Our Team

Medical Billing Specialists

Responsibilities: Charge entry, claim scrubbing, electronic claim submission, payment posting (ERA and manual), patient statement generation, secondary billing and routine payer correspondence across commercial, Medicare, Medicaid and managed care payers.
Expertise: Working knowledge of professional and facility claim formats (CMS-1500 and UB-04), clearinghouse rejection handling, payer-specific edits and major practice management platforms including Athenahealth, eClinicalWorks, Kareo, AdvancedMD, NextGen and DrChrono.
Contribution to reimbursement: Billers protect the front-end integrity of every claim — accurate demographics, valid coverage, clean coding and on-time submission — which directly influences first-pass acceptance, days in AR and the volume of avoidable denials downstream.

Responsibilities: Assignment of ICD-10-CM diagnosis codes, CPT and HCPCS Level II procedure codes and modifiers based on provider documentation; documentation queries when notes are incomplete; pre-bill coding review and post-bill audit support.
Expertise: AAPC and AHIMA credentialing (CPC, COC, CCS and specialty certifications), specialty-specific knowledge across cardiology, orthopedics, behavioral health, gastroenterology, radiology, primary care and others, plus ongoing study of LCD/NCD updates and CMS coding clinic guidance.
Contribution to reimbursement: Coders are the bridge between clinical documentation and reimbursable claims. Accurate coding protects legitimate revenue, reduces takeback exposure and keeps the practice's audit position defensible — three of the most consequential outcomes in the revenue cycle.

Responsibilities: Aged accounts receivable worked by payer, aging bucket and dollar value; payer phone and portal follow-up; status verification on submitted claims; identification of claims approaching timely-filing deadlines; root-cause categorization of payment delays.
Expertise: Payer-specific follow-up cadences, claim status code interpretation, knowledge of timely-filing windows across major payers, and operational fluency with payer portals (Availity, Navinet and direct payer systems) plus clearinghouse status feeds.
Contribution to reimbursement: AR specialists recover revenue that would otherwise age into write-offs. Their work directly drives days-in-AR, over-90-day AR percentage and gross collection metrics — and surfaces upstream issues (eligibility, coding, registration) that need correction at the source.

Responsibilities: Triage of denied claims by CARC and RARC code, gathering of supporting clinical documentation, drafting of payer-specific appeals, tracking appeal outcomes and reporting denial trends back to billing, coding, registration or authorization teams for root-cause correction.
Expertise: Detailed familiarity with payer medical-policy language, appeal level requirements (first-level, second-level and external review), bundling and modifier disputes, medical-necessity arguments and the documentation required to overturn each denial category.
Contribution to reimbursement: Denial specialists protect net collections by recovering legitimately denied claims and prevent recurrence by feeding root-cause findings into upstream workflows — turning denial work from a treadmill into a measurable improvement loop.

Responsibilities: CAQH profile creation and maintenance, initial payer enrollment applications, follow-up on submitted applications, re-credentialing on schedule, document expiration tracking (licenses, DEA, malpractice, board certifications) and payer contracting support.
Expertise: Application requirements across commercial, Medicare and Medicaid payers, state-by-state variation in enrollment timelines, PECOS and NPPES navigation, group versus individual enrollment workflows and payer-specific re-credentialing cycles.
Contribution to reimbursement: Credentialing turnaround directly determines when new providers can bill in-network. Disciplined credentialing protects both new-provider ramp revenue and existing-provider in-network status, eliminating one of the most preventable categories of write-off.

Responsibilities: Dual-level coding audits, payment posting reconciliation, denial-trend reviews, SOP adherence checks, periodic file audits and feedback loops to billing, coding, AR and credentialing teams when drift is detected.
Expertise: Coding audit methodology, statistical sampling, payer takeback risk evaluation, internal audit documentation and operational analytics across the full revenue cycle — applied independently of the production teams whose work is reviewed.
Contribution to reimbursement: QA exists as a separate function so accuracy is verified by people other than those producing the work. This separation protects clients from gradual quality drift and gives administrators an independent view of how the engagement is performing.