Hamza Ali

I provide comprehensive Revenue Cycle Management (RCM) and Credentialing services to solo and group medical practices across all states through Upwork. My mission is to help healthcare providers streamline administrative workflows, optimize revenue, and reduce operational burdens, so they can focus on delivering quality patient care. From insurance verification, claim submission, and denial management to provider credentialing and payer follow-ups, I ensure each step in the revenue cycle is handled meticulously. My work reduces claim denials, shortens reimbursement timelines, and maintains up-to-date payer enrollments, ultimately improving cash flow and operational efficiency. I approach every project with a strategic mindset, analyzing workflows, identifying bottlenecks, and implementing tailored improvements. I treat each task with diligence, transparency, and a commitment to compliance with payer requirements and regulatory standards. Over the years, I have supported a wide range of medical specialties, building trusted partnerships with providers who value accuracy, reliability, and measurable results. Practices that work with me often see smoother operations, fewer billing errors, and more predictable cash flow. Ultimately, my work empowers healthcare providers by taking the burden of RCM and credentialing off their shoulders, allowing them to focus on patient care, growth, and improving health outcomes. If you are a practice seeking a dedicated partner to optimize your revenue cycle and support operational success, I am ready to bring my expertise and commitment to your team.

Currently managing end-to-end medical billing and reimbursement for multiple Free-Standing Emergency Rooms (FSERs), specializing in inpatient, outpatient, and HOPD billing using GoRev software. I handle payment posting, AR follow-up, and lead federal and state-level IDR processes under the No Surprise Act, including TDI arbitration. My work ensures compliance, maximizes out-of-network reimbursements, and streamlines revenue for emergency care providers across various states.

In this role, I led billing operations for Community Mental Health, Plastic Surgery, and Oculoplastic Ophthalmology practices in NY and CA, focusing on clean claims, high-dollar reimbursements, and compliance. For New York-based Article 28 and 31 facilities, I ensured accurate UB-04 billing aligned with APG rate codes, value codes, and Article 28/31 NYS laws. I processed claims for individual and group therapy (90834, 90837, 90853), psychiatric evaluations (90791), medication management (99213-99214), and LCSW billing. I helped streamline behavioral health billing workflows using Simple Practice and TherapyNotes, maximizing claim accuracy and reimbursement. In California, I handled complex plastic surgery billing for out-of-network and IPA-contracted providers, including pre-surgery LOA (Letter of Agreement) negotiation with LA Care, Healthcare LA, and other IPAs. I billed for: Breast Reduction & Augmentation (19318, 19325) Facial Feminization Surgery (21127, 15788) Scar Revision (13100-13102) Rhinoplasty, Blepharoplasty (30465, 15820) Liposuction, Abdominoplasty (15877, 15847) I resolved underpaid and denied claims through Federal IDR, securing excellent reimbursement using NSA, UCR data, and payer negotiation tactics. I also managed oculoplastic billing using CareCloud, Office Ally, and other EHRs, covering procedures like ptosis repair, ectropion correction, and lacrimal surgeries. My strategies in AR follow-up, denial management, and No Surprise Act billing led to a measurable improvement in collections and provider satisfaction across diverse specialties.

At my second tenure in medical billing leadership, I managed complex out-of-network (OON) billing for high-volume Anesthesia, Pathology, and Gastroenterology providers across New York and neighboring states. My primary responsibility was to oversee the full billing cycle from claim creation to appeals, with a specialized focus on resolving underpaid and denied claims through strategic negotiation and regulatory dispute mechanisms—particularly leveraging the New York State Department of Financial Services (DFS) IDR process. In Anesthesia billing, I ensured accurate time-based CPT coding, modifier usage, and base unit calculations. I resolved coding-related denials, especially around concurrent anesthesia cases and medical necessity, by coordinating closely with coders and providers. For Gastroenterology and Pathology claims, I handled a range of services from colonoscopies and biopsies to high-volume lab testing. My team and I worked on scrubbing claims before submission to reduce initial rejections and improve first-pass acceptance. We also resolved denials tied to bundling, frequency limits, and authorization errors. When carriers failed to reimburse fairly for out-of-network services, I led the appeal process and initiated DFS IDR filings under New York’s surprise billing and emergency care protection laws. This included preparing clinical documentation, provider attestations, and UCR benchmarking to support our proposed reimbursement amount. In addition to IDR filings, I regularly engaged in proactive open negotiations and structured written appeals for payers like Aetna, UHC, Cigna, and BCBS. This led to significant revenue recovery from claims that would have otherwise been written off or significantly underpaid. Overall, my work resulted in a 40% increase in recovered out-of-network revenue and improved appeal success rates by 60%, making a measurable impact on bottom-line performance for specialty groups.

As a Revenue Cycle Management (RCM) specialist with over a decade of experience, I have worked extensively with Free-Standing Emergency Rooms (FSERs), out-of-network providers, and multi-specialty practices, helping them streamline billing operations, reduce claim denials, and recover millions in lost revenue. My core focus includes managing complex claims, eligibility verifications, and navigating the evolving reimbursement landscape under the No Surprise Act (NSA) of 2022. I have in-depth knowledge of insurance verification (VOB), pre-authorizations, and payer-specific documentation requirements. I ensure accurate capture of patient eligibility and benefits to minimize front-end claim issues. My strong grasp of CPT, ICD-10, and HCPCS coding supports clean claim submission and optimized reimbursement for both government and commercial payers. A significant part of my role involves managing out-of-network claims—resolving underpayments and negotiating fair reimbursements in line with U&C rates. I handle NSA-related claims from Open Negotiation to Federal IDR, ensuring compliance with CMS timelines and documentation standards. For Texas-based FSERs, I’m proficient in TDI arbitration processes, building strong case files, submitting complete packages, and communicating effectively with carriers and TDI officers. I’ve helped providers significantly reduce AR over 90 days, recover aged claims, manage appeals and similar denials. My process includes robust follow-up systems, data-driven reporting, and constant payer engagement to achieve maximum reimbursement. Whether it's facility billing under UB-04, out-of-network appeals, or navigating federal and state-level arbitration, I bring strategy, compliance, and results to the table. I also train and lead teams to manage volume effectively while upholding accuracy and turnaround KPIs.