Skilled medical billing and collections authority with 15 years of experience in enhancing claim processing efficiency, payment collection strategies, and accounts receivable oversight.
Overview
11
11
years of professional experience
Work History
Billing Lead
NYU Langone Health
Boynton Beach, Florida
02.2024 - Current
Led revenue cycle projects and initiatives, providing management insights on staff queries and training needs.
Identified and resolved payer, credentialing, and coding issues; recommended system edits to maximize revenue.
Prepared and escalated complex appeals using policies, contracts, coding guidelines, and medical records in coordination with billers.
Monitored WQ 31067 and offshore appeals folders; reported accounts outside turnaround time for remediation.
Facilitated system team calls and payment discussions; conducted weekly appeals meetings for timely resolution of outstanding items.
Reviewed CSC Tracker and communicated with credentialing regarding CSC-related issues.
Approved 'super reviewer' requests for users achieving over 100 appeal approvals.
Ensured accuracy of Panviva guidance and workflows; provided examples to improve process efficiency.
Manage Peds Retro WQ 4454: confirm and update newborn coverage in Epic to ensure the correct payer in a timely manner.
Reviewing and ensuring Panviva guidance and workflows are accurate and efficient for the team, if updates are needed, providing examples and resolutions to streamline the process.
Assist managers/specialists, review weekly trackers, and provide clarification and guidance to offshore teams.
Execute MCO escalations (bulk and single-item); conduct adjustment reviews, and audit (BMT) payments.
Billing Representative III
NYU Langone Health
Boynton Beach, Florida
09.2021 - 02.2023
Executed RCM workflows across authorizations, coding, correspondence, claims submission, A/R follow-up, and credits.
Recommended edits and process/policy improvements to increase clean-claim rates and revenue integrity.
Researched and appealed complex denials using payer policies, coding guidelines, contracts, and clinical documentation.
Monitored and resolved assigned work queues and reports to maintain acceptable inventory levels and aging.
Identified payer, credentialing, and coding issues; collaborated with management to implement solutions.
Led assigned projects; completed second-level appeals; tracked trends and throughput in WQ 31067.
Office Manager
Waters Edge Dermatology
Boca Raton, Florida
09.2019 - 09.2021
Established and optimized workflow processes; delegated duties to align with productivity goals.
Set, monitored, and maintained office KPIs; provided strong team support and customer service.
Managed scheduling, referrals, authorizations, and insurance verification.
Oversaw new-hire interviewing, payroll, and provider credentialing.
Coordinated marketing and advertising for new office procedures.
RCM Team Lead
Waters Edge Dermatology
Palm Beach Gardens, Florida
08.2014 - 09.2019
Led RCM staff; defined workflows and delegated tasks to meet service and cash goals.
Obtained prior and retro authorizations; coordinated peer-to-peer reviews for precertification.
Verified payer policies, articles, guidelines, and LCD/LMRP criteria to support medical necessity and reimbursement.
Served as a resource for staff on complex claims, coding, and denial troubleshooting.