AWONI A. DANIELLE AHOLI
Richmond,TX
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Clinical Trial Analyst
University Of Maryland Medical System
Linthicum Heights, MD
12.2023 - 01.2025
- Identified potentially billable items within the clinical trial during the development of the coverage analysis.
- Assessed policies, researched guidance, and guidelines from various sources, including federal, state, and the organization's.
- Maintained accurate records of appropriate final study documents during the synchronization of the final coverage analysis.
- Tracked coverage analysis progress amid cross-functional teams, and reported results in the document management system.
- Evaluated the needs of departments and acted as the intermediary between the vendor and the study teams during the coverage analysis creation.
- Identified specific resources for the justification of the appropriate billable item designations.
- Determined charge segregation and appropriate billing designations in EPIC.
- Performed basic and complex billing, budget analysis, as well as charge segregation audits to ensure ongoing compliance.
- Created Epic RSH records and fee schedules for each research study.
- Conducted reviews and resolved invoice discrepancies with the Central Billing Office and the study teams.
- Updated a log of over 85,000 results about closed studies in EPIC with current information.
Sr. Research Compliance Billing Analyst
Houston Methodist
Houston, TX
01.2016 - 01.2023
- Perform detailed review of protocols, budgets, Informed Consent Forms, Clinical Trial Agreements, Notices of Grant Awards (NOGA), FDA letters, and other relevant study-related documents
- Determine whether proposed clinical research studies are a qualifying clinical trial as defined by Medicare Clinical Trial Policy
- Work with investigators, coordinators, and sponsors in the MCA process to determine billing coverage determinations
- Create and revise MCA billing grids, derived from the protocol schedule of events, local and national treatment guidelines and relevant medical journal articles and citations (as per National Coverage Determination NCD 310.1)
- Research and communicate with appropriate stakeholders regulatory and contractual changes that impact on the billing
- Consult national/local treatment guidelines, conducts relevant literature review and consults Investigators to support billing coverage determinations
- Analyze Medicare benefit policies, coverage determinations, and medical practice guidelines related to study specific interventions
- Analyze and evaluate the accuracy of the billing process and conduct strategic risk assessment to ensure compliance and consistency of the payment terms
- Respond to and comply with audit requests using complex problem-solving techniques
- Responsible for the review of services and procedures for billing determinations for assigned portfolio of research studies across multiple disciplines
- Participate in developing and implementing policies and procedures and other monitoring tools to facilitate and enhance accurate claim submission
Senior Revenue Cycle Specialist, Plastics Surgery
Houston Methodist
Houston, TX
01.2014 - 01.2016
- Obtained complete and accurate insurance information, benefit verification then interpreted them pertinently
- Tracked, obtained, and extended precertifications, authorizations for upcoming surgeries
- Notify primary care physician for managed care plans that require PCP authorization
- Monitored scheduled surgeries and maintained organized list with status of pre-certification process
- Received charge documents and entered charges accurately and efficiently into the system
- Resolved any coding issues by appending the appropriate CPT/diagnosis codes
- Reviewed any compliance issues and took appropriate actions prior to submitting claims
- Worked with A/R and payers on delayed payments, claim denials and zero pays
- Interpreted Medicare billing/coding regulations to utilize them in the appeals
- Drafted appeal letters with appropriate documentation attached and aggressively pursued approvals and/or overturned denials
- Supplied patients with written or verbal estimates of surgical codes and fees automatically
- Collected pre-payment from patients, notified them of past due accounts
- Recommended accounts for collection agency and/or write off
- Worked with management to identify payer trends and non-payment issues
Education
Master - Public Health, Health Organization and Policy
UNIVERSITY OF ALABAMA AT BIRMINGHAM
Birmingham, Alabama01.2006
Master - Business Administration, Management
STRAYER UNIVERSITY
Washington, DC01.2003
Master - International Relations, Conflict Resolution
ST MARY’S UNIVERSITY
San Antonio, Texas01.1999
Bachelor - English, Minor in German
UNIVERSITY OF ABIDJAN
Abidjan, Cote d’Ivoire01.1996
Skills
- Time management
- Problem-solving skills
- Team collaboration
- Verbal and written communication
- Research and analysis
- Analytical problem solving
- Microsoft office
- Documentation and reporting
- MS Excel
- Account reconciliation
- Information gathering
- Attention to detail
Affiliations
- Colorado Public Health Association
- American Translators Association
- American Academy of Professional Coders
- American Public Health Association
- HIV Oraquick Testing and Counseling Advance Training (2005)
- Centura Health Mission & Ministry Communication Chair
Certification
- CPC, American Academy of Professional Coders (2014)/ AAPC ICD-10 Proficient
Languages
- Fluent in French
- Speak and read Spanish
Languages
French
Native/ Bilingual
Spanish
Limited
Timeline
Clinical Trial Analyst
University Of Maryland Medical System
12.2023 - 01.2025
Sr. Research Compliance Billing Analyst
Houston Methodist
01.2016 - 01.2023
Senior Revenue Cycle Specialist, Plastics Surgery
Houston Methodist
01.2014 - 01.2016
Master - Public Health, Health Organization and Policy
UNIVERSITY OF ALABAMA AT BIRMINGHAM
Master - Business Administration, Management
STRAYER UNIVERSITY
Master - International Relations, Conflict Resolution
ST MARY’S UNIVERSITY
Bachelor - English, Minor in German
UNIVERSITY OF ABIDJAN