Medical Billing
Resume:
Mary Martelloni, LPN,CPC
Healthcare Management Specialist, Clinical Review, Nurse Reviewer, Clinical Compliance, Certified Coder
**************@*****.***
Healthcare Administration. Revenue Cycle professional with over 25 years’ experience in Private Practice, CHC/FQHC facilities, and Hospital based practices, as well as corporate level management. Implement and structure strong organizational skills to maintain receivables with accuracy, enabling production efficiency and timely reimbursement.
Ability to utilize 25+ years of clinical nursing/compliance, documentation, and billing practices along with strong successful healthcare managerial experience in corporate healthcare operations. 12+ years of quality, regulatory, compliance, accreditation, and/or auditing experience to establish quality, safety and financial operational standards to produce positive impact on overall performance of the organization.
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PROFESSIONAL EXPERIENCE
Director of Operations and Business Development
DBA Maryland Pain Centers - Olney, MD
October 2016 to December 2019 Dr sold practice
●Oversee daily operations of the practice including billing, staffing, accounting, payroll, marketing, expansion, and direct supervision of the staff.
●Develop policies and procedures to ensure compliance.
●Audit charts for missing items, missed treatments, medical necessity, compliance and for accuracy.
●Recruit and train employees to ensure department is staffed with qualified personnel, including MDs, APNs, PAs, Radiology, and clinical support staff.
●Plan and oversee all patient care or administrative operations and programs.
●Assign cases and create schedules for all employees.
●Coordinate and supervise staff providing constructive feedback.
●Provide personnel with clinical training and opportunities for continuous development.
●Evaluate performance and discipline employees when necessary.
●Credential new providers with Medicare, Medicaid, and Private Payer insurances.
●Monitor compliance to legal guidelines, internal policies and quality standards.
●Increased clinic production and collections by 26%
●Expanded the practice from one to two locations, due to increase in efficiency, patient volume and community demand.’
●Successful in overturning Optium, and Maryland MCO audits, with proper information and appeals
●Provider and group credentialing
Owner/Operator
The Integration Group - Baltimore, MD
June 2011 to Sept 2016
●Managing partner in a start-up medical billing and consulting organization.
●Successfully grew the organization from 1 client to over 25 individual clients throughout the nation..
●Oversee operations, marketing, sales, accounting, IT and human resources functions within the organization.
●Hired and developed staff to "A" level status.
●Grew consulting and billing clients over a four year period through sales best practices and marketing strategies of direct response, email, internet, voice broadcast and search engine optimization (SEO).
●Grew retention revenue through improved operations, customer service and marketing.
●Provided Consulting Services to over 25 clients across the nation. Including, but not limited to, staff and provider recruitment, staff and provider training, insurance verification, medical records review, ordering of equipment and non-medical supplies responsible for day-to-day operations.
●Responsible for hiring, terminating, training and evaluations of over 30 full-time employees.
●Resource for any billing, or coding issues
●Resource for any and all insurance audits placed on clients from before they were at client status with the organization.
●Successfully overturned a $2 million audit refund request from CMS by properly auditing charts and gathering and sending appropriate medical records. By challenging the CMS audit contractor.
●Successfully overturned a $6 million audit refund request from BCBS by properly auditing charts and gathering and sending appropriate medical records.
Director of Operations
Baltimore Pain Relief Centers - Baltimore, MD
July 2011 to October 2015
●Directly responsible for growth of company from a single part time start up to six-full time, comprehensive Interventional Pain Management Centers generating $12M annually over a three year period.
●Responsible for recruitment and retention of staff, including MDs, APNs, PAs, Radiology, and Clinical Support Staff
●Coaching and development of a staff of 4 medical doctors, 10 mid-level providers, and 40-50 clinical and non- clinical support staff.
●Increased collection percentages by 20% by implementing checks & balance policies.
●Audit charts for missing items, missed treatments, medical necessity, compliance and for accuracy.
●Provider training, reporting, and response to payer requests
●Developed significant community based partnerships within the city, such as FQHCs, Total Health Care, Baltimore Family Health, and Baltimore Health Systems to integrate the interventional pain management relationship.
●Develop, monitor, and control the staffing needs, operations budget, and capital budget.
●Implemented a program of job-based pay for performance, orientation, and training for all employees.
●Developed a 10+ employee call center/intake and verification department.
●Work in conjunction with the CEO in the evaluation and development of existing and new locations throughout the Baltimore area, based on community needs.
●Worked directly with healthcare attorney in regards to any reporting issues or violations in company policy.
●Ensured compliance with government regulatory agencies and accrediting bodies.
●Handled all employment aspects for 60+ full-time employees such as, physicians, nurse practitioners, physician assistants as well clinical and non-clinical support staff, including, but not limited to payroll, performance evaluations, staff bonuses, staff health insurance, new hire paperwork, disciplinary actions and hands-on training.
●Successfully overturned a DMEPOS 800K audit refund request from CMS by properly auditing charts and gathering and sending appropriate medical records, challenging the CMS audit contractor
●Successfully overturned Carefirst 180k audit refund request, by properly gathering defence information that the owner was improperly advised to code a specific CPT
●Successful in overturning State of MD ruling that urine toxicology is only a requirement of Mental Health Providers to include Interventional Pain Mgt
Director of Operations
Lensgraf Clinic - Knoxville, TN
January 2008 to June 2011
●Responsible for day to day operations of a multi-disciplinary interventional pain management clinic while concurrently overseeing billing, collections, and compliance for MDC consulting.
●Increased collections over 40% within the first 8 months by applying several different policies for checks & balances.
●Developed and received State Accreditation as an Ambulatory Surgery Center resulting in the first in state designated site for MUA 2010.
●Develop, monitor, and control the staffing needs, operations budget, and capital budget.
●Oversaw billing, collections and accounts receivables..
●Brought current consulting clients into compliance, and assisted in expansion of consulting clients from 5 clients at time of hire, to over 32 clients, nationally. .
●Developed documentation standards, protocols, templates for procedures, along with ongoing training for staff and providers
●Develop, monitor, and control the staffing needs, operations budget, and capital budget.
●Recruiting and hiring of medical staff for the main company, as well as the consulting company.
●Oversaw billing and collection department for main company/clinic, as well as the consulting department of over 32 individual clients..
●Responsible for conducting educational and compliance seminars for clients quarterly.
●Served as a resource for clients with credentialing, billing and compliance.
●Successfully overturned a $150k audit refund request from CMS by properly auditing charts and gathering and sending appropriate medical records, challenging the CMS audit contractor, and handled ALJ hearing
National Compliance Auditor
21st Century Oncology - Ft Myers, FL
August 2005 to December 2008
●Covered national accounts to perform on site internal audits.
●Training of staff, review of site to ensure all corporate policies are being followed.
●Transitional training for employees during new corporate acquisitions.
●Responsible for ongoing training of onsite billing and coding staff.
●Responsible for training and mentoring new auditors.
●Audited radiation oncology, surgical oncology, urology, and oncology.
Coding and Compliance Auditor
Robert Wood Johnson Medical Systems/ UMDNJ - New Brunswick, NJ
2004 to 2006
●Directly in charge of all audits and reporting for the departments of Cardio-thoracic Surgery, General Surgery, Urology
●Reviewed inpatient medical records for coding and compliance with national standards
●Reporting and benchmarking of physicians results
●Education and training of physicians with regards to deficiencies
●Cross referenced for compliance documentation verse billed charges and initiated correction corrective actions and /or refunds
Director of Operations
VNA of Central New Jersey - Asbury Park, NJ
September 2000 to August 2004
●Oversaw the daily operations of a Federally Qualified Health Center which rendered over 50,000 visits per year, to medically underinsured and uninsured patients from birth through 99 years old.
●Oversaw a staff of 25, 4 RNs, 2 Social Workers, 3 MAs, 5 Front desk, and 6 Advanced practice nurses
●Overturned the financial state of the center, from being in the negative for 10+ years, to turning a profit within 6 months of hire, and successfully maintained that profit margin for the remainder of my employment.
●Directly responsible for state and federal reporting
●Responsible for organizing special community events and fundraising events.
●Prepared reporting for state immunization programs.
●Reported to a board of directors
●Assisted the COO of this location in writing government grants and securing additional state and federal monies through, HRSA, and the State of New Jersey.
●Worked in conjunction with the Ryan White Foundation, and community leaders in HIV awareness, early detection and treatment.
●Assisted in securing a $600,000 grant for expansion under Senator Frank Lautenberg.
Education
Ocean County College
1981 - 1982 - Practical Nursing
2005 - 2006 - Healthcare Management
AAPC
2005 - 2006 - Certified Professional Coder
Skills
Healthcare Administration● Operations ● Auditing ● Revenue Cycle Management Budgeting ● Certified Professional Coder ● Business Operations ● Human Resources and Healthcare Benefit Adm s ● Oncology ● Pulmonology ● Interventional Pain Management ● Home Health ● Nursing ● Call Center ● Compliance ● Medical Billing ● Medical Coding ● ICD-9-CM ● ICD-10-CM ● HCPCS ● CPT ● Medical Terminology ● EHR & EMR ● Government Payers ●Third Party Payers ● Worker's Compensation ● Medical Records ● CMS ● Tricare ● EOBs ● Payment Posting t ● Scheduling ● Insurance Verification ● Insurance Billing Procedures ● Insurance Claim Processing ● Practice Management ● Medical Office Procedures ● Triage ● MS Excel, Word, Outlook ● Medicare and Medicaid ● HIPAA Regulations ● Copayments ● Deductibles ● Reimbursement Methodologies ● Fee Schedules ● Practice Management ● CollaborateMD ● Practice Fusion ● Advanced MD ● CareCloud ● eClinicalWorks ● Medical Mastermind ● Epic
Certifications/Licenses
Licensed Nurse - Multistate Florida - Valid License PN 5239830 Exp July 31st 2021
CPC - AAPC 2005-current
Additional Information
AREAS OF IMPACT
Certified Professional Coder Revenue Cycle Compliance Business Development Change Management Strategic Planning & Leadership Profit Growth Product Development Executive Management Finance & Budgeting Operations Management
BUSINESS SKILLS
Recruitment and retention of staff, MD, APN, PAs, Radiology, Clinical Support Staff
Familiarity with systems and general business operations, Investigation and Interview skills
Thorough understanding of ethics, regulations, and laws
Working with management, regulators, and board members Forensic auditing and reporting skills
Professional References
Tatyana Reznikov, MD - 443-***-****
Thomas Raley, MD - 717-***-****
Neila Parrish, APN - 443-***-****
Fahim Fashif PA-C - 410-***-****
Daisy Uppal, MD - 410-***-****
Authorized to work in the US for any employer
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