carriers regarding payment and/or contract issues.o Address concerns and resolve problems with employees and patients.o Submit and audit electronic claims through Emdeon and inspect all paper claims for accuracy.o Research coding guidelines and audit medical records to determine if the billing is properly coded.o Assign tasks and ensure the quality of team member’s work daily to increase cash flow utilizing Advanced Data Systems and EClinical.o Ensure employees have the necessary tools and knowledge in order to be successful.o Prepare month end closings and specialized reports including balancing/reconciling for all entities.o Daily deposits for all monies received from insurance companies and patients.o Create and submit monthly invoicing and ensure timely payment from all providers.

o Direct complex projects from concept to fully operational status utilizing Medinformatix, EClinical, Zirmed, and Office Ally.o Ensure the collections of each accounts receivables are below 25% of the billed out charge amount.o Supervise department employees which involve such duties as instructing, assigning, reviewing work, acting on employee problems, select new employees, appraising employee performance, and recommend promotions, discipline, termination and salary increase.o Communicate regularly with client management to address ongoing strategies and concerns.o Research coding guidelines and audit medical records to determine if the billing is properly coded.o Handle the processing of payroll, health insurance and 401(k), & worker’s compensation.o Met with existing physicians and potential new clients.

o Supervise the billing and collections department by utilize my training and expertise in certified coding.o Establish reimbursement guidelines for 10 remote imaging centers.o Train staff and provide ongoing training and assistance on Medical Manager and Raintree.o Organize and track information to process payments for physician reimbursement using Excel.

o Assist nurse case manager in regards to medical authorizations.o Answer and route incoming call from beneficiaries and providers regarding authorizations. o Maintain policy manuals for Tricare Prime and Standard patients.o Determine if authorization if necessary and create authorization requests.o Prepare denials letters received from the Medical Director.

o Bill home infusion claims. Process claims for Medi-cal and California Children Services.o Create compound sheets in Excel to bill for Total Parenteral Nutrition and IV antibiotics.o Review claims and determine if paid correctly and process adjustments.

o Verify insurance benefits to determine collectability of therapies and diagnosis by reviewing state coverage.o Negotiate pricing with case managers and/or insurance companies.o Prepare documentation for the physicians such as Certificate of Medical Necessity.o Troubleshoot customer inquiries and phone insurance companies with billing issues.

o Investigate claims for pre-existing conditions by reviewing all medical records.o Review letters of appeals and determine if medical claims were processed correctly.o Evaluate charges for medical necessity and investigate any questionable diagnosis.o Determine if claim is payable and process according the state laws.o Create letters to inform insured of decision made regarding the appeal or pre-existing conditions.