Summary
Overview
Work History
Education
Certification
Timeline
Generic

Donna Wagoner

Middleburg,FL

Summary

Results-driven consultant with demonstrated expertise in medical coding and billing, known for optimizing team performance and delivering measurable financial outcomes through data-informed strategies and operational enhancements. In addition to 13 years of healthcare experience, other industry experience includes media, real estate, retail management, travel, legal, and mortgage banking.

Overview

13
13
years of professional experience
1
1
Certification

Work History

Consultant Coding and Billing

Payment Integrity Office, Florida Blue
09.2022 - Current
  • Collaborate with cross-functional teams to identify, implement, and monitor payment integrity department process improvements.
  • Design tailored training programs, assemble coding guidelines and resources, and perform quality audits for internal coding auditing team for high risk claims.
  • Support the governance of pre-pay vendor concepts and claim edits, and coordinate vendor team issue management.
  • Analyze data sets to identify trends and support provider network management and Special Investigation Unit (SIU) investigations.
  • Recognized with annual department Excellence Award three times.

PrePay Coding Analyst

Payment Integrity Office, Florida Blue
06.2017 - 08.2022
  • Participated in collaborative initiatives aimed at reducing claim denials due to improper coding.
  • Generated reports to identify coding trends and discrepancies.
  • Contributed to the development of internal coding guidelines, ensuring consistency across the team, and provided ongoing training and support to junior analysts.
  • Monitored changes in coding guidelines and regulations to provide recommendations for payment policy revisions.

Physician Billing Coder

Cardiology Department, UF Health Jacksonville
04.2016 - 02.2017
  • Assigned Evaluation and Management levels, ICD-10 diagnosis codes, and CPT procedure codes within Epic EHR per payer guidelines for inpatient and outpatient cardiology department physician encounters.
  • Ensured coding compliance for documentation related to resident teaching and supervision in an academic medical setting.
  • Assisted business group charge follow-up team with claim denial reviews.
  • Recognized with a "Super Nova" Star Award for Quality.

Emergency Department Coder

Healthcare Coding & Consulting Services (HCCS)
09.2015 - 02.2016
  • Assigned ICD-9/ICD-10 diagnosis and CPT procedure codes to emergency department records from Cerner EHR, ensuring claims data entry in compliance with client specifications and and payer guidelines.
  • Accurately coded records for assigned facilities remotely, meeting productivity benchmarks and quality assurance standards.
  • Assisted hospital billing department with claim edits via their MedAssets XClaim and SMART software products.

Certified Medical Coder

Medical Management Resources of TeamHealth
07.2013 - 09.2015
  • Assigned Evaluation and Management levels, CPT procedures, and ICD-9 diagnosis codes to emergency department records from Cerner EHR, ensuring claims data entry in compliance with client specifications and and payer guidelines.
  • Accurately coded records for assigned facilities both in office and remotely, meeting productivity benchmarks and quality assurance standards.
  • Researched suspended charts and worked with management team to resolve coding issues.

Front Office Assistant

Iselborn Chiropractic and Sports Medicine
05.2012 - 09.2012
  • Provided front-line communication, managing patient inquiries and appointment scheduling across multi-line phone systems.
  • Conducted patient check-in and check-out processes, including data entry, insurance verification, and charge capture in the Eclipse practice management system.
  • Performed daily accounting and balancing tasks.

Education

Bachelor of Science - Health Information Management

Charter Oak State College
New Britain, CT
12-2025

Associate of Science - Health Information Technology

Fortis College
Orange Park, FL

Associate of Arts - Liberal Arts

Three Rivers Community College
Norwich, CT

Paralegal Certificate - Paralegal Studies

American Institute For Paralegal Studies
Ann Arbor, MI

Diploma - Radio And Television Broadcasting

Connecticut School of Broadcasting
Farmington, CT

Certification

American Academy of Professional Coders (AAPC) Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Professional Compliance Officer (CPCO), Certified Outpatient Coder (COC), Certified Risk Adjustment Coder (CRC), Certified Evaluation and Management Coder (CEMC). National Center for Competency Testing (NCCT) National Certified Insurance and Coding Specialist (NCICS).

Timeline

Consultant Coding and Billing

Payment Integrity Office, Florida Blue
09.2022 - Current

PrePay Coding Analyst

Payment Integrity Office, Florida Blue
06.2017 - 08.2022

Physician Billing Coder

Cardiology Department, UF Health Jacksonville
04.2016 - 02.2017

Emergency Department Coder

Healthcare Coding & Consulting Services (HCCS)
09.2015 - 02.2016

Certified Medical Coder

Medical Management Resources of TeamHealth
07.2013 - 09.2015

Front Office Assistant

Iselborn Chiropractic and Sports Medicine
05.2012 - 09.2012

Bachelor of Science - Health Information Management

Charter Oak State College

Associate of Science - Health Information Technology

Fortis College

Associate of Arts - Liberal Arts

Three Rivers Community College

Paralegal Certificate - Paralegal Studies

American Institute For Paralegal Studies

Diploma - Radio And Television Broadcasting

Connecticut School of Broadcasting

Similar Profiles

CREATE PROFILE
Donna Wagoner