Patrick Williams
Saint Marys
Summary
Results-driven Revenue Cycle Management (RCM) Specialist with 10+ years of experience in medical billing, claims processing, denial management, accounts receivable follow-up, and payment posting for government and commercial payers. Expert in end-to-end revenue cycle operations including charge entry, claim submission, eligibility verification, appeals, and reimbursement optimization. Proficient in ICD-10-CM/PCS, CPT, HCPCS coding, and HIPAA compliance. Proven track record of reducing claim denials by 25-35%, achieving a 70%+ appeal overturn rate, and managing high-volume workflows, processing approximately 40 claims per day with 98% accuracy. Skilled in Epic, AthenaHealth, NextGen, eClinicalWorks, and multiple clearinghouse platforms. Proficient in Epic, Kareo, AdvancedMD, Athenahealth, and other EMR systems. Proven skills in revenue cycle management for medical facilities. Proficient in reducing debt, collecting payments, and collaborating with insurance companies to resolve concerns. Talented communicator and practiced multitasker.
Overview
10
10
years of professional experience
Work History
Revenue Cycle Specialist II
MTBC-CARECLOUD
02.2023 - 04.2026
- Verified insurance coverage and benefit levels for HMO and PPO plans; submitted corrected claims and appeals.
- Investigated denials, rejections, and underpayments; determined resolution strategy, reducing days in accounts receivable by 25%.
- Reviewed claims for accuracy, coding compliance, and payer guideline adherence prior to resubmission or appeal.
- Reviewed EOBs and ERAs to reconcile payments and identify discrepancies.
- Maintained detailed documentation within Epic and practice management systems.
- Managed end-to-end physician billing for multi-specialty practices including Behavioral Health, Pediatrics, Cardiology, and Orthopedics.
- Submitted CMS-1500 professional claims for office visits, procedures, and specialty-specific services.
- Investigated claim denials and rejections, identified root causes, and implemented corrective actions to prevent future issues.
- Collaborated with billing and coding teams to reduce recurring denials and improve claim accuracy.
- Prepared and submitted appeals and reconsiderations with supporting documentation, achieving a 70%+ overturn rate.
- Processed and submitted claims ensuring compliance with CMS guidelines, payer-specific rules, and HIPAA regulations.
- Verified patient eligibility, benefits, and authorizations prior to claim submission, significantly reducing front-end denials.
- Analyzed denied and underpaid claims across Medicare, Medicaid, commercial, and workers' compensation payers; identified root causes and initiated corrective action to reduce claim denials by 25-35%.
- Resolved coordination of benefits (COB) issues, posted payments and adjustments, and processed secondary claims while tracking account resolution.
- Averaged approximately 40 claims per day with 98% accuracy and full compliance with payer standards.
- Tracked claims through Change Healthcare, Availity, Waystar, Office Ally, and TriZetto clearinghouse platforms.
- Strengthened front-end eligibility processes and corrected coding errors, contributing to a 25-35% reduction in claim denials.
- Maintained strict HIPAA compliance, ensuring confidentiality of patient health information.
- Followed HIPAA privacy and security standards when handling all medical and financial records.
- Ensured claims met CMS and payer-specific billing regulations.
Medical Claims Resolution
MEDCARE MSO
03.2020 - 01.2023
- Verified insurance coverage and benefit levels for HMO and PPO plans; submitted corrected claims and appeals.
- Investigated denials, rejections, and underpayments; determined resolution strategy, reducing days in accounts receivable by 25%.
- Reviewed claims for accuracy, coding compliance, and payer guideline adherence prior to resubmission or appeal.
- Reviewed EOBs and ERAs to reconcile payments, and identify discrepancies. Maintained detailed documentation within Epic and practice management systems.
- Managed end-to-end physician billing for multi-specialty practices including Behavioral Health, Pediatrics, Cardiology, and Orthopedics.
- Submitted CMS-1500 professional claims for office visits, procedures, and specialty-specific services.
- Investigated claim denials and rejections, identified root causes, and implemented corrective actions to prevent future issues.
- Collaborated with billing and coding teams to reduce recurring denials, and improve claim accuracy.
AR Follow Up Representative I
OPTICURE-MEDIX
08.2016 - 02.2020
- Conducted detailed A/R analysis to identify unpaid, underpaid, and denied claims, prioritizing aged and high-dollar accounts.
- Resolved denials and underpayments through systematic appeal processes to maximize reimbursement.
- Reviewed aging reports and prioritized high-dollar accounts; ensured HIPAA and payer policy compliance.
- Investigated denials related to eligibility, authorizations, coding errors, timely filing, and medical necessity.
- Prioritized AR aging reports (30/60/90+ days) to accelerate collections and reduce outstanding balances.
- Posted insurance and patient payments in billing systems; conducted follow-up with government and commercial payers.
- Performed insurance follow-ups via phone, email, and payer portals to track claim status and expedite payments.
- Investigated claim denials and rejections, identified root causes, and implemented corrective actions to prevent future issues.
- Maintained a comprehensive log to monitor claim-related issues, ensuring timely updates and precise record management.
- Worked closely with various insurance providers, including both government and private carriers, to facilitate efficient and thorough claims processing.
Education
High School Diploma -
SAINT MARY'S ACADEMY
SAINT MARYS, KS05-2008
Skills
- Verification of insurance
- Claims investigation
- Appeals Creator
- Coding compliance
- Revenue cycle management
- Claims submission
- Medical billing practices
- Eligibility verification
- Payer relations management
- Aging report analysis
- Trend analysis
- Attention to detail
- Problem solving
- Effective communication
- HIPAA compliance
- Collaboration with teams
- Claims review
- Patient registration
- Multitasking
- Excellent communication
EHR/EMR
- Athena
- Advanced MD
- Kareo
- Cerner
- Epic
- Artiva
- Meditech
- NextGen
- Availity
- Change HealthCare
- SSI
- Quadax
Languages
English
Full Professional
Chinese (Mandarin)
Limited
Persian
Elementary
Hobbies & Interest
- Football
- Travelling
- Photography
- Music
- Cooking
Professional References
- Christopher Miel | RCM Supervisor| MedCare MSO | +1 (983) 212-4150
- Jerry Erickson | Team Lead| MTBC-CareCloud | +1 (646) 631-7245
- Charles Green | Senior RCM Specialist | Opticure-Medix | +1 (409) 934-7892
Timeline
Revenue Cycle Specialist II
MTBC-CARECLOUD
02.2023 - 04.2026
Medical Claims Resolution
MEDCARE MSO
03.2020 - 01.2023
AR Follow Up Representative I
OPTICURE-MEDIX
08.2016 - 02.2020
High School Diploma -
SAINT MARY'S ACADEMY