Our Experience

Kim Major is a healthcare professional with over 13 years of combined experience in bringing a wealth of knowledge and expertise in navigating the complexities of managed care plans. Our team understands the nuances of commercial insurance, Medicaid, Medicare, and other payer systems, enabling us to effectively manage reimbursements and streamline interactions between healthcare providers and insurance companies.

We excel in claims and denial management, leveraging our experience to analyze and resubmit denied claims for proper reimbursement. By meticulously reviewing CPT and ICD diagnostic codes, we ensure accurate coding and maximize reimbursement potential. Our expertise minimizes claim denials and ensures timely payment, alleviating the financial burden on healthcare providers.

Referral management is one of our core strengths. We work closely with members, physicians, and specialists, processing referrals and scheduling appointments. We abide by medical policies and criteria, facilitating a seamless referral process and ensuring timely access to specialty care. 

With our in-depth understanding of medical credentialing, we manage the entire lifecycle of credentialing for healthcare professionals. From application processing and verification to ongoing compliance monitoring, we ensure that providers meet the necessary qualifications and comply with regulatory requirements. By maintaining accurate provider databases, we help healthcare organizations build and maintain robust networks of qualified providers. 

Our expertise in health information management guarantees the secure and efficient organization of medical records. Through audits, record assembly, and adherence to privacy regulations, we ensure the accuracy, completeness, and compliance of medical records. Leveraging electronic health records and document imaging technologies, we facilitate seamless access to critical patient information, improving care coordination and patient outcomes. 

Medical records review and audits are conducted by our experienced team to identify areas for improvement and optimize documentation and coding practices. By ensuring accuracy and compliance, we help healthcare organizations enhance quality of care and regulatory compliance.   

Utilization management is another area of our expertise. By analyzing utilization patterns and assessing medical necessity and appropriateness of care, we optimize resource allocation for healthcare organizations. Our strategies drive optimal outcomes while managing costs efficiently.