Payer-side at Aetna and Magellan Behavioral Health. I use that to get claims resolved correctly.
Payer-side at Aetna Behavioral Health and Magellan Behavioral Health, in Quality Management Consulting and in provider and member customer service. I hold an MHA and I am HIPAA certified. I provide medical billing and administrative support to solo practitioners and small outpatient mental health practices.
Practices that participate with insurance are working inside a system that was not built around their interests. Payers apply rules inconsistently, reimbursement rates make sustainability difficult, and claims are denied on technicalities. Knowing how that system operates is the most direct way to get a practice paid for work already delivered, and to get clients the benefits they have already paid for.
That background means I know how payers evaluate behavioral health claims, where their own processes create the obstacle, and what information actually resolves a problem.
Record
- Payer-side
- Aetna Behavioral Health
- Payer-side
- Magellan Behavioral Health
- Function
- Quality Management Consulting
- Function
- Provider and member customer service
- Degree
- MHA, Master of Health Administration
- Compliance
- HIPAA certified
How I work
Most of the value in billing support is not in claim submission. It is in reading what the data says and acting on it before it becomes a larger problem.
The work is pattern-based. Data from benefit verification, claims, and remittance advice should paint a picture of a healthy revenue cycle. When it doesn't, the symptoms show up as scrubbing and rejection errors, denials, and claw-backs — often traced back to workflow gaps and complicated payer arrangements underneath. When something needs to change, I show you the data it came from and what changing it requires.
When I find something, I tell you what it is, what it means, and what the next step is. If the action is on my end, I take it. If it is on yours, I tell you specifically what to do and what to have ready. The standard is a billing process that holds up when a payer pushes back.
Who I work with
Independent clinicians and small outpatient mental health practices that want a biller who communicates directly, flags concerns early, and knows how payers work.
If you are selecting on price, or you need claims turned around without review, this is not a fit. If you want someone who reads the data and tells you what it says, including when it is not what you wanted to hear. That is the work.