Stephanie Points

Supervised revenue cycle, billing, and coding operations, ensuring accurate claims, compliant coding, appropriate documentation, and adherence to payer requirements across commercial insurance, Medicare, and Medicaid.

Managed complex RCM issues including denials, appeals, claim corrections, authorizations, eligibility, medical necessity, coding, documentation, timely filing, and payer processing.

Analyzed denial, A/R, and billing trends to identify root causes, preventable denials, revenue recovery opportunities, and process improvement needs.

Investigated claims, medical records, EOBs, ERAs, and payer correspondence to resolve billing discrepancies, coding issues, reimbursement challenges, and compliance risks.

Collaborated with payers, clearinghouses, providers, coders, clinical teams, and billing staff to resolve complex claims and optimize reimbursement.

Led staff and provider education, quality assurance, and process improvement initiatives focused on coding accuracy, documentation quality, denial prevention, and identification of fraud, waste, abuse, and overpayment risks.

• Lead billing and compliance investigations involving patient grievances, payer audits, billing irregularities, documentation discrepancies, overpayments, and regulatory risk. Review medical records, claims, reimbursement activity, and payer requirements to identify compliance gaps and potential fraud, waste, and abuse.
• Apply advanced expertise in CPT, HCPCS, ICD‑10‑CM, Medicare, Medicaid, and commercial payer policies to evaluate billing accuracy, identify coding and documentation vulnerabilities, and support development of corrective actions.
• Conduct trend and root‑cause analysis to identify systemic billing and documentation issues. Prepare investigative reports, case summaries, risk assessments, and remediation recommendations for Compliance leadership, Legal, and payer partners.
• Support program integrity and payer audit activities, including claims analysis, overpayment identification, audit response preparation, and corrective action planning. Collaborate with Compliance, Legal, Billing, Coding, Clinical, Provider Relations, and Payment Integrity teams to ensure coordinated resolution.
• Utilize Excel, Salesforce, SAI 360, athenahealth, NextGen, and audit platforms to analyze data and communicate findings. Provide targeted compliance education to providers and operational teams on billing, coding, and documentation requirements. Develop PowerPoint presentations, fact sheets, and standardized resources adopted across multiple affiliates to improve documentation quality and billing accuracy.