I have extensive experience navigating Medicare and Medicaid reimbursement processes, including understanding the intricacies of billing codes, documentation requirements, and compliance regulations. In my previous role, I ensured accurate and timely submission of claims, resolved discrepancies, and maintained up-to-date knowledge of policy changes. My ability to interpret complex guidelines and communicate effectively with stakeholders has consistently resulted in optimized reimbursement outcomes and minimized denials.

I prioritize accuracy and compliance by meticulously reviewing clinical documentation to ensure it meets regulatory standards and payer requirements. I collaborate closely with healthcare providers to clarify discrepancies and provide training on proper documentation practices. Utilizing electronic health records and auditing tools, I conduct regular reviews to identify and address potential issues proactively, ensuring that all documentation supports accurate reimbursement and minimizes audit risks.

When handling denied or delayed claims, I first analyze the root cause by reviewing documentation, coding, and payer guidelines. I then prepare and submit appeals with supporting evidence, ensuring clear and concise communication with payers. Additionally, I track trends in denials to identify systemic issues and implement corrective actions, such as staff training or process improvements, to reduce future occurrences and enhance revenue cycle efficiency.

I stay updated on reimbursement regulations and policies by regularly attending industry webinars, subscribing to professional newsletters, and participating in relevant training sessions. I also maintain active memberships in professional organizations, such as the American Health Information Management Association (AHIMA), which provide access to resources and updates. This proactive approach ensures I remain informed about changes and can implement them effectively in my work.

In a previous role, I identified a recurring issue with denied claims due to incomplete documentation. I developed and implemented a training program for clinical staff, focusing on accurate and thorough documentation practices. Additionally, I introduced a pre-submission review process to catch errors early. These efforts reduced claim denials by 25% within six months, significantly improving reimbursement outcomes and streamlining the revenue cycle.