Business Data Analyst/ Migration infostructure Analyst/bulling auditor
Resume:
Monica Wagner
******@*****.***
Summary
Monica has more than 30 years of experience in healthcare domain. She has worked as a Nurse, Medical Billing/coding supervisor, Medical Office administrator, Medical Coder, Medical billing Analyst, and Trainer/Instructor. She has IT experience in EDI Analyst, Data Analyst, Business Operational Analyst.
Monica has hands on experience with coding systems such as ICD-09, ICD-10-CM, ICD-10 PCS, CPT, DRG and HCPCS. She also has experience with X12 transactions such as 837 Institutional (Hospital), 837 Professional (Medical), 835 Remittance. She has worked in Hospitals, Providers Clinics, Colleges and State Medicare/Medicaid Agency (Payer).
Monica has completed her Associate in Science (3 yr. Nursing Degree) from United States.
Technical Skills
Operational Data Analyst
Billing/Coding Auditor
Migration Data Analyst
Program Analyst
Business Analyst
EDI Data Analyst
Clinical Engagement Manager
BI Query /SQL database knowledge
Data Pivot Wheel – raw data extracted to excel
Medicaid Management Information System (MMIS)
Mercator/Rapphl
3M Grouper (DRG)
ANSI x-12 transactions 837-I and 837-P, 835,276, 277, etc.
EDI Database knowledge
EncoderPro – Optium Medical Coding Tool
Paper Claims: HCFA 1500, HCFA 1450, UB04
Optium -ENCODER
EPIC
Ultra Edit
Microsoft Office Suite – Work, Excel, PowerPoint etc.
Compliance – HIPAA
Government Project Work – Federal CMS, IL State Medicaid Agency (HFS)
EHR (Electronic Health Record) and EMR (Electronic Medical Record)
Professional Experience
eviCore Healthcare (CitiusTechGroup) Franklin, TN Duration: March 2016 - Present
Project
Migration Data Business Analyst.
Role
Migrating 10 Outside Clients to the eviCore Platform,
Migration Data Analyst, Program / Business Operational Analyst
Responsibilities
Migrating 10 Client Platform to eviCore Platform
Extracting raw data from Client file
Map inbound raw data to eviCore MRS/SI
Updated Client grids
Located data issues and found resolutions
Creating Documents for Data Analysis
Creating Documents for Program Analysis
Creating Documents for UM ATTRIBUTES
Uncovering system issues with migrating clients, researching, and proposing a solution to solve
Work with EDI team for updating programs/codes
Worked with Letter team to update/correct templates
Worked with Config on Changes to program
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Illinois Department of Healthcare and Family Services (AIT Alert Group) Springfield, IL Duration: Jun 2013 – Dec 2015
Project
Hospital Rate Reform and ICD-10 Implementation
Role
Business Operational Analyst, EDI Analyst and Tester, Data Analyst, Certified Medical Bill Biller/Coder Auditor
Responsibilities
Mapped ICD-9 to ICD-10 new coding system
Reviewed ICD-10 CMS Coding guidelines to update/correct existing ICD-9 and report changes
Assisted Project Manager with coding changes to new procedure and diagnosis database
Involved in EDI transactions and paper claims testing
Wrote/Tested new/old Medicare edits, investigated testing outcome with error reports from front end and back end reports
Conducted data analysis based on user requirements
Verified results against X12 837,835,277, 278 and IMSM system
Studied CMS new guidelines with the state requirements for the ICD10 transition
Analyse claims with the 3M Grouper (DRG) with hospital HCC.
Extracted information from SQL/BiQuary database
Used Ultra Edit tools to produce test claims
Alegis Care/Home Physicians Care (Addison Group) Chicago, IL Duration: Nov 2011 – Jul 2013
Role
Medical Auditor/Medical HCC Assessment Coder
Responsibilities
Performed Medical Audits on Documentation, HCC Coding, & Billing.
Focused on assessment coding with Medicare HCC guidelines
Audit denied claims for payment resolution
Reviewed physicians documentation
Involved in filing documentation and assessment codes for payment
Worked with NextGen program
Northwestern Medical Facility Foundation (Advanced Resources) Chicago, IL
Duration: Jul 2012 – Oct 2012
Role
Medical Insurance Denial Auditor/Analyst/Coder
Responsibilities
Responsible to perform Medical Audits on AR, and locate denied Medicare claims, and denial trends
Designed plan to eliminate future errors and decrease AR
Corrected and resolved coding errors for resubmission of payment
Reported to director of financing on weekly basis with findings, issues and resolutions
Worked with IT team to locate hard coding issues
Behavioral Health Associates Skokie, IL Duration: Jul 2009 – Oct 2012
Role
Office Administrator/Billing manager (part time)
Responsibilities
Reviewed AR on denied claim issues and located denial trends
Designed plan to eliminate future errors and decrease AR
Corrected and resolved coding errors
Educated physicians on coding changes and insurance guidelines
Westwood College Woodbridge, IL Duration: Mar 2008 – Mar 2010
Role
Medical Assisting/Medical Administrative Instructor
Responsibilities
Taught classes in medical billing, coding, and insurance, office operations, and medical assisting
Assisted in Certification Prep
Administered Certification testing for CPC
Everest College / Corinthian Dallas, TX Duration: Mar 2000 – Mar 2008
Role
Medical Insurance Billing and Coding (MIBC) Department Chair & Instructor
Responsibilities
Reorganized, trained, and managed 8 instructors for MIBC program
Participated in the restructuring & implementing the MIBC curriculum (ICD-9 to ICD-10)
Taught Medical Insurance Billing & Coding Classes
Assisted in Certification Prep
Administered Certification testing for CPC
Orthopedic Hand Surgery – Michael V. Doyle, M.D, Dallas, TX Duration: Jun 1995– Mar 2007
Role
Nursing / X-ray / Office Manager / Supervised Billing Department
Responsibilities
Involved in Nursing-patient care in Specialized Office
Performed X-Ray,
Involved in surgery scheduling, authorization with insurance companies
Office manager, billing supervisor
Performed front office duties, filing daily charges, posting payments, resolve insurance denials, collections of patient balances
Involved with Physician credentialing, supervised front office duties, filing daily charges, posting payments, resolve insurance denials, collections of patient balances
Glaucoma Associates of Texas, Dallas, TX Duration: Mar 1989 – Jun 1995
Role
Ophthalmic Nurse
Responsibilities
Involved in Nursing -patient care in Specialized Office
assisting in surgery,
medical billing
Texas Oncology, PA, Dallas, TX Duration: Aug 1987 – Feb 1989
Role
Nurse
Responsibilities
Involved in nursing- patient care in specialized office
Medical billing
Educational Background
Associate in Science (3 yr. Nursing Degree)
oCentral Missouri State University, Warrensburg, MO -1982
oMajor – Nursing
oMinor – Psychology
George Roger Clark H.S. - Hammond, IND - 1977
Certifications
NCCT Billing/Coding/ Insurance Certification – Certified renew in 2018
ICD-10-CM/PCS - Certified - renew in 2018
HIPAA Compliance in EDW - Certified - renew in 2018
CPC – current renew in 2018
NCT X-ray Tech 9/1998
** References available upon request
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