Paul Smith Email & Phone Number

My responsibilities include overseeing billing teams at Rx RCM Medical Billing Services Pvt. Ltd, managing billing accounts, reviewing reports within billing software, watching to ensure quality claim checks are taking place before claims are being billed to insurance, looking over denials/rejections and related follow-up work, advising team managers on suggestions and input when needed

Working as a team lead and handling a team size 20+, taking care of Healthcare Revenue Cycle Management, Medical Billing, Medical Coding, Collections, RCM Transformation, Offshore BPO, Healthcare Payer BPO, Applications Development, Applications Support, Clinical Documentation Improvement, Software Services, Self Pay Follow-up, ICD-10, revenue cycle management, Accounts Receivable, Anesthesia Coding, Surgery Coding and Pain Management Coding.

Woodbridge, New Jersey, Us

For me the actual A/R is not just a follow up on recently submitted claim or the claim which is already shown in paid status on website. But for me actual A/R means to follow up on the claim which is not paid even after the 30 days of submission.I used to analyses the claims carefully and do the timely follow up if I found:A claim is under paid,A claim is partially paid,A claim is denied with an inappropriate reason,A claim is not processed at all even after 30 days bucket.The denied and under paid claims are appealed to get them processed correctly. Sometime claims are denied for Medical Necessity, so I used to prepare the Medical Necessity Letter and send it to the payer along with supporting documents including Medical Records to prove the medical necessity of a service or a procedure.

At Accretive Health my responsibilities were verifying primary, secondary and tertiary coverage details, including member ID, group ID, coverage period, co-pay, deductible / co-insurance information, and benefit informations.I used to contact with patient if needed to check if the patient has some other coverage (Auto, Worker Comps, Liability Insurances etc.)I used to verify the Out of Network benefits and the coverage of a certain service, if the service is covered or not under the patient plan and if the precertification is required or not to perform the service.