Medical Billing Expert

Specialties & Experience of this Expert Witness

Additional Information

Do you need someone who knows and understands medical billing? I have been in the industry since 1988. I know the games and tricks payers use to deny claims. I have been a claims examiner, biller, claims manager, medical billing company owner, and a highly sought-after lecturer. I am not some Johnny-come-lately. I have the tools that you need to succeed. • EXPERIENCE ACCURATE MEDICAL BILLING & AUDIT, Rancho Cucamonga, CA/McKinney, TX OWNER, CEO, AND FOUNDER Only Billing Service to earn Preferred partner status with San Bernardino County Medical Society. Only billing services are authorized in California to perform CEUs for doctors. Comprehensive knowledge and experience in insurance billing, claims, and collections. Recommended billing service by and to CCA members Recommended and endorsed by ICAC Co-Chair insurance and Managed Care Committee-California Chiropractic Association CONSOLIDATED HEALTHCARE SERVICES/A1 IMAGING/HALLMARK SURGERY CENTER NATIONAL DIRECTOR BILLING/COLLECTIONS Fifty-four current and past, state-of-the-art Open MRI Primarily Southeast United States Mentored training developed a direct staff of 24 and indirect staff of 72. Enhanced usage of current Athenanet software. Developed previously missing staff training. Met or exceeded monthly collections goal 16 out of the first 18 months of employment. The department previously met the goal 1 time in the previous three years. Severely impacted backlog without write-offs. Initiated automated insurance denial appeal process. PRIME HEALTHCARE HOSPITAL BUSINESS OFFICE MANAGER Incorporated fully managed care training and collections. Collaborated with legal counsel in the interpretation of medical records. Promoted to Business Office Manager within five months of employ Ensured best practices in supporting benefits administration and customer service initiatives related to healthcare concerns and questions associated with claims and insurance plans PEROT SYSTEMS (ACQUIRED BY DELL) IDX SYSTEMS ANALYST Maintained integrity and performed audits of GE/IDX System and HMO benefit tables and ESI health plan eligibility documentation. Facilitated and chaired monthly meetings with executive management concerning system contracts and benefit interpretation and applications. POMONA HOSPITAL MEDICAL CENTER CLAIMS SUPERVISOR Training, mentoring, and performance of elite claim analyst staff in managing inpatient and outpatient hospitals, ambulances, skilled nursing facilities, and professional/ancillary claims. DESERT PHYSICIANS MANAGEMENT IMPLEMENTED REVENUE RECOVERY DEPARTMENT Revenue recognition and recovery efforts with third-party lien recovery (TPL), hospital risk reconciliation, shared risk, and pharmacy risk pool reconciliation Recovery of previously unknown and undiscovered revenue. ARCADIAN MANAGEMENT SERVICES MANAGER REVENUE RECOVERY Heal, the care services company, provides administrative infrastructure and management services to healthcare provider groups, hospitals, and health plans. Created Revenue Recovery Department, introducing previously non-existent cost containment mechanisms and methodologies, including tenacious audit and shared risk review and recovery policies and procedures. Created and delivered ongoing training and education to Claim Audit Staff. We recovered over $250k in non-capitated services by implementing third-party lien recovery operations. USC UNIVERSITY AFFILIATES IPA MANAGER CONTRACTUAL ANALYSIS-AUDITING Liaison and central point of contact for contract interpretations and adherence to DHS and CMS regulations. Defined optimal staffing needs and training requirements. Formulated the policies and procedures for newly created departments corresponding to shared risk, stop loss, risk pools, insured services, and benefit interpretations. Achieved an