Fakhar A.

Are you a US primary care practice, medical group, or IPA struggling with aged AR, claim rejections, or HEDIS Star Ratings. I currently manage full-scope Revenue Cycle Management (RCM) and HEDIS quality operations for Southern California primary care practices across 16+ IPAs and 5,000–7,000 patient lives. Unlike general billers who only submit basic claims, I manage the complete financial lifecycle of PCP offices—ensuring clean claim submissions, aggressive denial recovery, seamless payment posting, and maximum HEDIS quality bonus payouts. 🌟 HEDIS & CMS Star Ratings Optimization 5-Star Target Management: Monthly ingestion, data cleaning, and reconciliation of health plan gap rosters across Humana, UHC, Aetna, Devoted, and regional IPAs. Clinical Chart Abstraction: Deep expertise in NCQA specifications for high-impact measures (EED, CBP, AAP, BCS, COL, HBD/CDC, COA, KED). CPT Category II Coding: Automated gap closure billing using correct CPT-II codes (2022F, 3074F–3080F, 3044F). Supplemental Data Ingestion: Direct uploads of non-claim clinical data to payer portals (Cozeva, Availity, NaviNet, Humana Vantage). Payer Dispute Overturns: Investigating automated payer "Fail" flags and filing compliant medical record appeals to turn rejected gaps into verified 5-Star passes. 💼 Full-Cycle Primary Care (PCP) Revenue Cycle Management Active PCP Billing Operations: Managing end-to-end daily billing workflows for primary care clinics, including patient insurance verification, encounter coding, CPT/ICD-10 claim creation, and direct electronic submissions. Clearinghouse Scrubbing & First-Pass Yield: Managing rules in TriZetto and Availity to scrub claims before submission. I ensure both fee-for-service claims and required CPT Category II quality codes pass clearinghouse checks on the first attempt. Aggressive Denial & AR Recovery: Hands-on resolution of 30/60/90+ day aged AR. I conduct direct portal and phone follow-ups with health plans and IPAs, draft clinical appeal packets, and submit corrected claims to recover stalled revenue. ERA/EFT & Payment Reconciliation: Managing electronic funds transfers and remittance advice posting via Zelis, Corpay, and clearinghouse portals—eliminating unapplied payments and ensuring accurate account balancing. Medicare & Medicaid Contracting/Credentialing: End-to-end provider onboarding, CAQH profile maintenance, and PECOS enrollment across Medicare, Medicaid Managed Care plans, and regional IPAs to keep provider panels active.