Touseer A.

Medical Billing Specialist | AR Specialist | RCM Expert | Credentialing & Enrollment | Eligibility & Benefits Verification | Denial Management I am an experienced Revenue Cycle Management (RCM) Specialist with over 8+ years of professional experience in medical billing, provider credentialing, denial management, accounts receivable (AR) recovery, and insurance follow-ups. I have successfully worked with multi-physician practices and healthcare organizations, helping them reduce claim denials, improve collections, and optimize their revenue cycle. I specialize in end-to-end medical billing and provider credentialing services, ensuring accurate claim submission, timely payment posting, efficient AR follow-ups, and smooth provider enrollment with insurance payers to maximize reimbursements and reduce administrative delays. I am also HIPAA Certified, ensuring full compliance with healthcare privacy, security standards, and patient data protection while managing billing, credentialing, and insurance processes. My expertise spans across multiple specialties including Primary Care, Urgent Care, Family Medicine, Internal Medicine, Oncology, Mental Health, Cardiology, Radiology, Acupuncture, and Laboratory Billing. Core Services I Provide • Medical coding and claim submission (CPT, ICD-10, HCPCS) • Insurance eligibility and benefits verification • Patient demographics entry and charge entry • EOB/ERA payment posting and reconciliation • AR follow-ups and denial management • Claims correction and resubmission • Pre-authorization and referral management • Monthly check balancing and financial closing • HCFA-1500 claim form preparation and billing • Patient and insurance payment reconciliation • Daily, weekly, and monthly reporting Provider Credentialing & Enrollment Services • Provider credentialing with Medicare, Medicaid, and commercial payers • CAQH profile creation, maintenance, and attestation • NPI registration and taxonomy updates • Insurance payer enrollment and revalidation • Re-credentialing and provider data management • Follow-up with payers for application status and approvals • Credentialing compliance and documentation management 🔹 Areas Where I Add the Most Value I specialize in identifying why claims are not being paid and taking the appropriate action to recover revenue. This includes working on issues such as: ✓ Eligibility and coverage problems ✓ Timely filing denials ✓ Authorization/referral issues ✓ Credentialing and enrollment problems ✓ Incorrect payer processing ✓ Coding/billing-related denials ✓ Missing information ✓ Claim submission errors ✓ Underpayments ✓ High-dollar outstanding claims ✓ Medicare and commercial payer issues I also understand the importance of documenting every AR action clearly so that claims can be followed through to resolution. 🔹 What You Can Expect From Me • Accurate and organized work • Consistent AR follow-up • Clear claim notes and documentation • Strong attention to payer guidelines • Proactive identification of revenue problems • Detailed reporting • Professional communication • Focus on reducing outstanding AR and improving collections EMR/EHR & Practice Management Systems • Kareo / Tebra • eClinicalWorks (ECW) • NextGen • AthenaHealth • Practice Partner • Lytec • SequelMed • Docomply • Office Ally • Simple Practice Clearinghouses I Have Worked With • Emdeon • RelayHealth • GatewayEDI (TriZetto) • Availity • Navinet • Office Ally I am well-versed in ICD-10 updates, LCD guidelines, modifier usage, and insurance policy requirements, including deductibles, co-insurance, co-pays, and in-network/out-of-network billing rules. Additionally, I am highly proficient in Microsoft Office (Excel, Word, Outlook, PowerPoint), Adobe Acrobat, and various billing support tools to maintain accurate documentation and reporting. Why Choose Me ✔ HIPAA Certified Medical Billing Professional ✔ 6+ years of hands-on medical billing and credentialing experience ✔ Strong expertise in AR recovery and denial resolution ✔ Accurate charge entry and payment posting ✔ Reliable communication and detailed reporting ✔ Ability to manage the entire revenue cycle and provider enrollment process I also work with a skilled team of medical billing professionals, allowing us to handle large billing volumes and full RCM management for healthcare practices. I am available for hourly projects, long-term contracts, or percentage-based billing services. Let’s work together to increase your practice revenue, streamline billing operations, and ensure smooth provider credentialing and payer enrollment. My goal is simple: fewer unresolved claims, cleaner AR, faster follow-up, and improved revenue.