Crystal Monio
Wylie,US
Summary
Experienced clinical denials and appeals leader with a strong work ethic and a track record of exceeding expectations. Recognized for effective team leadership and consistent delivery of results. Creative and motivated leader with exceptional design and planning strengths, successfully accomplishing complex projects. Skilled in teaching new concepts and implementing best practice strategies for driving success.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Denial Resource Center Supervisor
Baylor Scott & White Health
08.2022 - Current
- Demonstrated excellent leadership by building trust with a team that had low engagement and a weak culture of safety
- Collaborated with facility CDI to educate physicians on LCD changes related to facet injections, resulting in decreased Medicare denials
- Advocated for change in LCD L35093 by requesting providers to add scholarly comments during the proposed LCD comment period
- Tracked appeal inventory for cases referred to three vendors
- Developed processes and tracked IT escalations during the transition from MIDAS to EPIC for Appeals Workflow
- Successfully escalated 564 refund requests totaling $4.8 million, resulting in the closure of $2.2 million in refund requests
- Escalate cases to managed care providers and participate in JOC meetings to prevent further denials
- Analyze appeal deadlines and work queues, prioritizing high-importance cases to enhance resolution rates
- Achieved a 44% reduction in OT hours and a 98.31% decrease in downtime hours, improving operational efficiency
- Significantly improved survey results for Employee Engagement (from 76% to 90.8%) and Culture of Safety (from 61% to 86.5%)
- Led the development of a Productivity Tool for tracking productivity in EPIC
- Managed an inventory of 30K cases, recovering $128 million with a 71% overturn rate
- Consistently collaborate with other Revenue Cycle Department and Clinical leaders at facility to decrease denials
- Enhanced the Follow-Up Collector Workflow by contributing to the development of real-time notifications for new EOB correspondence from payors
Utilization Review Supervisor
Baylor Scott & White Health
11.2017 - 08.2022
- Ensure positive communication of UR process with staff, medical directors, and facility administration
- Assist employees in making timely decisions for favorable outcomes on denied cases
- Initiate actions to improve effectiveness, quality, and efficiency of UR operations within 24 hours
- Perform monthly quality audits for all staff to maintain high standards
- Supervised UR team, streamlined processes, reduced medical necessity denials through clinical reviews
- Led Workflow Committee, developed Job Aids, boosted team efficiency
- Tracked and escalated IT tickets during acquisitions, ensured seamless transitions
- Implemented automated tracking for denials, significantly reduced write-offs
- Developed training materials for new systems, facilitated smoother staff onboarding
- Optimized clinical review processes, reducing medical necessity denials, and saving UR nurse time through IT collaboration
- Tracked IT tickets during acquisition of 2 new facilities, ensuring seamless access for the UR team
- Developed a shared OneNote Notebook containing Job Aids, Workflows, and Standard Operating Procedures, enhancing team efficiency
- Led the Workflow Committee, updating existing Job Aids and creating new ones, fostering a culture of continuous improvement
- Revised UR priority list based on payor trends, improving the accuracy of medical necessity reviews and reducing write-offs
- Pioneered automated tracking systems for denials, significantly cutting down on administrative overhead
- Assisted with Process Design of UR transition from Interqual to Cortex UR for clinical reviews
- Presented key metrics at UM Committee Meetings and Quarterly Quality Meetings
- Sought out workgroups and offered suggestions to enhance UR operations and reduce denials
- Improved physician documentation to reduce high-dollar denials related to skin substitutes
Utilization Review Nurse
Baylor Scott & White Health
07.2015 - 11.2017
- Performed medical necessity reviews using evidence-based criteria, ensuring compliance and accuracy
- Coordinated peer-to-peer consultations with attending providers to resolve complex cases efficiently
- Escalated cases to physician advisors when medical necessity criteria were not met
- Initiated Condition Code 44, enhancing regulatory adherence and patient care standards
- Communicated denial trends to clinical resource management, driving strategic improvements
- Provided training to new staff on utilization review protocols, enhancing team proficiency and improving patient outcomes
Remote Telehealth Nurse Educator
Lash Group
08.2014 - 07.2015
- Educate and manage multiple sclerosis patients, enhancing treatment adherence through motivational interviewing
- Train staff on OneNote, reducing time spent searching for job aids
- Mentor new hires, fostering team growth within six months
- Guide patients on insurance and financial aid, improving access to necessary treatments
- Report Adverse Events promptly, ensuring patient safety and compliance
Telephonic Work at Home Case Manager
Optum (A UnitedHealth Group Company)
08.2012 - 08.2014
- Responsible for clinical operations and medical management for cancer patients, ensuring comprehensive care plans
- Achieved top performer recognition from leadership, reflecting exceptional performance
- Consistently received high consumer satisfaction ratings, demonstrating excellent service delivery
- Improved employee satisfaction scores by creating and implementing effective action plan
- Provided expertise on specific processes and procedures, supporting peer development and client needs
Infusion Nurse
Texas Oncology
12.2008 - 08.2012
- Delivered nursing care to oncology/hematology patients in outpatient setting, ensuring high-quality treatment
- Led infusion room team, addressing clinical questions and EMR support, enhancing staff efficiency
- Trained new staff, improving team competency and patient care standards
- Acted as lead RN, providing critical support and guidance, fostering a collaborative environment
Staff Nurse/Charge Nurse
Medical City
04.2005 - 10.2008
- Cared for cancer patients as staff/charge nurse, ensuring high-quality treatment and support
- Contributed to unit quality assurance, identifying issues and improving patient care processes
- Managed patient census and allocated staff assignments effectively to maintain optimal workflow
- Collaborated with team to enhance patient outcomes through continuous monitoring and evaluation
Staff Nurse/Extern
Christus St. Michael
06.2003 - 04.2005
- Maintained meticulous patient records and documentation, ensuring accuracy and compliance with healthcare regulations
- Collaborated with multidisciplinary teams to enhance patient care and streamline workflows, improving overall patient satisfaction
Education
Bachelor of Science - Nursing
University of Arkansas For Medical Sciences
LITTLE ROCK, ARKANSAS05.2004
Skills
- Process Design
- Clinical Denials
- Appeals
- Servant Leadership
- Revenue Cycle Operations
- Data Analysis
- Project Management
- Denial Reduction
- System Transition
- Effective Communication
Accomplishments
- Assumed Director responsibilities, successfully leading UM Committee Meetings, resolving contractual issues with Managed Care, and sharing denial trends with the CMO and CFO to prevent further denials.
- Supervised team of 14 staff members.
- Managed an inventory of 30K cases, recovering $128 million with a 71% overturn rate.
- Utilized Microsoft Excel to analyze denial trends and pinpoint areas for improvement.
- Developed an Excel spreadsheet to track vendor inventory, ensuring that appeal deadlines are met.
Certification
- Accredited Case Manager | American Case Management Association | 2019, June
Timeline
Denial Resource Center Supervisor
Baylor Scott & White Health
08.2022 - Current
Utilization Review Supervisor
Baylor Scott & White Health
11.2017 - 08.2022
Utilization Review Nurse
Baylor Scott & White Health
07.2015 - 11.2017
Remote Telehealth Nurse Educator
Lash Group
08.2014 - 07.2015
Telephonic Work at Home Case Manager
Optum (A UnitedHealth Group Company)
08.2012 - 08.2014
Infusion Nurse
Texas Oncology
12.2008 - 08.2012
Staff Nurse/Charge Nurse
Medical City
04.2005 - 10.2008
Staff Nurse/Extern
Christus St. Michael
06.2003 - 04.2005
- Accredited Case Manager | American Case Management Association | 2019, June
Bachelor of Science - Nursing
University of Arkansas For Medical Sciences
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