Accounts Receivable Business Administration
Resume:
South Ozone Park,
New York ****0
********@*****.***
Nicole Natelli, MBA, CPC, CRCR
Education
University of Phoenix Online
Major: Master of Business Administration
Graduated September 2012
The Roxbury Institute, Jamaica Estates, NY
Certified Professional Coder, Inpatient Billing/Ambulatory Surgery
Graduated June 2008
Berkley College, New York, NY
Bachelor of Business Administration, Major Management
Graduated March 2005
Experience
11/21-Present Trinity Health, Remote
Coding Payment Resolution Specialist
Responsible for reviewing all post billed denials for coding accuracy
Responsible for identifying and determining the root causes of denials
Responsible for leveraging coding and standard procedures to track appeals and ensure timely filing
Applied knowledge of coding and billing guidelines
Assist Accounts Receivable team with coding related denials
Consistently meet department defined benchmarks while maintaining accuracy code related denials
08/2017-10/21 ProHEALTH Care, Radiology Dept.
Certified Professional Coder
Assigned ICD 10 and CPT coding to various types of radiology reports such as Computed Tomography, MRI, Ultrasounds and X-Rays
Reviewed and corrected edits in the RIS system for claims that were denied for inappropriate reasons
Applied knowledge of coding and billing guidelines
Assist Accounts Receivable team with coding related denials
01/2016-07/2017 MD Billing Solutions, Brooklyn, NY
Coder
Performed ICD 10 and CPT 4 coding to ensure highest level of specificity based on providers supporting clinical documentation.
Reviewed and appealed unpaid and denied claims for medical necessity
Managed accounts for Urgent Care, Urology, Radiology, and Pain Management
01/2015-12/2015 Department of Veteran Affairs, NY, NY
MRT Auditor
Function as the technical expert in documentation requirements for correct coder assignments for various departments that include Psych, Ophthalmology, Urology, Internal Medicine, Podiatry and OBGYN.
Analyzed and accurately correlates laboratory test results, procedures, and treatments with the diagnosis being coded.
Coordinated final determination on the use of and submission of ICD-9, ICD-10CM,and ICD 10 PCS codes used to record new diagnostic terms, procedures, drugs, and therapies for which no reference or precedent is available.
10/2014-02/2015 Himagine Solutions, Inc.
Professional Remote Coder (temporary)
06/2014-09/2014 Business Dynamics Limited, RCM
Appeals Specialist (temporary)
10/2013- 12/2013 re solution consulting (Kingsborough Community Hosp)
Clinical Coder (temporary)
08/2010-08/2013 North Shore Long Island Jewish October 2012 APG Manager, Coding and Reimbursement
Conducted and monitored initial and subsequent training and education on E/M documentation, coding and billing guidelines for physicians and staff providing in the clinics.
Developed and monitored schedule for internal chart reviews and conducts reviews of documentation/coding and billing utilizing advanced, specialized knowledge of medical codes and coding procedures for clinic billing to assign and sequence appropriate diagnostic/procedure billing codes in compliance with governmental payer requirements.
Conducted training and education sessions on coding and regulatory updates for Coding/Compliance staff.
08/2010-10/2012 Compliance Reimbursement Coordinator/Lead Auditor
Ensured complete and accurate coding by conducting periodic audits for various departments including Emergency Room, Neurology, Neurosurgery, Pediatrics, Surgery, Cardiology, Surgery, and Internal Medicine
Utilized IDX and related modules to obtain, analyze and interpret coding, denial and other reimbursement data to support compliance and practice management activities.
Provided leadership and guidance to junior Coding Auditors with teaching instruction of Evaluation and Management guidelines.
Performed bench marking analysis of physician charges for various departments to identify areas of missed revenue opportunity and possible audit liability.
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08/2008 – 01/2010 Maspeth Roura Medical PC
Billing Manager
Supervised a staff of 6 registration and billing staff.
Implemented real time insurance verification at patient Check-in and Charge Entry at point of patient Checkout.
Processed credentialing for group physicians with various insurance carriers.
11/2007-07/2008 ICS Software Ltd. Customer Support
Processed requests from clients for Electronic Data Interchange submitter numbers for various insurance carriers.
Troubleshoot and test application via remote access as requested by clients.
Answered inbound calls in support of customer needs.
02/2005 – 04/2007 New York Downtown Hospital Billing Specialist
Assisted physicians with ICD 9 and CPT coding to ensure highest level of specificity based on supporting clinical documentation for General Surgery.
Conducted weekly meetings with physicians in order to resolve outstanding billing issues.
Processed heavy volume of patient demographic and insurance information for billing and collection purposes utilizing Athena Healthnet.
04/2000 – 12/2004 Comprehensive Care Mgmt Claims Representative
Managed operational tasks related to the authorization of durable medical equipment.
Determined benefit coverage based on membership records.
Reviewed and processed corrections for claims team representatives on daily basis.
08/1998 – 03/2000 Montefiore Medical Center Senior Accounting Clerk
Processed a heavy volume of patient demographic and insurance information for billing and collection purposes for the Radiation Oncology Practice.
Verified benefits with insurance carriers, completed timely charge capture and claim submission
Prepared and processed HCFA 1500 and UB92 claims to third party insurers, including electronic entry of Medicare Part A via Empire Medicare Ominipro System.
04/1994 – 03/1998 Naval Med Center San Diego United States Navy Hospital Corpsman-Third Officer Petty Class
Processed patient demographic and insurance information for billing purposes.
Performed medical record preparation for outpatients.
Maintained records for admissions and discharge of patients.
Honorable Discharge Awarded Petty Officer Third Class.
Good Conduct Medal Awarded.
Skills
Epic, Nthrive, 3m Encoder, Athena Health, Allscripts, QuadraMed, Unity, EMEVS, Empire Ominipro System, Epicor, Medisoft, doctors.com
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