Nancy Barbachan Email & Phone Number

• In charge of preventing denials by using analytics to mine large amounts of data for patterns; analyzing those patterns to understand root causes; and, finally create rules to prevent or mitigate the impact of future denials.• Proactively recommend opportunities for improvement in order to reduce denial risks.• Responsible for identifying and investigating denials that are potentially due to coding compliance issues and trends.• Perform thorough and complete investigation, and reports/coordinate any significant findings to the Content Management Team for rule enforcement.• Analyze and identify reimbursement risks, billing guidelines compliance, assist in the development of rules, strategies, and solutions to alleviate revenue loss due to commercial and government payer changes• Responsible for tracking/communicating commercial and governmental payer changes; and escalating payer rules for rule enforcement. • Perform CIQ edit overrides on existing edits after reviewing its validity, not relevant to the claim scenario being submitted to the payer.• Provide support to the Content Management Director to identify and manage projects requirements effectively• Provide assistance in understanding and interpreting payer guidelines and policies• Independently documents denial and impact pertaining to denial analysis and strategies.Achievements:• Responsible for creating rules to prevent denials and increase first time payment rate for over 40k providers and 70+ medical specialties in 50 states.

• Provided day to day support and troubleshooting for electronic claims submission, claims scrubber, encounter submission, real time eligibility checking, etc.• Classified problems as system, training, or process and recommend appropriate corrections.• Ensured accuracy of billing and developed protocols/rules to deal with repetitive errors.• Improved billing system by recommending system and information enhancements.• Resolved daily coding scrubber errors to ensure accurate coding structure for correct billing.• Provided assistance in understanding and interpreting payer guidelines and policies.• Evaluated the billing structure, to include identifying gaps and areas needed for improvement.• Advised and instructs customers regarding billing and documentation policies, procedures, and regulations.• Demonstrated a capability to work independently, with respect for priorities, and with multiple ongoing assignments.

• Performed detailed reimbursement analysis to find opportunities to create a business rules for denial prevention.• Responsible to manage all business rules including procedure, diagnosis, modifiers, crosswalks, frequency, bundling, medical records, inclusive and printing rules • Maintained payer and physician libraries to ensure they have the most current and up to date information

• Responsible for coding different types of medical claims which includes surgery, physical therapy, diagnostic testing, pediatrics, emergency services, among others • Worked with different insurance companies including Medicare, Medicaid, Commercial insurances, Workers Compensation and Auto insurances. Many years of experience with payer regulations and guidelines• Obtained patient eligibility and verified/obtained authorization for services rendered • Assisted reimbursement team to make necessary changes to claims to assure payment • Maintained a 98% coding accuracy

• Processed referrals and coordinated admissions for all patients • Responsible for the flow of information through the admissions process and forwarded to appropriate departments • Answered telephone promptly and courteously, providing information, completing all referral/intake forms as appropriate on each call • Completed insurance verification form with benefit and billing information • Scheduled and managed patient s appointments and confirmations• Collected patient responsibility co-payment and deductible at the time of visit.