Laura Ramirez, CPC, CPCO, CPB

Regional Billing Operations Manager for California, Arizona, and Washington Practice Groups

• Conduct RCM onboarding for physicians/practice management teams to establish relationships and develop billing operations aligned with organizational standards
• Work with System Implementation Specialists to ensure RCM practices are supported and practice builds completed
• Analyze, distribute, and communicate weekly reports to Chief Administrative Officer and executive team
• Work directly with Chief Operating Officer to improve operations and develop workflows across the region
• Work closely with Chief Administrative Officer to develop and analyze processes/strategies
• Drive change initiatives for organizational improvements while collaborating with cross-functional departments and leadership
• Prepare and present weekly/monthly operational and financial reporting presentations to executive leadership and practice physicians/managers
• Develop system supported processes to support billing services that align with organizational and practice goals
• Work directly with physicians to address and resolve compliance and billing concerns
• Serve as liaison to practice leadership on RCM concerns
• Manage contracted groups and contract updates to support organizational needs
• Optimize billing efficiencies and workflows to align with short and long-term goals
• Work with internal and external project managers to ensure project success
• Responsible for management of all facets of Billing, Coding, and Billing Operations across the region
• Managed an internal and offshore team of billing specialists, providing guidance on best practices and ensuring timely completion of tasks.
• Enhanced team performance through regular training sessions and performance evaluations, leading to improved efficiency in billing operations.
• Leveraged automation tools in the billing process, increasing efficiency and allowing for faster invoice processing.

• Conduct regular practice meetings to identify and resolve RCM challenges
• Monitor and analyze reports to delegate projects and determine necessary resources
• Delegate and manage projects; communicate results to leadership
• Update fee schedules and billing system data- including creating custom system rules
• Meet regularly with Account Managers to provide direction, advice, feedback, and guidance
• Direct and supervise internal and external/offshore claim release billing team performing an average of 3500 daily claim reviews
• Assess workflow and productivity utilizing various measurements in effort to drive production goals
• Evaluate performance and establish expectations/goals for the claim release and billing team
• Provide policy updates and education to improve billing standards
• Enhanced coding accuracy by implementing regular training sessions and performance evaluations for coding staff.
• Streamlined workflow processes by identifying areas of improvement and implementing necessary changes.
• Conduct documentation and billing audits- communicated results with physicians and other stakeholders for improvements
• Develop and manage outlines per practice to guide billing team on posting front office collections and claim release processes
• Develop and manage coding education tools for billing staff guidance
• Develop and manage credentialing outline tools for billing staff guidance
• Develop, train, and coach billing team in areas of coding, compliance, AR recovery, and system applications
• Maintain and update Sharepoint database of current policies, procedures, and workflows to ensure accurate information is available for staff and leadership
• Serve as contact for physicians and staff on billing, coding, and compliance concerns
• Collaborate with AR Manager team to resolve payment discrepancies, insurance denials, and claim rejections
• Manage ASC professional and facility billing, fee schedule updates, and process concerns in conjunction with RCM VP
• Work directly with all claim release teams across table spaces and platforms to ensure timely processing of claims
• Conduct regular meetings with Billing team, internal/external, to review items impacting RCM, provide guidance, provide education/coaching, and discuss process resolutions

• Managed and led the integration of outsourced coding team- including all EHR/Billing systems and process training
• Delegated target areas for Coding Team
• Provided guidance, education, and training to internal and remote Coding Team
• Professional and ASC Facility coding for pain physicians and anesthesia providers (Surgical, E/M, Anesthesia, Medicine, Radiology, Laboratory)
• Managed and delegated targets for day-to-day coding volume (est
• 200-350 claims) to ensure timely submissions
• Supervised and approved coding changes
• Developed workflows, coding training videos, and protocols for Coding Team
• Managed and conducted weekly coding calls with Coding Team
• Responsible for establishing coding policies and compliant billing practices
• Created billing system rules to reduce coding conflicts and claim issues
• Conducted regular coding reviews for QA
• Communicated with ASCs and offices for any billing/coding-related needs
• Served as consistent, responsive, and effective resource for providers and all staff regarding coding, compliance, and A/R denials
• Conducted regular internal coding audits to ensure billing compliance (E/M, pain procedures, and multi-specialty services)
• Identified and educated providers on compliant billing, documentation requirements, and accurate coding
• Communicated and coordinated practice, billing, and coding changes with management
• Researched and communicated changes in medical necessity policies and coding
• Worked with AR staff on chart auditing for medical necessity denials and appeals
• Participated in weekly meetings with Director and VP of RCM to report and discuss coding/compliance concerns.

• Ensured healthcare provider and billing process compliance with official current coding guidelines as well as Medicare and AHCCCS requirements for coding and billing
• Responsible for all office, anesthesia, and procedure claims coding, submission, PM troubleshooting, policy reviews, exception corrections, and front-end claims rejections
• Audited and analyzed encounters, reports, and other medical records to determine appropriate diagnosis and procedure codes to describe level of service and whether surgical professional services provided are valid, supported, and complete
• Optimized revenue cycle management with timely and precise code assignment for various medical procedures.
• Reviewed records to assure compliance with all required documentation- patient and record identification, signatures and dates where required, and all other necessary data to support billing and treatment provided
• Abstracted appropriate evaluation and management level of service from medical records per CPT and CMS guidelines
• Adhered to CPT, HCPCS, and ICD-10-CM billing guidelines while appropriately assigning modifiers, and multiple or add-on procedures
• Identified and educated healthcare providers and Billing Dept
• Staff on compliance billing, documentation requirements, and additional revenue opportunities
• Served as consistent, responsive, and effective resource for Billing/Non-Billing staff regarding coding inquiries and insurance coding-related denials
• Managed high-volume workloads effectively by prioritizing tasks according to urgency and importance while maintaining strict attention to detail.
• Provided comprehensive training for junior coders, resulting in increased productivity and skill development.
• Attended specialty and payor educational coding workshops, conferences, etc.

• Coding for 81 providers (MDs, mid-level providers, and CRNAs)- 95% and above accuracy rating
• Conducted audits and coding reviews of records to ensure all documentation is accurate and supported coding
• Audited office visits to determine appropriate E/M levels, then assign coding and diagnostic codes for charges
• Accurately coded anesthesia and pain management procedures for in-office, hospital, and ASC facilities
• Maintained accurate application and knowledge of ICD10s, HCPCS, modifiers, CCI edits, and coding/payor policies
• Collaborated with Coding Supervisor for physician inquiries regarding documentation.

• Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.
• Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
• Increased team productivity by implementing efficient workflows and setting clear expectations for staff members.
• Monitored account receivables through various modalities and reporting systems/collections analysis
• Reduced $2M aging WC accounts by 66% in 6 months
• Reviewed financial aging reports to develop team projects to target outstanding A/R
• Audited collector productivity and adjustments, for appropriateness, in coordination with management
• Coordinated and resolved collection issues while tracking billing trends to report to management
• Demonstrated thorough knowledge of billing functions, claims life cycle, denials, and appeals process
• Interpreted, applied, and educated staff on compliance guidelines to maintain billing integrity
• Performed and maintained regular department meetings to support RCM staff and present reports to leadership
• Provided coding, billing, posting, and collections training to RCM team
• Worked directly with physicians to address and resolve compliance and billing concerns
• Served as organization point of contact/RCM liaison for staff with regards to A/R, insurance matters (trends, coverages, news, regulations, coding), and patient billing
• Coordinated and managed department staffing and coverage.

• Served as contact for referral sources, providers, administration, and new patients while offering highest level of customer/patient service, leadership, and professionalism
• Planned, organized, implemented, and interpreted programs, goals, objectives, current policies, and procedures that are necessary for providing quality care
• Delegated tasks to team members & responsible for retention of referrals and APA doctor schedules
• Addressed patient complaints in professional, compassionate, and efficient manner
• Generated monthly reports, maintained procedure scheduling logs daily
• Trained employees and developed workflows to support cross-functional departments including scheduling, billing and authorizations, front office, and HIM department
• Managed employees and established department schedules, assignments, and projects.