Doustan S.

I am a seasoned Credentialing and Medical Billing Specialist with over 7 years of experience supporting healthcare practices across diverse specialties, including Medical, Behavioral Health, ABA/BCBA, Therapy Services, Home Health, DME and Dental Services. My skill set spans the full revenue cycle, from insurance verification and credentialing to claim submission, denial management, and payment reconciliation. My skill set spans the full revenue cycle, from insurance verification and credentialing to claim submission, denial management, and payment reconciliation. I specialize in credentialing providers with Medicare, Medicaid, and commercial payers, managing group and solo enrollments, NPI and CAQH setup, PECOS registration, and insurance contract negotiations. In billing, I am proficient in ICD-10, CPT, HCPCS coding, insurance policy navigation, and claim appeals ensuring timely reimbursements and reduced denials. Comprehensive Core Credentialing Competencies: 1. Managed credentialing and re-credentialing for solo providers, groups, clinics, hospitals, and home healthcare agencies. 2. Skilled in adding providers to existing contracts, new enrollments, and complex re-credentialing processes. 3. Expert in Medicare PECOS enrollment, Medicaid state portals, CAQH registration, and commercial payer enrollment. 4. Thorough knowledge of HIPAA, PHI, and federal/state healthcare credentialing regulations. 5. Conducted primary source verification for licensure, education, certifications, and professional background. 6. Managed full NPI lifecycle including creation, updates, and maintenance for billing accuracy. 7. Assisted in reviewing and negotiating managed care contracts to secure favorable reimbursement terms. 8. Maintained and updated CAQH profiles, PECOS, and multiple insurance payer portals. 9. Performed compliance audits and maintained credentialing files to prevent claim denials and ensure regulatory adherence. 10. LLC Formation. 11. Business Registration. 12. EIN/TIN and NPI Creation Medical Billing & Claims Processing Full-service billing: submission, follow-up, and posting ICD-10, CPT, and HCPCS coding for mental health, therapy, and medical specialties Denial management and appeals Claims tracking, reconciliation, and reporting EDI, EFT, ERA setup with insurance portals Insurance verification and pre-authorization Expertise in Medicare, Medicaid, BCBS, Aetna, Cigna, UHC, and other payers Out-of-network billing support and reimbursement recovery Revenue Cycle Management (RCM) AR follow-up, patient invoicing, and balance collection KPI tracking: Days in A/R, denial rates, collection rates Cash flow monitoring & financial performance reporting Monthly/annual AR reporting with tailored analytics Compliance & Quality Control: HIPAA and PHI confidentiality adherence Accurate documentation and audit preparation Credentialing file audits and compliance monitoring Regulatory knowledge across multiple states Specialty Knowledge Areas: Mental Health: Therapy, counseling, medication management, psychiatric services ABA/BCBA: Credentialing with Medicaid, commercial plans, and MCOs Therapy Services: PT, OT, ST including pediatric and adult therapy billing Ophthalmology & Retina: Mohs surgery, injections, imaging, and surgical claims Dermatology: Biopsies, cosmetic vs medical differentiation, multiple procedure billing Home Health & DME: HCPCS coding, supply chain coordination, eligibility verification Software Proficiency Billing Platforms: ECW, AdvancedMD, Kareo, Office Ally, Therabill, WebPT, CareCloud, RXNT Therapy & EHR Systems: Simple Practice, TherapyNotes, Central Reach, DrChrono, TheraNest, NextGen Insurance Portals: Availity, Navinet, Medicare/Medicaid state portals, CAQH Practice Management Tools: Tebra, eClinicalWorks, Claim.MD, and others Why Choose Me? 1. Specialized Experience: Deep understanding of credentialing and billing within niche sectors like ABA, therapy, and retina care. 2. Problem Solver: Skilled in identifying the root causes of claim denials and implementing corrective measures. 3. Compliance-Focused: I ensure complete adherence to all payer rules, HIPAA regulations, and industry standards. 4. Proactive Communication: Frequent updates, transparent reporting, and prompt responses. 5. Remote Team Leadership: Experience managing offshore billing teams and credentialing staff with consistent productivity. What I Offer: Credentialing for group and individual providers Medical billing and collections management Denial resolution and appeals handling Insurance contract support and negotiation Full-cycle revenue management and consulting Custom reporting and performance analysis EDI/EFT/ERA setup and troubleshooting One-on-one support for private practices and agencies Availability Remote/virtual work capability Flexible hours across U.S. time zones Immediate availability for short or long-term projects