REVENUE CYCLE MANAGEMENT
Review medical records to ensure proper charge capture and documentation supports billable service. Electronic claims submission with claims scrubbing and immediate claims rejections corrections. Payment posting by billing specialist to maintain denial management, trends and contractual issues. Medical Billing Charge Audits are completed monthly. Medical Billing Charge Audits are completed monthly
Expedited 30 to 90 day review of all outstanding accounts receivables. Forensic claims review of 91 plus outstanding account receivable. Refund reviews and dispute. Administrative Appeals and Third Party Settlement Negotiations.
Credential all new providers with all the major payers -Medicaid/MCO, Medicare and Commercial Plans. Maintain CAQH profile and other portals. Maintain Contracts and renegotiate when the opportunity arises.
Consult with existing clients on process improvements within clinic to maximize billing. Provide guidance to clinicians on template designs, workflows, and documentation to ensure optimal accuracy. Potential clients on industry trends, regulatory changes, potential opportunities to enhance existing services or expand outreach. Evaluation of business model and financial viability.