Monica Coleman
Katy,Tx
Summary
Energetic and highly motivated. Expertise lies in providing top-quality provider contracting, credentialing and data analyst while maintaining a professional demeanor. Results-oriented manager committed to exceeding set goals who easily establishes trust and support with the public. Excellent communicator with effective relationship building skills and the ability to influence and satisfy customers to exceed their expectation. Highly flexible, with the ability to stay calm and focused on stressful situations. Excellent problem solver, negotiator with excellent follow-through.
Overview
19
19
years of professional experience
Work History
Sr. Contract Data Analyst
United Healthcare
12.2017 - Current
- Performs complex conceptual analyses
- Maintained current provider data to ensure the quality of the network for delegated entities
- Assess work performed by others to provide recommendations for improvement
- Lead or participate in applicable projects related to analysis and reporting of provider data
- Engage with Healthcare Partners to gather and or verify data received from multiple resources (e.g., Excel files, emails, claims) internal and external
- Provides technical and subject matter expertise on escalated issues concerning policies, procedures, customer, and regulatory guidelines
- Utilize database systems and tools to research and generate reports based upon provider data (e.g., NDB, CSP Facets, Cosmos, Examiner, Danner, Scrape Reporting Macros and Amaardi.) Receive claims escalations for all LOBs inquiring about incorrect provider data that impacts the outcome of the claim
- Triage issues that incorrectly impact pricing discrepancies and incorrect application
- If not triaged timely it can impact inter claims area inventory turnaround time expectations
- System Experience includes Microsoft office, Sales Force Impact, Phycon, NDB-Network Database, CSP Facet, Cosmos, Pulse, Amaardi, Orbitz, Danner, Emptoris, CLM-Contract Lifecycle Management, PLMI-Provider Loading Maintenance Instructions and PGA Examiner, NICE, ARC Examiner
Senior Provider Data Analyst
United Healthcare
05.2016 - 12.2017
- Managed the database maintenance, reporting and extracting data for various reports and analyses, initiating database improvement
- Developed and maintained standards for database integrity and quality assurance, coordinates corrective activities to clean database and retain users, and manages communication processes with other departments regarding database improvements
- Conducts audits and provides feedback to reduce errors and improve processes and performance
- Maintained current provider data to ensure the quality of the network
- Sometimes responsible for representing the provider network area on company IT projects, reporting, and tracking provider calls and complaints, or for the support, coordination, and production of the paper directory cycles
- Represented the Central Region Contract Analytics team during the Provider Data Expos providing expertise for the Indianapolis, IN Market
- System Experience includes Sales Force Impact, Phycon, NDB-Network Database, CSP Facet, Cosmos, Amaardi, Orbitz, DANNER, Emptoris, PLMI, RESCU, RFP Grid (Request for Participation)
Provider Relations Contracting Representative/Credentialing Coordinator Sr
MDwise Inc.
10.2014 - 05.2016
- Provides/coordinates provider training for claims and billing procedures, contract compliance, medical management, and pharmacy issues
- Supports and maintains current provider network through customer service including training, credentialing assistance, claims resolution and advocacy
- Develop and provide a standard orientation package for newly contracted providers
- Facilitates provider network by recruiting necessary PCP, Specialist, Ancillary, and Hospital providers and assisting Network Support, Contracting, and Credentialing as well as Mentoring, Coaching and train lower-level staff
- Ensure policies and procedures comply with MDwise, OMPP regulations, and NCQA guidelines.
Sr Credentialing Coordinator
MDwise Hoosier Alliance
07.2012 - 10.2014
- Provide education to an average of 40 providers weekly regarding, contracting, credentialing and enrollment applications
- Prepare four adhoc credentialing reports to senior management and state of Indiana to distribute to the Quality Auditing Department to ensure the provider directory is updated at the end of the month
- Ensure policies and procedures comply with MDwise, OMPP regulations, and NCQA guidelines
- Provide education to an average of 40 providers weekly regarding credentialing and enrollment applications
- Prepare four adhoc credentialing reports to senior management and state of Indiana to distribute to the Quality Auditing Department to ensure the provider directory is updated at the end of the month
- Ensure policies and procedures comply with MDwise, OMPP regulations, and NCQA guidelines.
Credentialing Coordinator
IU Health Physician
10.2010 - 07.2012
- Processed over 18 files daily for credentialing and re-credentialing between the Indiana Clinic providers and the Credentials Committee to ensure applications are complete
- Collected enrollment information and recorded information into the CAQH system for more than 25 providers weekly for use in completing payors applications
- Conducted interviewing and screening for candidates for the Credentialing and Provider Enrollment Department
- Train new employees on work place procedures and processes
- Administered and maintains departmental policies, procedures, and ensures completed documentation complies with policies, procedures, systems, under the NCQA standards
- Prepared three adhoc reports of pertinent information regarding delegated audit to the MDwise system and IU Health CVO to ensure all credentialed providers were captioned and credentialed as requested for third party payors and other internal and external customers.
Provider Operations Coordinator
WellCare
08.2008 - 05.2009
- Responsible for resolving obstacles for a network of 2000 hospitals, PCP's and ancillary
- Gathered, analyze and report verbal and written member and provider complaints, grievances, and appeals
- Loaded and kept track of all CMS guidelines and regulations audits configuration on new contracts for 150 Medicare Providers monthly
- Assisted with HEDIS production functions including data entry, calls to provider's offices, and claims research
- Assisted with special projects as assigned or directed Coordinated the distribution of the Credentialing Committee List to the department
Credentialing Coordinator
Clarian Health Partners
09.2004 - 08.2008
- Position included working closely with the Chief Medical Officer to assist with credentialing programs and projects for all 2600 practitioners within the Clarian Health system
- Processed all credentialing (appointment and reschedules) documents and provided administrative support to leadership and strategic planning for 50 providers on a weekly
- Trained staff on departmental policies and procedures and presented new policies and procedures to medical staff
- Interacted with practitioner applicants, service chiefs/co-chiefs, and members of the appropriate medical staff, nursing and hospital committees to assure timely processing of applications
- Administered and maintained departmental policies, procedures, ensured that all completed documentation complies with policies, procedures, systems, Medical Staff Bylaws, JCAHO, and the Indiana State Department of Health
Customer Service Rep - Contact Ctr
Ascension Health
01.2018
- Responsible for responding to telephone and or internet inquiries from customers seeking information
- Collects relevant caller data to assist with measurement, tracking and reporting activities
- Answers incoming calls and performs triage of inquiries from established patients within the St Vincent Medical Group practices.
Education
Bachelor of Science (Business Administration) -
Indiana Wesleyan University
04.2013
Skills
- Credentialing Contracting Policies and Procedures
- Provider Education Leadership/Management
- Reports Training
- Medicaid/Medicare/HIP HMO/PPO/POS
- Data Management Reporting
- Data Validation
- Gap Analysis
- Project Management
- Data Exports
- Business Performance Analysis
- Data Analysis
- Database Management
- Oracle Business Intelligence
- Data Quality
- Microsoft Access
- Data Integrity Validation
- Query Tools
- Business Management
- Healthcare Claim Coding
- Medical Terminology
- Microsoft Office Excel, Word, Powerpoint & Access
- ICD-9 Coding
- HIPAA Compliance
- ICD-10 Coding
- CPT & HCPC Coding
- Medicaid Knowledge
Timeline
Customer Service Rep - Contact Ctr
Ascension Health
01.2018
Sr. Contract Data Analyst
United Healthcare
12.2017 - Current
Senior Provider Data Analyst
United Healthcare
05.2016 - 12.2017
Provider Relations Contracting Representative/Credentialing Coordinator Sr
MDwise Inc.
10.2014 - 05.2016
Sr Credentialing Coordinator
MDwise Hoosier Alliance
07.2012 - 10.2014
Credentialing Coordinator
IU Health Physician
10.2010 - 07.2012
Provider Operations Coordinator
WellCare
08.2008 - 05.2009
Credentialing Coordinator
Clarian Health Partners
09.2004 - 08.2008
Bachelor of Science (Business Administration) -
Indiana Wesleyan University
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