Experience

Hiro Health

• United States
• Health, Wellness & Fitness
• 1 - 100 Employee

• Billing Director

  • May 2020 - Present

  Responsible for ERM management systems. Updating Charge Master. Ensure System RCM is properly set up for smooth Revenue Cycle Process. Setup of payer ERA enrollment for Posting. Reporting Financials on Month End. Problem Solving payer denials includes implementing Appeals Process. Initiating Payer Contracts and reviewing Contract Fee for proper reimbursement rates on finalized executed provider contracts. Q.A. on all Claims for proper Billing and Coding Establish process on Claims Processing and Submission Proper Training of Staff to implement accurate and efficient workflow.



UMMC/ Ayraamed

• Out Patient Billing Director

  • May 2019 - May 2020

  Responsible for overseeing all Out Patient Cilnic and HOPD Billing as well as the Multi Specialty Group. Billing and Coding of Sleep Center Lab under the Hospital. Working with providers and carriers to ensure that all credentialing process are up to date to secure proper processing of payment. In charge of updating all Pecos Enrollment for the Group. Reviewing all Revenue Cycle deficiencies and putting action plans in place to secure payment of claims. Coding and Billing of LOP contracted Law Firm accounts for Hospitsl services.



Globonics LLC

• Billing / Revenue Cycle Manager of Hospital Billing

  • Sep 2015 - May 2019

  Billing /Revenue Cycle Hospital Director. Knowledge of all payers billing rules and regulations for processing of payments. Responsible for review of Appeals prior to submission. Responsible for Writting Medical Necessity Appeals on denied IP and Out Patient Surgery services with assistance of the facilities Case Manager. Sending all Appeals in a timely fashion meeting all payer guidelines for reimbursement. Responsible of Revenue Cycle Accounts Receivables on all IP claims as well as Out Patient. Managing and keeping the AR for the facility up to date. Making sure that claims are coded and submitted in a timely manner, following all payers timely filling guidelines. Negociation of claim payments on some out of network payers. Managing The Hospitals Billing Team as well as Coders for the appropriate processing of Claims. Training team members on any updates of EMR systems as well as any additional Billing Training and Collections on the correct processing of Claims.



Tomball Regional Medical Ctr

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Medicaid and Medicaid Managed Care Patient Accounts Representative

  • Oct 2014 - Sep 2015

  Review all Medicaid Denials and Medicaid Manged Care. Following up on all accounts for payment. Keeping up to date with all Payer Plans policies and procedures. Working claims in a timely manner to meet all deadlines. Having knowledge of each plans appeals process for payments. Having knowledge of CPT coding process as well as revenue codes and correct billing codes on institutional claims. Having knowledge of the Billing process and each payers fee schedule. Reviewing payments of each payers and making sure its what is expected according to the facilities contract. Working an AR report in a timely manner.



Alegis Revenue Group

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Appeals and Denials

  • Oct 2013 - Oct 2014

  Working Medicaid and Medicaid Managed Care Accounts. Reviewing all Denials in a timely fashion for the process of an appeal with the Health Insurance Company for payment. Having knowledge of Institutional Billing on Uniform Bill. Working Medicaid and Medicaid Managed Care Accounts. Reviewing all Denials in a timely fashion for the process of an appeal with the Health Insurance Company for payment. Having knowledge of Institutional Billing on Uniform Bill.



Anthony Jordan Health Center

• Billing Specialist

  • Apr 2003 - Aug 2013

  Billing Institutional Claims as well as professional. Working the AR report efectively. Reviwing Medicaid Denials for corrections and resubmission. Working the clearing house edit reports for resubmission of claims. Keeping track of policies and procedures. Educating Front Desk Personel for correct Insurance Verification. Filing in for MVA and Workers Compensation billing when needed. Billing Institutional Claims as well as professional. Working the AR report efectively. Reviwing Medicaid Denials for corrections and resubmission. Working the clearing house edit reports for resubmission of claims. Keeping track of policies and procedures. Educating Front Desk Personel for correct Insurance Verification. Filing in for MVA and Workers Compensation billing when needed.