Gale Baird, CPC, CPCO

Review and evaluate patient charts and medical records to ensure coding for Diagnoses (ICD-10), procedures (CPT-4 & HCPCS codes), and services is accurate and compliant with relevant coding standards and guidelines. Ensure coding practices adhere to federal and state regulations, payer requirements and internal policies. Provide feedback and training to physicians, coders, and billing staff to ensure understanding of the proper coding practices and requirements.

Evaluate the existing revenue cycle operations to identify strengths, weaknesses, and bottlenecks. Review metrics such as days in accounts receivable, denial rates, and claim rejection rates. Ensure adherence to relevant regulations such as HIPAA, Medicare, Medicaid, and other payer-specific guidelines. Develop and enforce internal policies that align with compliance standards, including documentation requirements and billing practices. Provide regular training for staff on compliance issues and updates to regulations. Research and implement industry best practices for revenue cycle management.

Ensure accurate coding and billing practices to reduce claim denials and delays. Address issues with claims and denials early to prevent delays in payment. Maintain strong relationships with payers to resolve issues quickly and ensure timely reimbursement.

Responsible for comprehensive management of operations of the Revenue Cycle department. Provider staff of 20+, instrumental in development of in house billing from outsourced services. Developed billing data management plans including KPI's for the practice, along with review of resources, systems, and timetables ensuring successful execution of the organizations operational goals. Manage the revenue cycle setup for new facility start ups. Oversee and assist with credentialing all new providers with payers. Compliance Officer for corporation. Reports directly to the CEO.

Manage team of coders, billers, reimbursement specialists and payment posters. Work with eClinicalWorks EMR/PM with global team, investigate and resolve issues esaled from the team members and assigned clients. Build and maintain strong relationships with clients, managing multiple clients simultaneously. Communicate with assigned clients, weekly/monthly to review practice revenue health. Educate teams on all new billing guidelines and protocols as needed.