1. Identifying faulty practices and identifying corrective actions
2. Provides second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.
3. Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.
4. Interacts with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation.
5. Trains, instructs, and/or provides technical support to medical providers and Medical Coding Analysts as appropriate regarding coding compliance documentation, and regulatory provisions, and third party payer requirements.
6. Staying abreast with changing coding guidelines and government regulations
7. Reviews, develops, modifies, and/or adapts relevant client procedures, protocols, and data management systems to coordinate these with UNM methodology, to ensure that client billing operations meet the joint requirements of both the local facility and UPA.
8. Interacts with providers and management to review and/or implement codes and to update charge documents.
9. Reviewed coding and billing systems and recommended proper training to employees
10. Ensures strict confidentiality of financial records.
11. Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations.
12. Performs miscellaneous job-related duties as assigned.

1. Oversees the operations of the billing department, encompassing medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management.
2. Maintains contacts with other departments to obtain and analyze additional patient information to document and process billings.
3. Prepares and analyzes accounts receivable reports, weekly and monthly financial reports, and insurance contracts in concert with the Practice Administrator. Collects and compiles accurate statistical reports.
4. Audits current procedures to monitor and improve efficiency of billing and collections operations.
5. Participates in the development and implementation of operating policies and procedures.
6.Reviews and interprets operational data to assess need for procedural revisions and enhancements; participates in the design and implementation of specific systems to enhance revenue and operating efficiency.
7. Analyzes trends impacting charges, coding, collection, and accounts receivable and take appropriate action to realign staff and revise policies and procedures.
8. Performs physician credentialing actions.
9. Maintains a working knowledge of all health information management issues such as HIPAA and all health regulations.
10. Maintains library of information/tools related to documentation guidelines and coding.
11Supervises billing office personnel, which includes work allocation, training, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.
12. Provides, oversees, and/or coordinates the provision of training for new and existing billing staff on applicable operating policies, protocols, systems and procedures, standards, and techniques.
13. Coordinates team member time off in a manner that does not negatively impact necessary daily functions.

Responsibilities & Results:
Improved revenue for most recent provider over 25% with same patient load
Experienced billing for Family Medicine, Ophthalmology, Dermatology, and
Mental Health specialties
Ensure claims are entered and submitted with 48 hours of receipt
Accurately apply payments to patient accounts
Post and reconcile insurance and patient payments. Research and resolve
incorrect payments, EOB
rejections, and other issues with outstanding accounts
Insure accuracy of insurance claims. Verify correct ICD-9 and CPT codes for a
variety of specialties
Set up new patient accounts
Assign ICD-9 to physicians diagnosis and insure correct level of service and
various other CPT codes
Set-up practice management software for submission of electronic claims to
clearinghouse. Work with clearinghouse to resolve file compatibility issues
Retrieve Electronic Remittance Advice (ERA's)
Send secondary claims upon processing of primary insurance.
Monthly processing of Patient statements. Answer and resolve patient billing
inquires
Follow up on Insurance and patient aging. Re-submit insurance claims as
necessary. Knowledgeable
in timely filing restrictions
Insure office practices are in compliance with HIPAA regulations.

Executed accounts receivable reporting enhancements and reconciliation
procedures in order to integrate Quick
Managed accounting operations, accounting close, account reporting and
reconciliations.
Performed debit, credit and total accounts on computer spreadsheets/databases,
using specialized accounting software.
Received, recorded, and banked cash, checks, and vouchers as well as reconciled
records of bank transactions.
Reviewed previous accountants book entries to ensure accuracy of the G/L.
Reviewed collection reports with the general manager to determine the status of
collections and the amounts of outstanding balances.
Performed complex general accounting functions, including preparation of journal
entries, account analysis and balance sheet reconciliations.