Claims Resolution Manager

• May 2021 - Present

Healthcare Consultant

• Jan 2010 - Aug 2021

• Extensive knowledge in Revenue Cycle Management. • Provide on and offsite training to set up billing and collection systems and processes.• Effectively resolve billing and coding issues resulting in increased revenue for medical practices.• Analyze trends and resolve root cause issues working externally with vendors and payers.• Conduct payer outreach and research activities and maintain active payer relationships.• Work claims and claim denials to ensure maximum reimbursement for services provided .• Prioritize process and resolve complex payer and provider issues to optimize client and organizational performance. • Utilize multiple websites to support documentation for coding compliance issues.• Extensive knowledge of athenahealth practice management system.

AR Manager

• May 2018 - May 2021

Account Manager

• Jul 2009 - Oct 2017

• Successfully managed a book of business with over 90 clients.• Managed client performance to ensure positive results and reduce client retention. • Expanded the services of clients after analyzing their performance and workflow which increased their revenue.• Identified metrics and defined success criteria to create transparency and visibility into program success and or improvement areas.• Successfully worked independently and collaboratively within a team environment.• Escalated project or support issues to ensure timely resolution and customer satisfaction.• Lead and influence cross functional teams to implement specific components of project plans while setting clear expectations with stakeholders.• Identified new opportunities to streamline processes resulting in less manual input. • Conducted offsite training for medical practices of athenahealth electronic medical record systems (EMR).• Mentored and coached Account Associates and acted as a resource for all aspects of account management processes and procedures.

Claims Analyst

• Jul 2009 - Aug 2010

• Initiated and assisted appeals as needed to payers following the guideline outlined for that payer.• Maintained compliance standards in accordance with the compliance policies.• Accurately followed coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies.• Researched and resolved unpaid or denied claims with various insurance payers.• Aggregated data and monitored activity for trends that were used to identify opportunities to prevent future unpaid or denied claims.• Obtained missing remittances for various payers.• Created reports and spreadsheets to analysis trends for clients based on their payer group.

Practice Manager

• Apr 2003 - Jul 2009

• Managed all aspects of the office managing a team of 7, including administrative, billing, Human Resources, policies, procedures, and Payroll. • Responsible for billing and coding all office visits and surgical procedures.• Maintained Fee schedules.• Worked denials and appealed claims.• Responsible for all aspects of Revenue Cycle Management. • Managed all aspects of the office managing a team of 7, including administrative, billing, Human Resources, policies, procedures, and Payroll. • Responsible for billing and coding all office visits and surgical procedures.• Maintained Fee schedules.• Worked denials and appealed claims.• Responsible for all aspects of Revenue Cycle Management.