Experienced and results-driven healthcare IT professional with years of hands-on expertise in implementing, configuring, and supporting eClinicalWorks (eCW) across multi-specialty practices. Demonstrates a strong understanding of clinical workflows, documentation standards, and regulatory compliance requirements. Proven ability to train and support diverse user groups—including providers, clinical staff, and administrative teams—with a focus on optimizing EMR usage and enhancing efficiency. Skilled in collaborating with clinical leadership and IT teams to maintain EMR stability, streamline operations, and ensure accurate data capture. Well-versed in CMS guidelines, including Merit-based Incentive Payment System (MIPS) reporting requirements, and experienced in leveraging eCW dashboards to monitor provider performance and support quality reporting. Also proficient in Electronic Prescribing of Controlled Substances (EPCS) registration and DEA data management.
• Supervise daily operations of the revenue cycle team, ensuring accurate and timely billing, collections, and payment posting across multiple service lines.
• Collected an average of $6 million monthly on No Surprises Act (NSA) claims through proactive follow-up, payer outreach, and compliance enforcement and appeals.
• Prepared and submitted appeals to out-of-network payers, including UnitedHealthcare (UHC) and Cigna, ensuring proper reimbursement in alignment with federal regulations and contract terms.
• Monitored and analyzed claim denials, underpayments, and payer responses to identify trends and implement corrective actions.
• Collaborated with cross-functional teams, including coding, patient financial services, and compliance, to resolve complex claim issues and prevent revenue leakage.
• Trained and mentored billing and collections staff on payer-specific requirements, NSA regulations, and appeal processes.
• Conducted regular audits of claims and remittances to ensure accuracy and identify process improvement opportunities.
• Generated performance reports for senior leadership, highlighting collections performance, denial resolution rates, and appeal success metrics.