Monica Wagner

aczu8a@r.postjobfree.com

708-***-****

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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