REGINA KORNEGAY, CCSREGINA KORNEGAY, CCS

INDEPENDENT CONSULTANT

SKILLS

Benefit Configuration, UAT Testing (Claims), IP/OP/DME/ER, Medicaid, Medicare, CPT, ICD-9/10 and specialty coding, A/R, A/P, month end and escalation reports, collections, medical records, SQL, Epic Oracle, APEX, QNXT, RALLY, Outlook, Excel, Word, Lotus Notes, Macess, Access, Windows, SharePoint, WP, Oracle, Java, MMIS, AMISYS, Cactus, QCCD, Epic, ERISCO, Facets, McKesson, RIMS, Eagle, IDX, IDRS, Webcare, AS400, CRT, Medex, Meditech, SMS, Affinity, FACS, Riverbend, Medisoft, SAP, Amtrust, Bloomberg, Medical terminology, 835 and 837, HIPAA 4010/ 5010, UB04 and CM-1500, Medicare, Medicaid, HMO, PPO, DME, coordination of benefits, POS and numerous other healthcare and medical systems.

EDUCATION

Database Administration / Programming - Bachelor of Science in Information Technology – University of Phoenix – July 2014 - current

CERTIFICATIONS

CCS certified via Dorson Vocational 04/2010 - 02/2011

04/2011 – 04/2015 (current)

EXPERIENCE

Saint Francis Hospital, Epic Implementation Consultant / Super User (CONTRACT) 04/15-05/15

Successfully completed system configuration and assisted with the implementation process with provider offices throughout the hospital. Assisted the IT department with the workflow design for the end user.

Trained office staff of provider offices and hospital departments on CAQH, billing, registration, and ambulatory operations on Epic and On Board applications.

Troubleshoot, addressed technical support issues and errors. Performed functional testing on the system. Analyze problems and developed solutions to fix them.

Addressed charge entry, referral, patient registration, scanning, billing, provider information, prescription order entry, patient accounts, documentation, call logs, and end user questions.

Worked at Saint Francis Hospital and Medical Centers of Connecticut via Kforce.

Connecticare and AvMed, Benefit Configuration Analyst (CONTRACT) 09/14-11/14 & 01/15-04/15

Data Analysis, successfully created, updated and configured benefits, benefit packages, components, riders, keywords, counters, cost shares, and provider information with a high success rate.

Trained consultants to perform benefit configuration on AMISYS and created workflow do cumentation and assisted with the workflow progression.

Created and updated excel spreadsheet with benefit updates, limits, corrections, new products and benefits, components, keywords, benefit products, regimes, cost sharing and status via AMISYS and CareNet.

Create, configure and built benefit specifications, compared benefits and products via AMISYS, Service Request Tracker, Access and claims testing, QA and functional testing, pulled data using Access and BP Reports.

Build benefits, benefit and code sets, benefit and code groups, created benefit plans from draft products, coordinated configuration of products, policy, and claim information and approved all benefit configurations

Worked at Connecticare in Connecticut and AvMed in Miami, FL. via Catalyst Solutions.

HealthPlus and Blue Cross Blue Shield, Benefits Configuration Analyst (CONTRACT) 11/13-05/14

System Implementation, created, updated and configured benefits, components, pricing, riders, provider information via AMISYS and CAQH, etc...

Successfully completed the training of full time employees on AMISYS for benefit configuration and assisted with developing a system module training guide.

Performed QA on updates to the system and workflow. Tested the system for errors before GO live and gave written reports to upper management on the status of the testing.

Created and updated excel spreadsheet with progression updates, limits, corrections, new products and benefits, regimes, cost sharing and status via AMISYS.

Created, configured and built benefit specifications to the client’s request, compared benefits and products via AMISYS, APEX and SQL, claims testing, QA and functional testing, pulled data using SQL

Worked at HealthPlus in Flint, Michigan and Blue Cross Blue Shield of NJ via HighPoint Solutions.

Harvard Pilgrim, Benefits Configuration Analyst (CONTRACT) 09/13-11/13

System Implementation, Create, configure and built benefit specifications in Oracle and CMM1, compared benefits and products via AMISYS, APEX, PDM and SQL, created Rally Stories for testing, QA and functional testing, pulled data using SQL

Tested and created functional testing on products created, UAT testing on claims systems.

Created and updated excel spreadsheet with updates, limits, corrections, new products and benefits, regimes, cost sharing and status via AMISYS .

Compare benefits and products in AMISYS, Oracle, PDM Reports, Schedule of Benefits and APEX.

Checked and created functional testing, completed configurations in production and created queries in APEX.

Created, updated and configured benefits, components, fee schedules, riders, provider information, etc.

Worked at Harvard Pilgrim in Massachusetts via HealthTech Resources

Emblem Health, BTS / UAT Tester for Claims (CONTRACT) 10/12- 04/13

System Implementation, Created raw data, entered claims for testing, tested claims for production and regressions, pulled claims for quality assurance

Trained employees on AMISYS for benefit configuration and claims testing.

Produced results of testing and documented findings, updated various systems to comply with testing regulations.

Pulled queries via Access and SQL, performed pricing configuration via AMISYS

Identified scenarios and data for scenarios, provided data for testing, test scenarios, test plans and test cases

Worked at Emblem Health in New York via Sharp Decisions, Inc.

Hoboken University Medical Center, Claims / Credentialing Consultant (CONTRACT) 04/12-10/12

Resolved facility, DME and medical claims, coding, database and contract issues and discrepancies via Epic and Cactus.

Reviewed, configured and updated all contract requests and compliance requirements via Cactus.

Updated database with fee schedules and provider documents, contract amendments, coded and corrected claims information and ran audits on credentialed work for completion.

A/R, Provider reimbursement, configuration, set-up and maintenance

Benefit configuration and coordination, queries, data abstraction and data mining.

Responsible for configuration around conversion in Cactus for Managed Care, DME, Medicare and Medicaid.

Produced all bi-laws, policies and procedures for DME, Medicaid and Medicare contracts. Responsible for testing Cactus.

Some mapping, requirements gathering and provider agreements via Cactus and CAQH.

Project Manager of credentialing, processed, corrected and added provider information and credentials

Ameri-Group, Claims / Credentialing Consultant (CONTRACT) 01/11-5/11

Resolved hospital, DME and medical claims, A/R, coding, billing, database and contract issues and discrepancies

Reviewed, configured and updated all contract requests and compliance requirements via AMISYS.

Benefit configuration and coordination, data abstraction and data mining via AMISYS

Project Manager of Credentialing, processed, corrected and added provider information and credentials.

Updated database with fee schedules and provider documents, amendments, coded and corrected claims and ran audits on credentialed work for completion

Used Macess, Facets, QCCD, IDRS, Success, Medex, AMISYS, FACS, SharePoint and Medisoft

Emblem Health, Healthcare Consultant / Data Analyst (CONTRACT) 05/09 - 9/09

Project Manager, UAT analysis, performed product validation activities including test planning, test development, issue/defect triage, data mining and abstraction, test execution for claims, benefits, fee schedules, provider information and go live support

System Implementation, Analyzed data manually and online via SQL and Access while creating solutions and solving issues

Conducted quality assurance tests on the claims and provider systems

Processed new and existing provider and fee schedule information and rate inquiries in AMISYS

Benefit coordination and configuration, updated, adjusted, and revised fee schedules, coding, rates, provider contracts, database, claims and information via AMISYS.

Oversaw merger restructuring for GHI and Emblem Healthcare

Used Eagle, IDX, SharePoint, Success, Webcare, Facets, AMISYS, QCCD and IDRS

Worked at Emblem Health in New York via Sharp Decisions

WellCare, Credentialing Consultant (CONTRACT) 01/08 - 8/08

Benefit configuration for DME, Medicare, Medicaid and Managed Care contracts, responsible for adjusting, updating and revising provider contracts via Facets

Project Manager of Credentialing, analyzed database, go live support, information, DME and medical claims data on paper and in systems and provided solutions to issues

Reviewed, configured and updated all contract requests and compliance requirements.

Processed new and existing provider data and rate negotiations

Performed quality assurance and resolved billing and payment issues, fee schedules and pricing via Facets

Consulted with sales on enrollment issues and updates

TMG Healthcare, Healthcare Consultant / Data Analyst (CONTRACT) 4/07 - 12/07

Claims analysis, A/R, A/P, claims entry, claims processing and claims auditing

Performed quality checks on Medicare, Medicaid, DME and Medical claims to help with backlog

UAT analysis, consulted with client on updates, issues and solutions and go live support

Benefit coordination and configuration, responsible for medical records documentation, data abstraction, negotiations, adjustments and revisions

Updated database and contracts in relation to billing, medical records, claims and provider relations

Responsible for write-offs, contracts, reports, and correspondence using Epic, Facets, Eagle, Success, IDX, QCCD, IDRS, RIMS, SharePoint, AMISYS and NASCO

Worked at TMG Healthcare/New Brunswick Hospital via Besler Consulting.

United Health Group (UHG), Provider Relations Representative / Data Analyst (CONTRACT) 8/05 - 4/07

Responsible for pricing, fee schedules, audits credentialing, adjusting and revising provider contracts and updating database

Oversaw provider relations, including managing contracts and follow-up with the records and merging between Oxford Health and UHG

Reviewed, configured and updated all contract requests and compliance requirements.

Performed quality assurance on billing, medical records and payment issues

Consulted with providers on rates, contracts, merger information and obligations

Used QCCD, AMISYS, Success, RIMS, Eagle, IDX and SMS

Medical and Workers' Comp Representative / Biller via Office Team Healthcare (CONTRACT) 4/04 - 4/05

Clients include: Aetna, Local 42, and BlueCross BlueShield NY

Responsible for A/R, A/P, collections, write-offs, fee schedules, data abstraction for medical records and reimbursement

Provided billing, coding, customer service, follow-up, eligibility, enrollment and adjustments on healthcare, Medicare, Medicaid and DME claims

Worked with Facets, Webcare, Epic, Erisco, Riverbend, AS/400 and NASCO

Caduceus, Inc., Medical Biller / Patient Accounts Representative (FULL TIME) 4/03 - 4/04

Responsible for provider relations, contracts, and month-end reports for various insurance clients in NY, NJ, CT, and PA

Responsible for A/R, A/P, reimbursement, adjustments, write-offs and collections concerning medical records for medical, DME and workers' comp claims. Medicare and Medicaid

Posted payments, setup agreements and updated pay rates

Performed billing, coding, customer service, collections, claims follow-up and revisions for HMO, Managed Care.

Completed product validation activities, including test planning, test development, issue/defect triage and test execution

Responsible for payment negotiations, pricing, fee schedules, referrals and pre-certifications

Used Eagle, IDX, SharePoint, Riverbend and SMS

Kessler Adventist Rehab, Medical Biller / Patient Accounts Representative (CONTRACT) 9/02 - 12/02

Performed customer service, coding, quality assurance, A/R and A/P for DME via IDX and Epic

Processed and billed medical, Medicare, Medicaid, DME, collections, adjustments and write-offs

Responsible for provider relations, contracts, referrals, and price adjustments

Setup and cleaned files in the database regarding reimbursements, medical records, and month-end reports

Claims Processor / Customer Service Representative via Insurance Overload Systems (CONTRACT) 1/88 - 12/89, 1/02 - 5/02

Clients include: Blue Cross Blue Shield, Mariner Healthcare and Oxford Healthcare:

Processed medical, Medicare, Medicaid, dental, prescription, and worker's comp claims

Analyzed adjustments, eligibility and payment rates for medical and DME

Responsible for benefit and patient information and updating database

Used Eagle, IDX, Macess, IDRS and Webcare

Blue Cross Blue Shield and Cigna, Billing Coordinator / Customer Service Representative (CONTRACT) 1/01 - 11/01

Performed A/R duties, including posting payments, write-offs, billing, pricing and updating medical records

Performed extensive customer service, coding, collections, suspense and follow-up of medical and DME claims

Updated database, provider relations information and patient accounts

Chase Manhattan Bank, Mutual Funds Consultant (FULL TIME) 2/00 - 12/00

Performed delivery, redemption, and purchases of shares

Updated database and prepared and submitted verification requests

Became familiar with mutual funds

Reported directly to VP on mutual fund transactions

Travel Healthcare Consultant / Claims Processor/Benefit Coder via Claim Services Resource Group (CONTRACT) 8/94 - 1/00

Clients include: Blue Cross Blue Shield, Aetna, Cigna and Prudential:

Acted as Project Manager and Consultant for various insurance companies

Provided quality assurance, customer service, collections, pricing and billing for medical records

Traveled to different states assisting clients with their claim backlogs

Dealt with client contracts, data, pricing, payments and medical records

Communicated with clients to validate desired testing results

Analyzed quality problems as related to customer assigned problem log

Processed, adjusted, and coded health and DME claims using Eagle/IDX, Riverbend, AS/400, CRT, Facets, RIMS, McKesson, Webcare, Medisoft, Medex and Meditech

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