Intellex Acquires Expert by Big Village

We're thrilled to announce that Intellex has acquired Expert by Big Village, effective March 22, 2024. This strategic move enhances our capabilities and strengthens our commitment to delivering exceptional solutions to our customers.

Stay tuned for more updates on how this acquisition will benefit our clients and experts.

For inquiries or more information, please contact us at info@intellex.com.

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Expert Details

Medical Billing

ID: 734982 California, USA

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A highly sought-after expert and speaker on insurance billing, reimbursement, and litigation. Expert's company is the only medical billing service authorized to teach Ethical Billing and Coding to doctors for their Continuing Education. Expert’s accolades include but are not limited to Certified Medical Reimbursement Specialist, Certified Medical Billing Specialist, Certified Coder (in many disciplines), Certified Instructor, Certified Auditor, and Certified HIPAA Professional. He also is a member of the Board of Directors of countless Medical Billing and Coding institutions and organizations. He also holds a prestigious position within the Managed Care and Insurance Committee of the California Chiropractic Association. He talks about many insurance issues, such as AB1455, ACA, HMO, PPO in a no-nonsense fashion. The International Chiropractic Association of California has tapped Expert for a majority of their CEU seminars, in Proper and Ethical Billing and Coding. He brings an unparalleled perceptive of auto insurance, PI, health insurance, Medicare, and cash. Expert has been instrumental in setting up Revenue Recovery, Claims, 3rd Party Liens, Eligibility, Capitation, and Customer Service Departments within the most prestigious Medical Groups, Independent Practice Associations (IPA), Physician Health Organizations (PHO), Management Services Organizations (MSO), and hospitals throughout Southern California. Expert was consistently among the top 1% of all claims examiners nationwide for production, quality, and mentoring during his days at Aetna.
Expert owns and operates a highly successful Medical Billing and Audit Company located in CA, specializing in learning your software.

Work History

Years Employer Title Department
Years: 2014 to Present Employer: Undisclosed Title: Owner, CEO, and Founder Department: owner
Responsibilities:
Only billing service to earn preferred partner status with San Bernardino County Medical Society
Only billing service authorized in the state of CA to perform CEU's for doctors.
Comprehensive knowledge, experience in all aspects of insurance billing, claims, and collections.
Recommended billing service by and to CCA members
Recommended and endorsed by ICAC
Years Employer Title Department
Years: 2011 to 2013 Employer: (Undisclosed) Title: Director of Billing and Collections Department: Billing
Responsibilities:
Oversaw, trained, mentored, scheduled, and led 24 staff including managers, supervisors, team leads, collectors, billers, eligibility verifiers, trainers, auditors, customer service reps, and contracting professionals; collections included, but were not limited to, from patients, private insurance, HMO PPO, POS, Medicare, Medicaid, Medi-Cal, auto insurance, PIP, liens, and attorneys. Maintained up-to-date, communicated, and enforced complex mandates and laws across multiple states
Years Employer Title Department
Years: 2009 to 2011 Employer: Prime Healthcare Management Title: Manager-Business Office Operations Department: Billing/ Coding Business Office
Responsibilities:
Business Office Manager
Promoted to Business Office Manager within 5 months of employ. Incorporated full managed care training and collections. Ensured best practices in supporting benefits administration and customer service initiatives related to healthcare concerns and questions associated with claims and insurance plans. Collaborated with legal counsel in the interpretation of medical records.
Years Employer Title Department
Years: 2007 to 2009 Employer: Perot Systems Government Services Title: IDX Systems Analyst Department: I.T. Benefit System Support
Responsibilities:
Maintained integrity and performed audits of GE/IDX System and HMO benefit tables and ESI health plan eligibility documentation.
• Facilitated and chaired monthly meetings with upper-level management with regards to system contract and benefit interpretation and applications.
Years Employer Title Department
Years: 2004 to 2007 Employer: Pomona Valley Hospital Medical Center Title: Claims Supervisor Department: Capitation
Responsibilities:
Accountable for the staffing, training, mentoring and performance of elite claim analyst staff in managing inpatient and outpatient hospital, ambulance, skilled nursing facility and professional/ancillary claims.
Years Employer Title Department
Years: 2003 to 2004 Employer: Desert Physicians Management Title: Revenue Recovery Manager Department: Revenue Recovery
Responsibilities:
Privately held medical care facility operating under St Mary Choice Medical Group.

Responsible for revenue recognition and recovery efforts with third party lien recovery (TPL), hospital risk reconciliation, shared risk and pharmacy risk pool reconciliation.
• Conducted weekly hospital operational and claims audits, resulting in the discovery and recovery of previously unknown and undiscovered monies.
Years Employer Title Department
Years: 2002 to 2003 Employer: Arcadian Management Services Title: Manager, Revenue Recovery Department: Revenue Recovery
Responsibilities:
Arcadian Management Services, Inc., a health care services company, provides administrative infrastructure and management services to health care provider groups, hospitals, and health plans.

Created Revenue Recovery Department, introducing previously non-existent cost containment mechanisms and methodologies including tenacious audit and shared risk review and recovery policies and procedures. Created and delivered ongoing training and education to Claim Audit Staff.
• Recovered over $250k in non-capitated services through the implementation of third party lien recovery operations.
Years Employer Title Department
Years: 2000 to 2002 Employer: USC University Affiliates IPA Title: Contractual Analyst/Auditor Department: Revenue Recovery
Responsibilities:
Actively participated as liaison and central point of contact in contract interpretations and adherence to DHS and CMS regulations. Defined optimal staffing needs and training requirements.
• Formulated the policies and procedures for newly created department corresponding to shared risk, stop loss, risk pools, insured services, and benefit interpretations.
• Conducted extensive, high-level claims audits, recovering $1.2+ million in lost revenue and cost savings
Years Employer Title Department
Years: 1997 to 2000 Employer: Promed Health Care Administrators Title: Revenue Recovery/Supervisor I.T./Report Writer Specialist Department: Revenue Recovery
Responsibilities:
ProMed Health Care Administrators is a California-based Health Care Service Plan and Management Services corporation, providing comprehensive managed care services to Independent Practice Associations (IPAs) and Medical Groups.

Implemented department governing shared risk, stop loss, risk pools, insured services, first and third party liens, and benefit interpretations.
• Achieved an overall cost savings and revenue recovery of $1.4 million.
• Promoted from Financial Analyst and Information Services/Technology Supervisor positions.
Years Employer Title Department
Years: 1995 to 1997 Employer: Med-Partners / Pacific Physician Services Title: Supervisor of HMO Recovery, Customer Service, & Mail room Operations Department: Audit/Revenue Recovery
Responsibilities:
Redlands, CA
Years Employer Title Department
Years: 1992 to 1995 Employer: St. Bernardine Medical Center IPA/Inland Health Organization Title: Claims Manager, Eligibility Manager, Customer Service Manager Department: Claims
Responsibilities:
San Bernardino, CA
Years Employer Title Department
Years: 1988 to 1992 Employer: Aetna Health Plans of Southern California Title: Senior Claims Adjudicator/Auditor/Trainer/Lead Department: Claims
Responsibilities:
Santa Ana/San Bernardino, CA

Career Accomplishments

Associations / Societies
California Chiropractic Association (CCA)
International Chiropractic Association of Calirfornia (ICAC)
American Academy of Professional Coders (AAPC)
American Medical Billing Association (AMBA)
Health Billing and Management Association (HBMA)
Medical Group Management Assocation (MGMA)
San Bernardino County Medical Society (SBCMS)
Los Angeles Couty Podiatric Medical Soceity (LACPMS)
Business Network Internation (BNI)
Rancho Cucamonga Chamber of Commerce
Licenses / Certifications
Medical Reimbursement Specialist
ABSLL
Certified Medical Reimbursement Specialist
Certified Professional Coder- Plan Certified
Professional Coder- Instructor Certified
Chiropractic Professional Coder Certified
Chiropractic Reimbursement Specialist AMBA
Chiropractic 101 Billing
AMBA
False Claim Act Compliance
Certified Professional Biller
Liles Parker PPLC
Audit Entities and Mitigating Risk of Audits
Certificate of Recognition- Rancho Cucamonga Chamber of Commerce
Certificate of Recognition- County of San Bernardino
Accurate Medical Billing and Audit
Professional Appointments
Northwest College- "Proper usage of modifiers"
International Chiropractic Association of California- "Continuing Education Units- Proper and Ethical Billing", 16 seminars
California Chiropractic Association- San Gabriel CHapter "Proper Chiropractic Billing- Strapping"
California Chiropractic Association- Riverside Chapter "History of Insurance and Medicare Billing"
International Chiropractic Association of California- Annual Conference/ Convention "Is what the insurances doing even legal?"
Southern California University of Health Sciences- "The ICD-10 train is coming will you be on it or under it?"
International Chiropractic Association of California- "Are you tired of the tricks the insurances play?" "How to fight and win against insurance companies" "
How to Appeal. Where to Appeal. When to Appeal."

Fields of Expertise

medical billing, false billing, billing service, legal billing

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