William Kocurek Email & Phone Number

United States

Florida, United States

• Achieved expert level knowledge of Hospital EMR in first 90 days, working with training team and front-end users to maximize understanding.• Provided full cooperation and support to internal and external team members by creating professional relationships in less than 30 days. • Utilized ongoing training to create departmental training manual.• Increased knowledge of all unique HMO Contractual in 45 days. • Streamlined departmental Chargemaster audit process by generating specialized report for each department to do own random audits for charge accuracy.• Evaluated all medical necessity audits prior to receiving final sign off from HIMS leadership team to strategically appeal or agree with findings. • Oversaw service pricing using recommendations from third party consultant, utilizing area averages, and evaluated commercial contractual to be competitive and transparent. • Managed complex claim edits and inquires by front end billing staff and claims follow-up team. • Educated clinical staff the proper resolutions to claim edits and/or implement alternate charging practices to reduce AR and reach full compliance. • Led post-pay audits, including in-house desk audits. Strategized decision to appeal with assistance of departmental clinical staff, reaching overturn rate of 60%. • Created comprehensive list of chemotherapy drugs. Trained nine staff members on proper IV charging, using CMS non-chemotherapy drug list, and CMS medical record requirements.• Developed 2-Midnight rule training document for physicians to properly bill inpatient R&B.• Identified anesthesia charge errors. Worked with Cerner dedicated build team to implement 15-minute rule. Worked with Cerner dedicated builders to create alternate payees in chargemaster to properly charge HCPCS required only by commercial payors. • Reviewed all supply items to code implants and supplies, resulting in additional revenue for all carveout listed in HMO contracts over six month period.

United States

• Supervised team of clinical chart auditors to perform routine claims audits/analysis and investigations, to detect, investigate, remediate accurate claims submission and payment. • Ensured managed care or law enforcement as appropriate incidents of fraud, waste and abuse (FWA), arising in connection with behavioral health and other healthcare services. • Analyzed provider data to detect aberrancies and trends utilizing Excel pivots, formulas including VLOOKUP and complex IF statements.• Educated providers regarding compliance with documentation requirements and medical necessity of services provided and billing guidelines. • Utilized treatment resources, contractual agreements, and federal and state regulations. • Managed case assignments, case development, case review, overpayment recoveries, law enforcement referrals, training of staff, and coordination with other departments to mitigate and remedy FWA. • Directed onboarding for five new investigators with full training and success realized. • Created pre-pay audit program for Florida market, including report writing and education.• Increased overpayment collection from $265,000 to $535,000 over one-year span. • Served as direct contact for provider and facility education on documentation requirements. • Ensured monthly, quarterly, and yearly reports are timely and accurate.• Developed 14 new process and procedures within department. Added 21 cheat sheets for team use. • Reduced appeal/dispute receipt by 20% over six-month period by working with team to accurately educate providers on fraud, waste, and abuse.

Jacksonville, Florida Area

• Managed business office operations including AR, billing, admissions, and collections.• Maintained goal of 105% of AR goal for ten consecutive months.• Reduced AR by 20% over six-month period.• Resolved credit balance accounts to keep it under $20,000 each month. • Oversaw numerous collection issues with payors. Created long-standing relationship to achieve reimbursement timely.• Reported to CFO/CEO accurately and timely on weekly/monthly basis on performance of AR/Billing.• Implemented protocols to improve efficiency and quality within business office including creating new spreadsheets and reports to better manage daily activities.• Assisted in establishing policies and procedures relating to overall financial goals of facility. Led new collection procedures and audit programs to ensure high quality performance.• Functioned as appeal expert, understanding root cause of denials and effectively working with all departments to obtain payment.• Completed unbilled accounts to 20 any given week for six consecutive months.• Led late scheduled accounts to under 10% each week for ten consecutive months.

St Augustine, Fl

• Working proficiency of Medicare Reimbursement methodologies including OPPS, DRG• Competent in Billing, Coding, Modifier usage, NCCI Edits, MUE, Medicare Claims Guidelines• Denial management – analyze, track, forecast all denials and track appeals• Contract payment accuracy to optimize full payment from commercial and Medicare• Created 10 new charge audit programs; both front end and back end• Meditech professional including Item Master, Chargemaster, OR Module, BAR Edit, PCI• Member of FHA, AAPC and various discussion forums to keep abreast of industry standards• Medicare and Commercial payor remit educator for employees of Business Office• Implemented new Implant P&P resulting in revenue capture of greater than $100,000 for FY09• Pharmacy billing expert maximizing reimbursement by coding specifically according to Medicare. Medicaid, and Commercial requirements and contractual obligations. Netting an additional >$50k/yr.• Insurance professional supporting Insurance audits resulting in saved revenue of $250,000• Created E&M level criteria for 4 areas of Hospital, including OB, Oncology, and ER capturing $250,000 additional revenue• Implemented new process of time capture in OBS to remain in compliance with Medicare guidelines• Educated and implemented new IV infusion time capture process resulting in > $150,000/revenue• Intensive charge review in order to maintain consistency in markups and improve revenue• Worked with Supply Chain Mgmt. to improve Item Master to Chargemaster relationship• • Initiated high cost drug project, charging appropriately resulting in $50,000 addl. revenue for FY09• Working knowledge of Lab, Radiology, Nuc Med, Card. Pulm, and Oncology charging processes• • Denials Management Professional collecting over $500k in net revenue in one year. Aptitudes include Denial Trends, Root Causes, Resolution management while understanding the front end charge practices remaining compliant with Federal, State and Commercial guidelines.