Casey J.
Senior Revenue Cycle Auditor
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Casey J. is a proficient Revenue Cycle Management Specialist with over six years of experience in delivering comprehensive RCM solutions across various healthcare environments, including hospitals and behavioral health. Currently working as a Senior Revenue Cycle Auditor at MBA Medical Billing, Casey conducts exhaustive audits of back-end operations, focusing on accounts receivable, denial management, and claims adjudication for both hospital and physician billing. His forte lies in identifying revenue leakage, reducing claim denial rates, and optimizing reimbursement processes through effective denial management and appeals strategies. Casey's depth of knowledge in CPT, ICD-10-CM, and HCPCS coding complements his skills in managing payer contracts and compliance with Medicare, Medicaid, and commercial insurers. With experience across more than 20 EHR/EMR platforms, including EPIC and Cerner, Casey effectively collaborates with diverse healthcare teams to improve documentation accuracy and streamline billing workflows. His education includes a Bachelor of Business Administration from Western Governor’s University, and he holds certifications such as Certified Professional Biller and Certified Professional Coder.
Experience
Senior Revenue Cycle Auditor
MBA Medical Billing · 2024 — PresentConducted detailed audits of revenue cycle operations, focusing on accounts receivable, denial management, cash posting, appeals, and claims adjudication. Analyzed trends in claim denials from various payers, identifying causes and creating plans to address them. Verified the accuracy of payment posting workflows in compliance with payer protocols. Identified process gaps and billing errors, presenting findings and recommendations to leadership. Ensured compliance with payer timelines for appeals and managed prior authorization processes while verifying medical necessity for behavioral health services. Conducted insurance verifications and benefits analyses. Maintained AR aging reports and developed follow-up strategies. Created summaries and reports for senior leadership, ensuring adherence to HIPAA and CMS regulations while collaborating with clinical and administrative teams to enhance billing workflows.Revenue Cycle Specialist
Human Medical Billing · 2022 — 2024Oversaw the entire revenue cycle process for hospital and physician billing, encompassing patient registration, charge entry, claims submission, follow-up, and payment posting. Handled insurance and eligibility verification along with benefits analysis for a significant volume of patients. Entered and validated coding for CPT, ICD-10-CM, and HCPCS to ensure claim integrity. Managed authorization processes for various services and resolved claim denials through root cause analysis and timely resubmission of claims. Submitted appeals with comprehensive documentation and took responsibility for AR management and reconciliations of payments. Communicated with payers and patients regarding claims and payment responsibilities while upholding compliance with HIPAA.Medical Billing Specialist
RhinoMDs · 2021 — 2022Handled medical billing operations for physician and facility claims, processing both CMS-1500 and UB-04 forms across various specialties. Conducted eligibility verification and assessed insurance benefits. Managed prior authorizations and referrals for medical procedures while performing denial resolutions and appeals to enhance reimbursement. Monitored payer guidelines and maintained AR reports, overseeing collection activities.
Skills & Expertise
Education
- Bachelor of Business Administration (BBA)Western Governor’s University · 2017 — 2021
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