Back Office support for Mental Health Professionals and Small Business. As the Private Practice or Business Owner are you not finding enough time throughout the day to manage all of your office projects and get it all done? Maybe you are just starting out and really do not have the need for a full time Receptionist, Medical biller or Office Manager. Valley View Office compiles all of these positions into one to serve you better. Let us make a impact by helping you grow your business.

Work closely with the pharmacy is ensure billing is accurate across all plans and contracts. Track and monitored for pricing compliance, therapeutic interchanges and clinical edits.Support all facilities in regards to pharmacy issues. Medicare Part D plans, Medicaid, other third party plans and specialty drugs. Signed on as agents for all of our prescribers to supply information only to the Medicaid and third party plans for drug prior authorizations. Work closely with Ohio, Maryland, PA, VA, WV and IN Medicaid. As well as the Managed Medicaid plans within these states to ensure accurate pharmacy billing based upon our signed contracts. Setup and coordinated Cover My Meds box with for each facility and the process for the pharmacy to send the prior authorizations directly into the facility CMM boxes.Identify, track and monitor those high cost medication that are excluded from the daily rate based upon our signed contracts with the managed care plans. Support our managed care team by providing these excluded medications and provide any additional support that is needed.Provide support as needed to the company pharmacists and pharmacy techs. Manage and monitored Monthly QA Summaries, Consult pharmacist monthly summaries and P&T meetings for compliance.

Pharmacy- Healthcare IndustryWorked directly with a corporate chain, servicing 32 of their entities. Supported onsite pharmacy management and personnel to insure policies and producers were followed as set forth by the National Billing Department. Monitored and reviewed online adjudication for Medicare Part D, Medicaid and other third party claims. Worked directly with clinical intervention to resolve rejected Medicare Part D submissions. Verified and logged monthly consulting hours. Daily audits of backup documentation for charges. Over seen contract and pricing compliance were followed. Monitored two operating systems and web based application for any issues. Preformed monthly invoicing and verified the GL account coding setup. Reviewed and investigated all disputed invoices. Tracked all variances of invoicing for probable issues. Monitored invoices for payments, credits and discounts. Prepared training documents via Excel spreadsheets and Power Point presentations. Provided web based training to all national account associates. Traveled upon request to pharmacies to provide on hands training to onsite employees.

Monthly invoicing for private pay, Medicare Part A & B and Medicaid. Prepared, mailed and tracked monthly invoices for payment. Billed Medicare A & B via operating system clearinghouse for positive payment via Ivan portal. Reviewed and corrected claims for positive submission. Verified accurate coding on the claims. DX, HCPC, CPT log codes. Completed all necessary information regarding admission, hospital stays and discharges via web based Medicaid application. Coded and logged all Medicare related invoices for payment. Tracked and coded facility invoices for payment. Monthly reviewed the PL for target areas of concern.

Provided leadership to eighteen customer service billing representatives. Responsible for all aspects of interviewing, hiring, discipline and tracking of salaries and benefits. Overseen all aspects of the billing functions within the billing unit and customer service to all inbound calls. Audited for pricing compliance, contract commitments, third party applications, documentation references and processes of invoicing. Pulled data based information from the operating systems. Closely worked with other departments on quality data base information. Facility information, billing information, pricing associated with their contract, and third party applications for their state. Monitored operating system for pricing issues regarding on shelf inventory. NDC, compounds, tabs and liquids. Audited for reorder on demand and cycle fill issues regarding third party application. Supported and worked through system conversions, verifying for SOX compliance. Traveled to other billing sites within the Midwest Region to establish proper billing functions and adjudication processes. Implemented policies and procedures as set forth by the company. Attended weekly conference calls on the company's goals and objectives. Educated the billing team on Medicare Part D. Provided educational webinars to facilities for Medicare Part D. Traveled to facilities for informative meeting on Medicare Part D and resolution on billing issues.

Long Term Care FacilityWorked under the direction of the Dewitt County Board. Monthly invoicing completion for private pay and Medicaid room & board charges. Completion and submission of all necessary paperwork for admission and discharges within the facility for Medicaid. Worked on aspect of the yearly budget and present to the county board for approval. Revenues versus expense. Substantial knowledge of PPD calculation related to categories of expenditures; employee cost, equipment, facility maintenance and food cost. Tracked all deposits and withdrawals associated with the yearly tax levy appropriated for the nursing home operation. Coded according to the approved budget and submitted monthly expenses for approval to the county board for payment.Completed bi-weekly payroll for union and exempt employees. Followed, negotiated and processed according to the union contract Acme. Tracked and maintained files on salaries and or county, union benefits.