Tanger Giddens-Baker

· Lead Biller for a Medical School of two-family practice clinics with a multi-specialty approach, Student Health Services, Skilled Nursing Facilities, In-patient and Outpatient physician care.

· Reviewed all outpatient charges for services provided to ensure accuracy of billing and coding and prior authorizations and referrals.

· Collaborated with Medical Group Billing Administrators to optimize billing processes and enhance accuracy in monthly financial reviews.

· Conducted daily chart reviews and audits of all outpatient physician notes and encounter forms to ensure complete charge capture.

· Check Active Tasks and queries in EMR daily. Review & enter daily inpatient hospital charges in system and compare hospital inpatient reports and notes to data in IDX and EHR system to ensure all charges are accounted.

· Clarified physician coding and billing inquiries to ensure accurate and timely resolution.

Reviewed work queue and patient encounters daily to ensure all charts in the review queue were addressed and corrections were communicated to the facility.

· Queries physicians when documentation is not straightforward, inadequate or unclear for coding purposes.

· Resolved outside lab denials from Sentara and LabCorp by researching and correcting lab-related billing issues, ensuring proper reimbursement.

· Reviewed coding related denials from payers and recommended the appropriate action to resolve the claim based on payer guidelines.

· Trains all billers in the department.

· Managed Medicaid billing, verified eligibility, and secured prior authorizations for behavioral health and foster care services, ensuring compliance and timely access to care.

· Submitted claims for acute care, therapeutic foster care, and day treatment services to state and federal payers.

· Monitored accounts receivable aging reports and followed up on outstanding claims, facilitating quicker reimbursements and reducing delays.

· Researched and resolved billing discrepancies, denied claims, and responded to payer inquiries, enhancing accuracy and improving overall claim resolution.

· Maintained compliance with state billing regulations and healthcare documentation requirements.

· Performed monthly account reconciliations and financial adjustments in coordination with finance departments.