Experience

Southern California Orthopedic Institute

• United States
• Medical Practices
• 1 - 100 Employee

• Team Lead Workcomp Division

  • Jun 2019 - Present

  • Assist with implementation of policies, procedures, and centralization of WC RFA division.• Provide support and direction WC PBC representatives.• Monitor outstanding work queues and provide reports to staff. • Coordinate training schedules and orientation of all new FTE’s.• Train new FTE’s. • Lead monthly team meetings.• Conduct daily audits on outstanding WC Work queues. • Creating RFA’s.• Ensuring WC RFA’s are completed timely. • Obtaining Authorization/and or denial and entering in system. • Communicating to Physicians support staff on the status and outcome of each individual account.• Setting peer to peer reviews between NCM, UR department and our physicians. • DME negotiations and obtaining Purchase Orders from all third-party vendors.• Liaison between WC Patient benefit reps and Physicians support staff. Show less

• Team Lead Revenue Cycle

  • Jul 2008 - Jun 2019

  • Provide support and direction to assigned Insurance Representative and Billing Assistants.• Monitor staff productivity and quality of work.• Coordinate and assist with training and orientation.• Lead monthly team meetings.• Work on those accounts escalated to second level review.• Conduct Insurance Representative and Billing Assistant monthly audits.• Assisted in creating targeted campaigns to analyze and control A/R 90-120 days.• Assist with implementation of policies and procedures.• Communicate with Medicare to ensure appropriate payment of claims.• Staying current with Medicare/Medi-cal guidelines and changes.• Investigate non-payment.• Review all surgical and office denials and appeal when necessary.• Re-bill and file appeals.• Assist processing of Insurance claims aged 90 days. Show less



ORTHOPEDIC CONSULTANTS MEDICAL GROUP, INC.

• United States
• Medical Practices

• Team Lead Revenue Cycle

  • Oct 2003 - Jun 2008

  • Managed and trained 12 Employees. • Stay current with OMFS, Medicare and Private insurance guidelines and changes. • Work on special projects. • Process and run aging reports to distribute. • Provided support to staff by assisting with Correspondence and follow up. • Reviewed denials for both surgical and office to ensure maximum reimbursement is received. • Received all insurance checks, processed and deposited in the bank daily. • Coordinated and scheduled all depositions for the physicians. Show less