Alicia N. Wissler
House Springs,MO
Summary
Experienced professional in claims processing, provider contracts, and benefit configuration. Dedicated to delivering high-quality results. Seeking to utilize expertise in UAT planning, test execution, defect management, and system configuration analysis to contribute to a dynamic healthcare organization. Strong focus on quality and a proven track record in the industry, confident in ability to enhance operational efficiency and drive positive outcomes.
Overview
8
8
years of professional experience
Work History
UAT QA Lead
Mphasis Contractor-Peak TPA
10.2023 - Current
- Responsible for UAT planning, test case specifications, test execution, defect management, and test status reporting activities
- Develop and follow a test plan which adheres to standard UAT quality practices/processes
- Perform positive and negative testing to identify and ensure any defects found are corrected prior to implementation
- Specialize as subject matter expert for all of health plan management operations across claims system and integrated EHR applications, ensuring the consistency of information across the every department
Configuration Analyst
Mphasis Contractor-Peak TPA
01.2021 - 09.2023
- Responsible for accurate management of plan benefits design, test execution and validation efforts
- Analyzes new plan business requirements for benefit design changes to establish the appropriate solution
- Performs system configuration analysis, testing, validation, quality review, documentation and maintenance of applications
- Participates in review, impact assessment, testing and modifications for application updates, upgrades and installations
- Build and maintain custom fee schedules according to contract and clients business needs
- Works with Sr
- Enterprise Application Administrator to coordinate updates/changes to claims processing system of various code sets to ensure accurate and timely operations
Provider Network Specialist
Peak TPA
12.2020 - 01.2021
- Maintain facility and provider data within the company database
- Create/Update Provider records in the claims processing system and link records to the appropriate fee schedule for claim reimbursement
- Responsible for analyzing and interpreting provider contracts to ensure accurate reimbursement
Senior Claim Examiner
Peak TPA
12.2016 - 12.2020
- Evaluates claims for completeness and validity to determine payment/denial according to provider contracts, authorizations, and Medicare processing guidelines
- Processes various Medicare and Medicaid claim types, including Professional, Facility and Dental claims
- Accurately analyzes and interprets provider contracts
- Researches claims and makes appropriate adjustments
- Assists with testing of new processes, and provides feedback
- Assists with training new or existing staff, as requested
- Responds to client's inquiries related to claims processing
Education
Associate of Applied Science - Medical Billing And Coding
Vatterott
Sunset Hills, Mo12-2015
Skills
- Intermediate Microsoft Office applications
- Claims processing applications
- Database management
- Data entry
- Technology mastery
- Patient confidentiality
- HIPAA compliance
- Data extraction
- Test Data Management
- Test case design
- Regression Testing
Training
- ICD 10 CM
- CPT/HCPCS
- HIPAA
- Data Entry
- Medical Terminology
- Auditing
- Comprehensive Insurance Billing
- MS Office Applications
Timeline
UAT QA Lead
Mphasis Contractor-Peak TPA
10.2023 - Current
Configuration Analyst
Mphasis Contractor-Peak TPA
01.2021 - 09.2023
Provider Network Specialist
Peak TPA
12.2020 - 01.2021
Senior Claim Examiner
Peak TPA
12.2016 - 12.2020
Associate of Applied Science - Medical Billing And Coding
Vatterott