Director of RCM Services

• mar. 2022 - - Prezent

Pain Management & Anesthesia Billing & Coding RCM Manager

• aug. 2018 - mar. 2022

The Billing & Coding Manager is responsible for providing overall insight, management, and compliance for the full billing & coding revenue cycle for the pain management division. This position is responsible for trending denials for root cause analysis reporting, follow and create value added processes related to pain management generated revenue, account reviews and audits, appeals management, coding compliance, billing compliance, and insurance follow up to maximize revenue for our pain management practices and providers. This position is responsible for the overall health of the revenue cycle as it relates to pain management revenue.Summary of Duties:• Provide guidance on documentation requirements, queries, and documentation improvement processes.• Communicates coding and DRG findings to management, including applicable references, as appropriate.• Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.• Audit coders work to determine proper codes for medical records and patient services were selected.• Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.• Implemented best practice standards for billing resulting in substantial reduction of accounts receivable delays.• Monitored and guided revenue cycle operations.• Assessed current revenue cycle procedures and implemented improvements to foster efficiency.• Completed financial reporting and analysis for billing revenue cycle.

Medical Coder

• aug. 2015 - aug. 2018

• Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.• Guarded against fraud and abuse by verifying all coded data accurately reflected services provided.• Interacted with physicians and other healthcare staff to ask questions regarding patient services.• Applied charges and updated patient records by using Medsuite.• Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.• Verified signatures and checked medical charts for accuracy and completion.• Accurately selected proper descriptive code when more than one anatomical location was indicated.• Reviewed outpatient records and interpreted documentation to identify all diagnoses and procedures.• Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.• Resourcefully used various coding books, procedure manuals and on-line encoders.• Initiated, performed and documented quarterly coding audits for physicians.• Reviewed patient charts to better understand health histories, diagnoses and treatments.• Reviewed 200 medical records per day to select appropriate coding sequences.

Assistant Practice Administrator

• apr. 2005 - aug. 2015

• Monitored and guided revenue cycle operations.• Supported clinical team members with all revenue cycle procedures and addressed any issues as needed.• Assessed current revenue cycle procedures and implemented improvements to foster efficiency.• Completed financial reporting and analysis for billing revenue cycle.• Identified discrepancies between budgetary targets and actual revenue and expenses.• Handled job duties for staff members which were unavailable or out of office.• Communicated effectively with staff members, physicians and patients, employing active listening and interpersonal skills.• Developed policies and procedures for effective practice management.• Assisted with regulatory issues such as compliance.• Developed close working relationships with front office and back office staff.• Provided outstanding support to entire staff which helped improve process flow and boosted efficiency.• Ordered all office supplies and kept check on inventory levels.• Assessed processes and procedures, complying with OSHA and HIPAA regulations.• Communicated closely with patients, ensuring medical information was kept private.• Developed and maintained electronic record management systems to analyze and process data.• Consulted with healthcare professionals on business decisions.• Managed 15 employees with various personalities and from different cultures for large 8-physician practice.