Victoria Porter

I was in charge of reviewing and auditing denials for 3 different hospitals. Auditing process included correcting authorizations, insurance and coding on claims. Worked extensively with Tx Medicaid, private insurance policies and facility revenue management in order to retain payments. Worked primarily within EPIC EMR.

Worked on accounts and claims within the Mass General Boston hospital network which included 10 different hospitals and associating physicians. Responsible for contacting all insurance companies to correct claims that are not billed out properly and resubmit the claim. Claim corrections included authorizations, coding, coordination of benefit issues or rate codes. If corrected claim deadline had passed then I was responsible for submission of appeals and follow up of that process. Responsible for working and resolving 40 to 50 accounts per day ranging from $500 to $800,000.

Scheduled and authorized all total joint surgeries with hospitals, insurance companies and patients

Arranged surgical equipment to be present for all surgeries which required coordination with surgical scheduling at hospitals and equipment rep companies

Made sure that all dictation submitted by doctor and scribe matched coding requirements for EHR

Responsible for implementing all requirements for staff each year for input of data for Medicare and MIPS reporting guidelines

Responsible for hiring and termination of employees, all HR policies, maintaining current state employee worker policies and mandates

Did bi-yearly review of all insurance contracts with physician and negotiated with insurance companies accordingly

Made sure all physician credentialing with state board, CME credits, radiology licenses, Medicare, Medicaid were renewed and up to date

In charge of all paperwork for patient disability and/or FMLA which included assessment of medical records before and after surgical treatment.