Senior Coding Quality Auditor

• Nov 2017 - Present

Billing Manager

• Aug 2016 - May 2017

Accounts Receivable Manager

• May 2003 - Aug 2016

•Conduct and administer fiscal operations, including accounting, planning budgets, authorizing expenditures, and helping establishing rates for services, and coordinating financial reporting. •Responsible for the day to day operations and outcomes of the physician billing services department working closely with other managers and teams to review, develop and implement workflows and processes for maximizing account collections. •Managing customer service operations to ensure excellent patient experience as well as making sure their issues, inquiries, or complaints are resolved in a timely manner. •Managing and supervising self- pay collections, reviewing reports to determine collection status and amounts of outstanding balances as well as the submission of delinquent accounts to outside agencies for collections. •Responsible for insurance billing, denial follow-up and appeals for government and commercial payers, PPOs, EPOs, IPAs, HMOs, Workers Compensation, Third party Liability, LOAs, minimizing rejection rates and increasing payer reimbursement. •Coordinate operations with Coding, Data Processing, and medical directors to make sure the flow of information is as accurate as possible. •Conduct regular department meetings with staff to distribute company internal policies and procedures as well as new information. •Plan, implement and administer programs and services in the department, including personnel administration, training, and coordination of responsibilities. •Responsible for the recruitment, hiring and training of personnel including annual performance review. •Develop and implement organizational policies and procedures for the department. •Manage change in integrated health care delivery systems, such as work restructuring, technological innovations, and shifts in the focus of care. •Prepare activity reports to inform management of the status and implementation of plans, programs, services, and quality initiatives. Show less

Accounts Receivable Supervisor

• Sep 2001 - May 2003

•Resolve customer complaints or answer customers' questions regarding policies and procedures.•Supervise the work of office, administrative, or customer service employees to ensure adherence to quality standards, deadlines, and proper procedures, correcting errors or problems.•Implement corporate or departmental policies, procedures, and service standards in conjunction with management.•Train or instruct employees in job duties or company policies or arrange for training to be provided.•Discuss job performance problems with employees to identify causes and issues and to work on resolving problems.•Evaluate employees' job performance and conformance to regulations and recommend appropriate personnel action.•Recruit, interview, and select employees.•Interpret and communicate work procedures and company policies to staff.•Research, compile, and prepare reports, manuals, correspondence, or other information required by management or governmental agencies.•Coordinate activities with other supervisory personnel or with other work units or departments.•Design, implement, or evaluate staff training and development programs, customer service initiatives, or performance measurement criteria.•Monitor inventory levels and requisition or purchase supplies as needed. Show less

Accounts Receivable Liaison

• Aug 1989 - Aug 2001

Responsibilities:•Coordinate the communication flow between Bristol Park Medical Group and the outsourcing billing agency to ensure adequate operations.•Locate and attach appropriate files to incoming correspondence requiring replies.•Provide employees with guidance in handling difficult or complex problems or in resolving escalated complaints or disputes.•Train employees in job duties and company policies or arrange for training to be provided as needed.•Discuss job performance problems with employees to identify causes and issues and to work on resolving problems.•Review productivity reports to verify details, monitor work activities, and evaluate performance.•Prepare and issue work schedules, deadlines, and duty assignments for office or administrative staff.•Research, compile, and prepare reports, manuals, correspondence, or other information required by management or governmental agencies.•Coordinate activities with other supervisory personnel or with other work units or departments.•Make recommendations to management concerning such issues as staffing decisions or procedural changes.Bristol Park Medical Group , Irvine, CA Revenue Recovery Specialist•Conduct searches to find needed information, using such sources as the internet and/ or company data source.•Analyze HMO contracts and run database reports to identify discrepancies in capitation payments and seek reimbursement for services not included in the contract agreement (carve-out procedures),•Run daily, weekly and monthly reports to identify overpayments to contracted physicians paid claims and initiate the revenue recovery process.•Audit patient HMO enrollment files for changes and termination of member's eligibility and run it against services provided to identify possible overpayments and initiate the reimbursement process•Follow-up on refund requests.•Create and present to management monthly written reports on revenue recovered. Show less