William E. Email & Phone Number

Knoxville, Tennessee, United States

Managed compliance with payer medical and reimbursement policies, regulatory coding guidelines (CPT, ICD-10, HCPCS), and federal healthcare statue, achieving a 70% appeal success rate and recovering $250,000 per year in denied claim payments.Developed tracking systems using VBA and SQL, reducing appeal lead time by 50% and increasing overall efficiency.Ensured 100% compliance in documentation accuracy, flagging high-risk billing and coding issues and escalating them to… Show more Managed compliance with payer medical and reimbursement policies, regulatory coding guidelines (CPT, ICD-10, HCPCS), and federal healthcare statue, achieving a 70% appeal success rate and recovering $250,000 per year in denied claim payments.Developed tracking systems using VBA and SQL, reducing appeal lead time by 50% and increasing overall efficiency.Ensured 100% compliance in documentation accuracy, flagging high-risk billing and coding issues and escalating them to leadership to mitigate potential audit risks.Reported key compliance metrics, contributing to a 10% overall reduction in appeal rates, and a 28% reduction in unwarranted appeal requests, by identifying and addressing systemic issues. Show less

Analyzed denied claims for coding and policy compliance, resolving 35 claims daily at 99% accuracy, resulting in a 33% reduction in A/R days.Diagnosed underlying causes of claim denials and rejections such as coding discrepancies, demographic errors, and coordination of benefits issues through a meticulous process of root cause analysis.Crafted and submitted persuasive appeal letters to various private and government payers, successfully overturning 60% of denied claims… Show more Analyzed denied claims for coding and policy compliance, resolving 35 claims daily at 99% accuracy, resulting in a 33% reduction in A/R days.Diagnosed underlying causes of claim denials and rejections such as coding discrepancies, demographic errors, and coordination of benefits issues through a meticulous process of root cause analysis.Crafted and submitted persuasive appeal letters to various private and government payers, successfully overturning 60% of denied claims, demonstrating strong written communication skills and effective stakeholder engagement.Maintained strict privacy of patient information in accordance with HIPAA regulations. Show less

Knoxville, Tennessee, United States

Processed and accurately keyed an average of 1,000 charges a day while maintaining a 99% accuracy rate, demonstrating exceptional data-entry skills and a high capacity for managing large datasets.Ensured compliance with company, payer, and coding regulations during charge entry and review, ensuring that all data met quality standards.Ensured 100% accuracy of patient demographic and insurance information to secure proper reimbursement.Maintained strict privacy of patient… Show more Processed and accurately keyed an average of 1,000 charges a day while maintaining a 99% accuracy rate, demonstrating exceptional data-entry skills and a high capacity for managing large datasets.Ensured compliance with company, payer, and coding regulations during charge entry and review, ensuring that all data met quality standards.Ensured 100% accuracy of patient demographic and insurance information to secure proper reimbursement.Maintained strict privacy of patient information in accordance with HIPAA regulations. Show less

Knoxville, Tennessee, United States

Received job-specific training in medical billing operations, including shadowing of a diverse range of departments within the billing office.Keyed data from superbills in accordance with established guidelines.Hired from externship site on final day of engagement.

Bachelor Of Science - Bs, Computer Science, 3.3/4.0

Activities and Societies: ACM, IEEE, Golden Key Theory and practice of computer science. Notable coursework includes: ◆ Technical.

Mathematics And Statistics

Self-instruction in bachelor's-level and first-year graduate-level mathematics, including: ◆ Proofs and proof theory ◆ High school.