Ali

Detail-oriented Medical Billing, RCM, and Credentialing professional with 5+ years of fully remote experience supporting U.S. medical and behavioral health organizations end-to-end — from claims submission and denial management through Medicare/PECOS enrollment, Medicaid credentialing, commercial payer enrollment, and CAQH attestations across NC, FL, SC, TX, and GA. Proven track record includes an 8-day Medicaid credentialing approval, a 98–100% clean claim submission rate, a 70% denial overturn rate with a 15% clean claim improvement, and a consistent 5-day AR/follow-up turnaround. Skilled in full-cycle billing (CPT, ICD-10-CM, HCPCS, modifiers), payer enrollment (CAQH/PECOS/NPPES, EFT/ERA setup, hospital privileging), and daily use of leading EHR, clearinghouse, and payer portal systems — all delivered with full HIPAA compliance and zero-supervision reliability.

RCM Manager, Credentialing & Enrollment Lead at MedZo Billing Solutions LLC (2023-11 – 2025-02)

• Directed a billing team covering eligibility verification, charge entry, claims submission, clearinghouse rejection correction, denial management, AR follow-up, and payment posting across multiple client accounts.
• Managed end-to-end provider credentialing files, including CAQH attestations, PECOS/NPPES data updates, and credentialing agreement preparation.
• Achieved an 8-day turnaround on a state Medicaid provider credentialing approval through proactive follow-up and complete, error-free submissions.
• Completed Medicare/PECOS, Medicaid, and commercial insurance credentialing/contracting for individual and group providers across NC, FL, SC, TX, and GA, from submission through approval.
• Processed hospital privileging applications for affiliated providers, ensuring complete and accurate submission packets ahead of medical staff review deadlines.
• Applied Medicare, Medicaid, and commercial payer billing rules across Internal Medicine, Family Medicine, Mental Health, Behavioral Health, and Physical Therapy accounts.
• Implemented process improvements that measurably reduced AR days and improved collection rates through repeatable billing protocols.

Medical Biller / VOB Specialist (Remote) at Mental Health Matters (2025-03 – 2026-03)

• Owned the complete billing cycle independently — claim review, insurance billing, charge entry, claims submission, payment posting, denial support, AR follow-up, patient billing, and monthly reconciliation with zero supervision required.
• Corrected and resubmitted clearinghouse-rejected claims, resolving coding, eligibility, and data-entry errors to restore clean claim status before payer submission.
• Drove a 70% denial overturn rate by authoring targeted appeal letters and conducting root cause analysis on claim rejections, directly recovering lost revenue.
• Improved clean claim submission rate by 15% through systematic identification and correction of CPT, ICD-10, and modifier errors upstream of submission.
• Navigated Availity and multi-payer portals daily to track claim status, retrieve EOBs, follow up on unpaid claims, and support EFT/ERA enrollment setup, achieving consistent 5-day AR turnaround.
• Conducted insurance eligibility and benefit verifications (VOB) prior to appointments, clearly communicating deductibles, copays, and patient responsibility.
• Maintained accurate, HIPAA-compliant provider and patient documentation across EHR systems, supporting downstream credentialing and payer-enrollment accuracy.

Account Manager – Operations (Remote) at CareCloud Medical Transcription and Billing (2021-01 – 2023-10)

• Managed offshore U.S. healthcare billing for a multi-specialty client portfolio, handling full-cycle claims from submission through payment posting.
• Followed up on returned, denied, and pending claims within 5 business days, resolving clearinghouse rejections and minimizing revenue leakage.
• Submitted primary and secondary claims electronically and via HCFA/CMS-1500 forms, applying accurate CPT, ICD-10, and modifier coding.
• Coordinated directly with insurance payers and providers to resolve documentation and status discrepancies, and to obtain authorizations.

Bachelor of Science in Computer Science – Gomal University