Job Search Status
Open to workDesired start date: 2 weeks notice
Open To Work
Karon O’Brien Manning
Healthca
Lithonia,GA
Work Preference
Summary
Results-driven healthcare professional with 20+ years of experience in Business Analytics, Project Management, medical coding, payment policy, claims adjudication, system configuration, and revenue cycle operations across Commercial, ACA, Medicaid, and Medicare lines of business. Recognized as a Coding Subject Matter Expert (SME) with deep expertise in CPT, HCPCS, ICD-10-CM, and ADA coding, reimbursement methodologies, and prospective payment systems. Proven ability to translate complex requirements into executable system configuration and business rules. Strong background in client integration, project management, audit, compliance, and cross-functional collaboration. Consistently upholds AHIMA ethical coding standards and delivers data-driven solutions that improve accuracy, compliance, and operational efficiency. Prepared and maintained Business Requirements Documents (BRDs) for the Marketplace Line of Business (LOB), translating regulatory, benefit, and coding requirements into functional specifications supporting QNXT configuration, claims adjudication accuracy, and compliant benefit implementation.
Overview
27
27
years of professional experience
1
1
Certification
Work History
Client Integration Specialist/Business Analyst
Zelis
Atlanta
08.2025 - Current
- Lead day-to-day client-facing integration activities, supporting system enhancements and payment accuracy initiatives.
- Provide coding and adjudication support during pre- and post-production phases, validating policy logic and configuration outcomes.
- Interpret pre-production and test data to ensure alignment with medical policies, contractual requirements, and regulatory guidelines.
- Act as primary client point of contact during the integration lifecycle, ensuring timely issue resolution and stakeholder alignment.
- Lead discovery sessions to gather technical, operational, and coding requirements, translating business needs into detailed technical and configuration specifications.
- Partner with internal technical, policy, and implementation teams to mitigate risk, ensure data integrity, and support successful client go-lives.
Project Manager – Coding Business Analyst
Molina Healthcare, Inc.
Long Beach
07.2023 - 07.2025
- Planned and directed Marketplace benefit and medical coding requirements from initiation through implementation.
- Develop BRDs for the Marketplace LOB to ensure compliance and configuration accuracy.
- Led benefit coding initiatives, including review and implementation of new and updated Marketplace medical codes.
- Conducted Marketplace code edit trend reporting and participated in weekly approval meetings.
- Audited system configuration for Marketplace LOB to ensure compliance and adjudication accuracy.
- Performed high dollar claims reviews and collaborated with Payment Integrity (CES, Cotiviti) on coding edits.
- Developed SOPs, benefit interpretation documents, and governance workflows for Configuration and BI teams.
- Supported leadership with process flows, documentation, and business decision-making.
- Researched and resolved member grievances related to benefit interpretation and coding.
- Analyzed requirements and supported QNXT configuration teams with change requests and system design.
Lead Configuration/Business Analyst
Molina Healthcare, Inc.
Long Beach
07.2013 - 07.2023
- Audited and configured QNXT Marketplace and non-Marketplace benefits for new and existing products.
- Served as Coding SME supporting coding concepts, claim research, reimbursement analysis, and contract codification.
- Managed fee schedule updates, new CPT/ICD-10/HCPCS implementations, and contract analysis.
- Collaborated with Clinical Policy, UM, and Medical Directors on policy codification and prior authorization requirements.
- Developed business requirement documentation and configuration standards across multiple markets.
- Led implementations and conversions of new and existing health plans.
- Maintained configuration change request forms (CCRFs), and ensured audit readiness.
- Stayed current on Medicare and Medicaid regulatory changes impacting configuration and payment.
- Configuration of Marketplace Benefits using QNXT system.
Project Manager, Revenue Cycle IT (Consultant)
APEX Systems
Atlanta
04.2013 - 07.2013
- Led revenue cycle IT projects supporting WellStar Health System.
- Developed system-specific project plans, timelines, testing, and implementation strategies.
- Collaborated with third-party vendors and internal stakeholders for Epic implementations.
- Served as Coding SME supporting revenue cycle application design and validation.
Payment Policy & Training Manager
Peach State Health Plan
Atlanta
08.2012 - 04.2013
- Served as SME for CPT, HCPCS, ICD-9 coding audits and Medicare/Medicaid payment policies.
- Provided analytical recommendations to senior leadership on reimbursement, trends, and cost avoidance opportunities.
- Led payment policy implementation and provider education initiatives.
- Resolved complex provider claims inquiries and conducted contract audits.
- Supported ICD-10 implementation, UAT, EDI compliance, and system configuration resolution.
Sr. Medical Coding Project Analyst
WellCare of Georgia, Inc.
Atlanta
02.2009 - 08.2012
- Served as Coding SME for Medicare, Medicaid, and HEDIS-related initiatives.
- Conducted coding, payment policy, fraud & abuse, and compliance audits.
- Researched federal regulations and developed network communications and payment policy updates.
- Supported new product implementations and ICD-10 deployment.
Medical Director Assistant
iHealth Technology, Inc.
Atlanta
06.2007 - 02.2009
- Supported Medical Directors with payment policy alignment and business rule updates.
- Developed and tested claims edits and RAC initiatives.
- Served as SME on professional coding, claim processing, and UAT/EDI validation.
Independent Consultant
J. Alexander & Associates, LLC
Atlanta
05.1999 - 06.2007
- Provided interim revenue cycle leadership, coding audits, compliance program development, and reimbursement analysis.
- Delivered coding and billing education, contract review, chart audits, and revenue optimization services.
- Served as Coding SME supporting legal, compliance, and payer policy initiatives.
Education
Bachelor of Science - Health Information Management (HIM)
DeVry University
Decatur, GAAssociate of Applied Science - Health Information Technology (HIT)
DeVry University
Decatur, GASkills
- Medical coding and claims adjudication
- Revenue cycle management
- Audit and compliance
- Project management
- Standard operating procedures development
- Epic and Facets configuration
- SQL and PEGA proficiency
- 3M and Amethyst expertise
- Citrix and Microsoft Office Suite skills
- AI literacy
Certification
- Registered Health Information Technician (RHIT)
- Certified Professional Coder (CPC)
- Certified Physician Billing Specialist (CPBS)
References
Available upon request
Timeline
Client Integration Specialist/Business Analyst
Zelis
08.2025 - Current
Project Manager – Coding Business Analyst
Molina Healthcare, Inc.
07.2023 - 07.2025
Lead Configuration/Business Analyst
Molina Healthcare, Inc.
07.2013 - 07.2023
Project Manager, Revenue Cycle IT (Consultant)
APEX Systems
04.2013 - 07.2013
Payment Policy & Training Manager
Peach State Health Plan
08.2012 - 04.2013
Sr. Medical Coding Project Analyst
WellCare of Georgia, Inc.
02.2009 - 08.2012
Medical Director Assistant
iHealth Technology, Inc.
06.2007 - 02.2009
Independent Consultant
J. Alexander & Associates, LLC
05.1999 - 06.2007
Bachelor of Science - Health Information Management (HIM)
DeVry University
Associate of Applied Science - Health Information Technology (HIT)
DeVry University