Stephen Clifton

Identified and resolved claim underpayments and denials, correcting data discrepancies through the NextGen EHR system. Developed appeal and grievance letters to insurance payers, and acted as a consultant for coding, claim, and NextGen issues.

Conducted follow-up on denials, underpayments, and overpayments, correcting claims for coding and modifier issues. Rebilled corrected claims and resubmitted them in Waystar and Advantx, while also training and overseeing new staff members.

Performed claim follow-up, appeals, corrections, and resubmissions for FQHC, and posted payments to Advanced Medical Systems (AMD). Developed spreadsheets for claim issues, resolved billing problems, and researched issues in Centricity.

Billed inpatient claims to insurances using SSI and HMS, correcting and resubmitting claims for payment. Followed up on claim denials and underpayments, obtaining and reviewing medical records for claim submissions.

Reviewed and entered MSO provider claims, initiating all claim submissions to RBHA and denials service providers. Voided and edited claims in Avatar, Emdeon, and insurance portals, and developed Excel spreadsheets for voids and recoupments.

Managed all day-to-day operations of the Business Office, including payment and charge reporting, appeals, and workman's comp follow-up. Reduced Aging A/R over 90 days from 32.4% to 8.55% and increased claims collection revenue by 28% in 2015 and 15% in 2016.

Billed Hemodialysis claims, worked credit balances, and verified billing information accuracy. Developed and filed all claim appeals, and was designated to work complex claim denials and issues.

Audited claims for correct diagnosis, CPT, HCPCS, Modifier usage, and reimbursement (HCFA-1500 / UB-04). Performed follow-up on Practice Management Claims and reviewed EOB denials, reducing A/R for practice management accounts from 24% to 6% for accounts at 90 days plus.

Conducted reviews of facility UB-04 claims and EOBs for underpayments and discrepancies, and reviewed commercial contracts. Determined correct payment amounts for claims according to contracts, fee schedules, and DRG, and developed appeals for claim underpayments.

Managed provider network administration functions, ensuring efficient operations and compliance. Collaborated with healthcare providers to optimize network performance and resolve administrative issues.

Handled insurance billing and follow-up tasks, ensuring timely and accurate claim submissions and resolutions. Also served as a Cash Control Auditor and Trainer, contributing to financial accuracy and staff development.

Completed coursework focused on business principles, management strategies, and organizational operations. Gained foundational knowledge in areas such as finance, marketing, and human resources.

Pursued a broad curriculum in general studies with a specific emphasis on communication. Developed strong analytical and critical thinking skills through diverse academic subjects.