Revenue Cycle Specialists

&

Utilization Review Specialists

​Increase Your Revenue, Get Paid Faster!

Get The Right Billing System In Place! 

Get Accurate Daily Account Reporting!

Get The Software To Do All Of The Work!

Get Our INHOUSE Billing System!

Translates To:

Increases Workflow Efficiencies!

More Accurate, Accountable Reports!

Well Trained, Motivated & Supervised Staff!

Increased Provider & Office Staff Satisfaction!

 

Our Team Consists of

Seasoned, Credentialed & Certified

Multispecialty Providers

 

Team Leaders & Developer Specialists:

 

• UR Professionals with Over 100 Years of Combined Experience

• EMR-PM-Clearing House-Carrier Onboarding Trainers & Supervisors

• Utilization Management Optimization, Customization & Oversight

• Collection Team Build Out Specialist: Level 3 Peer Panel Reviewers

• RCM Billing & Collection Reimbursement AP/AR Auditors Tool Developers

• ICD-10 Crosswalk Optimization & Customizations by Provider Taxonomy

• API Code Architect Design Specific to Your Practice, Facility or Group

• CMS Experts for Coding & Modifier Alignment: Tax-Dx-CPT-HCPCS-MOD

 

Professional Workflow Competencies:

 

• Advocates for the Most Comprehensive and Integrated Patient-Provider Access to Practice Specific Service Lines for All Staff and Treatment Team Providers

• Promotes Effective Utilization Resources for Patients to Provide the Highest Standard and Quality of Care and Highest Reimbursements

• Collaborates with Treatment Team Daily Regarding: VOBs, Auths/Certs and Continued Stay Criteria

• Coordinates with Level 1-3 Payer Case Managers and Level 1-3 Peer Review in the Appeals Process

• Maintains Accurate Daily-Weekly-Monthly Statistical Reports then Prepares Proper Drill Down Documentation of Findings

• Communicates, Educates and Supervises Payer Provider Manual Requirements to all Staff Providers

• Maintains Proper Documentation and Notation Through Daily Chart Audits for all Related UR activities for All Patients and Providers

• Assures and Completes Peer Panel Approvals for All Appeal Collections and Overseas All Concurrent Reviews for Accuracy, Efficiency and Efficacy

• Provides Intel Updates Regarding all Patient ti Staff Workflows for Intakes and Discharges and Reporting into EMR-PM Documentation Logs

• Prepares Daily, Weekly, Monthly, Quarterly and Annual Audit Reports and Minutes Agendas for Leadership

• Reviews Admission, Intake and Discharges Processes as well as any Incidents and Emergent Issues

• Reviews Claim Data Daily and Updates Reimbursement and Denial Statistics for all Current and Aging AR from EDI-ERA Data

• Initiates Immediate Claims Appeals within 24-48 hours of Denials and Reconciles AP/AR Reports for All Payments and Reimbursements

• Consults with Office Administration, Billing and Leadership to Clarify EOB and EOP Remittance Data for RCM Optimization

• Ensures and Supports Daily Team Workflows from Upfront Insurance Pre-Certification Process through the Concurrent UR Processes

• Provides Accurate and Detailed Medical Necessity Intel to Payer Peer Review Panels to Maximize and Increase Revenue Stream

• Trains and Supervises All Staff and Providers for Building and Maintaining Proper Medical and Clinical Necessity to Capture All Revenue Opportunities

• Advocates for Patient High Acuity Placement in the Appropriate Level of Care with the Appropriate Days

• Establishes and Manages Positive Effective Payer Relationships to Maximize Length of Stay and Level of Visit for All Levels of Care

• Analyzes and Identifies Any and All Revenue Disparities and Turns Then into Positive Revenue Opportunities

DATA DRIVEN REAL TIME ANALYTICAL TOOLS FOR DETAILED DRILL DOWN REPORTING!

RUN YOUR OWN REPORTS, ITS YOUR REVENUE!

STOP ALLOWING BILLING COMPANIES TAKE ADVANTAGE OF YOUR MONEY! &

DONT LET THIRD PARTY BILLERS SEND YOU FAKE, DOCTORED REPORTS!