Nancy Anselmo
North Aurora,IL
Summary
Strategic and detail-oriented Health Information Management professional with extensive experience in medical coding, payer compliance, and data analytics. Proven track record in optimizing workflows, mentoring coding teams, and driving audit-proof documentation. Adept at leveraging HIM principles to enhance payment integrity, reduce claim denials, and ensure regulatory compliance across payer systems.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Research Analytics Lead
Claritev
03.2023 - Current
- Manage daily operations of research analytics team, optimizing staff workload and performance metrics.
- Review complex inpatient and outpatient data sets for billing accuracy and coding compliance.
- Direct orientation and training programs for coders and physicians to enhance proficiency.
- Facilitate claim review meetings, resolved complex cases, and implemented new coding protocols.
- Apply certified coding knowledge to drive operational excellence and maintain standards.
- Serve as a subject matter expert, guiding clinical teams and fostering collaboration.
- Monitor turnaround times across platforms, recommending improvements to boost efficiency.
Senior Coding Specialist
Claritev
04.2019 - 02.2023
- Designed algorithms and criteria for claims editing based on coding standards to ensure accuracy.
- Partnered with multidisciplinary teams—including physicians and data analysts—to create or enhance coding edits and claim logic, driving improved payment integrity outcomes.
- Conducted comprehensive reviews of inpatient, outpatient, and practitioner claims for medical necessity and billing accuracy.
- Led education initiatives for coders, negotiators, and physicians through onboarding, training, and mentorship programs.
- Facilitated daily coding operations meetings to resolve complex claims issues and implement new coding protocols.
- Drove coding excellence by applying certified expertise while remaining current with evolving standards.
- Served as subject matter expert providing guidance on coding, documentation, and reimbursement strategies.
- Analyzed claims and supporting documentation to identify trends, discrepancies, and cost containment opportunities.
Coding Specialist
Northwestern Medicine
08.2013 - 04.2019
- Abstracted and assigned CPT/HCPCS and ICD-10 codes for E&M and surgical procedures across multiple specialties including ENT, Neurosurgery, General Surgery and Thoracic Surgery.
- Resolved medical record discrepancies and incomplete data to ensure accuracy.
- Collaborated with internal departments to analyze and address overpayments, payment reductions, and claim denials.
- Delivered training sessions on best documentation practices, billing, and coding for physicians and clinical staff.
Medical Billing & Coding Manager
Center for Cardiovascular Excellence
03.2012 - 07.2013
- Managed the revenue cycle and workflow processes including preclaim submission activities, claims processing, accounts receivable and claims reconciliation and collections.
- Monitored account activity and accuracy of HCPCS/CPT and ICD-10-CM coding.
- Researched Medicare LCD/NCD policies, along with other third-party payer policies for coverage and medical necessity requirements.
- Corresponded with third-party carriers regarding billing issues and served as patient resource in resolving EOB issues with medical bills.
Medical Billing & Coding Supervisor
Midwest Food and Ankle Clinics
10.2008 - 06.2012
- Optimized revenue cycle and workflow processes, including claim submissions and collections.
- Credentialed new physicians with government programs and commercial payers.
- Participated in EHR software implementation, redesigning practice workflow and establishing new policies.
- Developed accounts receivable process that significantly increased reimbursements from third-party payers and patients.
Education
Master of Science - Health Informatics
Northwestern University
Evanston, IL03.2018
Bachelor of Science - Health Information Management
University of Illinois At Chicago
Chicago 05.2013
Skills
- Payment integrity and claims review
- HIM and coding compliance
- CPT, HCPCS, and ICD-10-CM expertise
- Clinical documentation improvement
- Staff training and mentorship
- Regulatory research and audit response
- EHR systems (Epic, Athena)
- Data analysis
- SQL
Certification
- Registered Health Information Administrator (RHIA), AHIMA, 01/2013, Present
- Certified Professional Coder (CPC), AAPC, 01/2007, Present
- Certified Professional Auditor (CPMA), AAPC, 01/2007, Present
Timeline
Research Analytics Lead
Claritev
03.2023 - Current
Senior Coding Specialist
Claritev
04.2019 - 02.2023
Coding Specialist
Northwestern Medicine
08.2013 - 04.2019
Medical Billing & Coding Manager
Center for Cardiovascular Excellence
03.2012 - 07.2013
Medical Billing & Coding Supervisor
Midwest Food and Ankle Clinics
10.2008 - 06.2012
Master of Science - Health Informatics
Northwestern University
Bachelor of Science - Health Information Management
University of Illinois At Chicago
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