Job Search Status
Open to workDesired start date: Flexible
Open To Work
Denise Pittinaro
Denials and Appeals Analyst
Rochester,NY
Work Preference
Summary
Dynamic professional with over 15 years of expertise in Medicare and commercial denials and appeals processes, complemented by strong analytical and communication skills. Proven project management abilities enhance efficiency and drive results in fast-paced environments. An entrepreneurial mindset, paired with advanced marketing research, inventory management, and systems management capabilities, fosters innovative solutions. Recognized for exceptional organizational skills and dependability, consistently managing multiple priorities while maintaining a positive attitude and a high degree of accuracy.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Entrepreneur
Self-Employed
Rochester, NY
07.2020 - Current
- Determined business plan, mission statement; vision statement
- Devised processes to boost long-term business success while increasing profit levels. Reduced turnaround time by introducing new processes while improving systems workflows
- Managed purchasing, sales, marketing ,customer account operations efficiently.
- Launched new product lines successfully through comprehensive planning; strategic research
- Generated additional revenue streams through constructive partner and client relationships.
- Network marketing to include TIKTOK Shop; BLOG; Pinterest; Instagram; META for Business; Linktree
- Built websites utilizing Shopify; enhanced with Landing pages and marketing with linktree
- Market with VIdeos, Reels, Shoppable Videos, LIVE videos; LIVE Self-marketing
- Affiliate Marketing through Amazon; Miscellaneous Brands utilizing Linktree on several different Social Media sites
- Built business to 100 returning customers by implementing effective marketing and customer engagement plans
- Determined business plan, mission statement, and vision.
Account Recovery Liasion Specialist II
Trinity Health
Livonia , MI - Remote
01.2024 - 03.2025
- Developed and implemented strategic processes to improve operational efficiency across teams.
- Assisted team in Medicare and Medicaid Denials and Appeals preparation for DOJ, ALJ, ,
- Contributed to the successful execution of company-wide initiatives through diligent tracking of project milestones and deliverables.
- Enhanced customer satisfaction with timely and accurate issue resolution.
Denials and Appeals Coordinator
Rochester Regional Health
Rochester, NY, NY
03.2011 - 01.2023
- Acted as team leader in group projects, delegating tasks; providing feedback. Departmental resource on all appeal matters for entire organization under inpatient, outpatient & specialty denials.
- Investigate and resolve complaints and grievances in accordance with State and/or Plan guidelines. Ensure all components of any grievance/complaint are researched and addressed
- Coordinated with Medicare and State Independent Contractors: (i.e.; Performant/RAC/MAC/QIO/C2C) for adequate documentation.
- Appealed denied claims, including researching underlying root cause, collected required documentation from Contractor portals.
- Fully reviews all appeals and grievances assigned, to determine appropriate supporting documentation needed to address issues being appealed.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Coordinates appeal and dispute process through collection of clinical records and consultation with Physician Advisors/Medical Director and communicates final determination
- Works closely with organization’s third-party physician advisor in requesting clinical justification letters for retrospective, medical necessity and coding appeals
- Performs administrative activities including, but not limited to, generating, printing and mailing determination and authorization notification letters. Completes all associated data entry and authorization creations in all supported systems. Correctly and completely preps completed case files for scanning and archiving; including all outpatient, inpatient, specialty, ancillary, compliance cases which require special and /or indirect responses
- Coordinated directly with contractors and payers CMS/RAC/MAXIMUS/QIC/QIO/C2C/Blue Cross/Cigna/Wellcare/Tricare/Performant/auditors, and contractors to ensure complete and accurate documentation was received, documented, and included in all case filings
- Coordinated with CBO; Finance; Compliance; Patient BIlling; Utilization Management for Medical Necessity cases; Behavioral Health for Specialty cases to ensure proper documentation and medical records were noted and received to carry cases throughout entire appeal process
- Developed appeals functions, policies and procedures and documentation.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Coordinated with contracting department to resolve payer issues.
Utilization Management Clinical Data Analyst
Thompson Health
Canandaigua, NY
05.2008 - 03.2011
- Integrated decision support, clinical pathways and best practices into health information technology to enhance delivery of care and workflows
- Served as liaison between end-users and health IT team
- Analyzed electronic health records to identify areas for care improvement and cost reduction.
Education
Associate of Applied Science - Health Information Technology
Monroe Community College
Rochester, NY05-2005
Associate of Applied Science - Computer And Information Sciences
Pikes Peak Community College
Colorado Springs, CO01-1986
Skills
- Business Planning and Business Development
- Detail-oriented
- Motivated; Independent; Self-Starter
- Excellent Teamwork
- Excellent Verbal and Written Skills
- Excellent Professional Relationships
- Project Management
- Conflict Management
Accomplishments
..Collaborated with and trained several vice presidents and senior management on government denials database reporting to meet the deadline for the development of quarterly Corporate Physician's Denials Reporting.
- False Identity project lead me to two patients with 3.5 mil
Certification
- RHIT, AHIMA - 2007-2023
Timeline
Account Recovery Liasion Specialist II
Trinity Health
01.2024 - 03.2025
Entrepreneur
Self-Employed
07.2020 - Current
Denials and Appeals Coordinator
Rochester Regional Health
03.2011 - 01.2023
Utilization Management Clinical Data Analyst
Thompson Health
05.2008 - 03.2011
Associate of Applied Science - Computer And Information Sciences
Pikes Peak Community College
Associate of Applied Science - Health Information Technology
Monroe Community College