Medical Training
Resume:
Kasandra Gurnett
adgooi@r.postjobfree.com
SKILLS SUMMARY
A broad skill set that includes coding, Benefits, Provider, Contract and Claims operations in Healthcare. A team player with a consistent record for developing new business and ensuring outstanding customer service.
KEY WORDS
Leadership Decision Making
Customer Focus Integrity
Consistent Results QNXT
Medicaid Medicare
PERSONAL STRENGTHS
Communicator Implementation Organized
Team Organizer Integrity & Trust Problem Solving
Team Player Persuasive Verbal & Written Skills
Mentor and Coach Tenacious Analysis
PROFESSIONAL EXPERIENCE
Molina Healthcare, Inc. 08/2008-Current
Senior Configuration Analyst
Currently performing the configuration lifecycle for Molina Healthcare, Inc. ACA, Medicaid and Medicare line of business to include Business Requirements Analysis, Authoring Business Requirements Documentation (BRD’s) for Benefit and Provider Contract business requirement documentation; Configuration of QNXT for Benefit and Provider Contract and finally prepare testing documentation for the Testing Unit to perform tests of configuration. The other primary responsibility has been to maintain the 118 MRDT (Master Reference Data Tables) in QNXT to ensure all MRDT codes are up to date and accurate. Further related to the MRDT responsibilities have been to configure Global Day’s, Unbundling and CPT Modifier functionality in QNXT. Assessing, mapping out and creating QNXT specific training documentation. Building reference guides and Walkthroughs to aid in future and present U.I training needs.
Primarily responsible for the implementation of Medicaid Benefit and Design, Configuration and Testing. Other responsibilities included Medical Coding best practice, QNXT Service Groups and participating in a multi-disciplinary configuration work group to align Benefit set up in QNXT with Provider Contracts, Claims and UM/QM. Training and documentation on Benefits.
Other responsibilities for the implementation have been Reporting design and Specification Development and Testing. Other responsibilities included MRDT Training, Medical Coding best practice, QNXT Service Groups and participating in a multi-disciplinary configuration work group to align Reports with how the QNXT System was configured in support of the Reporting Requirements for Provider Contracts, Claims and UM/QM.
Claims resolution for Claims pended to configuration or health plan which require claims adjustments and/or reversals for claims correctness.
EDUCATION
Education and Training:
2008 Concorde Career College - Portland, OR
Medical Insurance Coding Specialist/Coder
American Coding Academy - CPT-4, HCPC and ICD-10 Coding
AAHP – Health Insurance Course Work
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