Nicole Natelli
South Ozone Park,United States
Summary
Nicole Natelli, MBA, CPC, CRCR
Driven professional with strong background in providing conflict resolution. Resourceful in gathering relevant information regarding disputes, providing appropriate documentation and guiding both individuals and groups to reach satisfactory agreements and settle complicated issues. Devoted to adhering to ethical guidelines and laws throughout all casework.
Overview
31
31
years of professional experience
Work History
Coding Payment Resolution Specialist
Trinity Health
11.2021 - Current
- Review and analyze denied claims for all post billed coding denials
- Recognize recurring denial reasons and collaborate with billing, coding and Rev integrity for resolution through to payment
- Identify and track coding denial trends specific to CPT and/or ICD 10 cm codes with associated CARC/RARC codes
- Initiate phone calls to insurance payors based on specific CARC codes
- Identify and determine the root causes for denials, including coding errors or policy discrepancies.
- Perform appeals for claims based on timely filing limits
- Meet department defined benchmarks consistently while maintaining accuracy coding related denials
- Assist Accounts Receivable team with ad-hoc coding denial related requests
- Recently promoted to Level II Specialist (Feb 25)
Certified Professional Coder
ProHEALTH Care
08.2017 - 10.2021
- 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
- Completed a daily production log
- Assist Accounts Receivable team with coding related denials
Coder
MD Billing Solutions
Brooklyn, NY
01.2016 - 07.2017
- 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
- Audited current procedures to monitor and improve efficiency of billing and collections operations.
MRT Auditor
Department of Veteran Affairs
NY, NY
01.2015 - 12.2015
- 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.
Professional Remote Coder (temporary)
Himagine Solutions, Inc.
10.2014 - 02.2015
- Confirmed complete coding of clinical coding for various departments that include Ophthalmology, Orthopedic, and Cardiology
- Completes data entry of cpt and diagnosis through Epic
- Maintained knowledge of coding and billing requirement. Attends coding meetings for each new assignment and training sessions.
Clinical Coder (temporary)
Resolution consulting
10.2013 - 12.2013
- Company Overview: Kingsborough Community Hosp
- Confirmed complete coding of clinical coding for Ophthalmology, Orthopedic, and Neurology
- Completed data entry of cpt and diagnosis through Unity/QuadraMed
- Utilized 3M for assistance with coding of clinical documentation
- Kingsborough Community Hosp
APG Manager, Coding and Reimbursement
North Shore Long Island Jewish
08.2010 - 10.2012
- 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.
Compliance Reimbursement Coordinator/Lead Auditor
North Shore Long Island Jewish
08.2010 - 10.2012
- 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.
- Reviewed documentation for Medicare CERT audits and operative reports.
Billing Manager
Maspeth Roura Medical PC
Maspeth, NY
08.2008 - 01.2010
- Supervised a staff of 6 registration and billing staff.
- Performed ICD 9 and CPT 4 coding to ensure highest level of specificity based on providers supporting clinical documentation.
- 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.
Customer Support
ICS Software Ltd.
11.2007 - 07.2008
- 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.
- Maintained a daily log of tasks that need to be completed in a timely fashion.
- Answered inbound calls in support of customer needs.
Billing Specialist
New York Downtown Hospital
New York, NY
02.2005 - 04.2007
- 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.
- Provided bi-weekly status reports, which include Utilization Threshold, Accounts Receivable, and collections to senior management.
- Processed heavy volume of patient demographic and insurance information for billing and collection purposes utilizing Athena Healthnet.
Claims Representative
Comprehensive Care Mgmt
04.2000 - 12.2004
- Managed operational tasks related to the authorization of durable medical equipment.
- Determined benefit coverage based on membership records.
- Responsible for data entry of HCFA’s and UB92’s in Plexis.
- Reviewed and processed corrections for claims team representatives on daily basis.
Senior Accounting Clerk
Montefiore Medical Center
08.1998 - 03.2000
- 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.
- Conducted extensive A/R follow up with collection letters and telephone inquiries.
Hospital Corpsman-Third Officer Petty Class
Naval Med Center San Diego
San Diego, United States
04.1994 - 03.1998
- 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.
Education
Master of Business Administration - Major
University of Phoenix Online
09.2012
Certified Professional Coder - Inpatient Billing/Ambulatory Surgery
The Roxbury Institute
06.2008
Bachelor of Business Administration - Major Management
Berkley College
03.2005
Skills
- Epic
- Nthrive
- 3m Encoder
- Athena Health
- Allscripts
- Code correct
- Microsoft Word,Excel
Timeline
Coding Payment Resolution Specialist
Trinity Health
11.2021 - Current
Certified Professional Coder
ProHEALTH Care
08.2017 - 10.2021
Coder
MD Billing Solutions
01.2016 - 07.2017
MRT Auditor
Department of Veteran Affairs
01.2015 - 12.2015
Professional Remote Coder (temporary)
Himagine Solutions, Inc.
10.2014 - 02.2015
Clinical Coder (temporary)
Resolution consulting
10.2013 - 12.2013
APG Manager, Coding and Reimbursement
North Shore Long Island Jewish
08.2010 - 10.2012
Compliance Reimbursement Coordinator/Lead Auditor
North Shore Long Island Jewish
08.2010 - 10.2012
Billing Manager
Maspeth Roura Medical PC
08.2008 - 01.2010
Customer Support
ICS Software Ltd.
11.2007 - 07.2008
Billing Specialist
New York Downtown Hospital
02.2005 - 04.2007
Claims Representative
Comprehensive Care Mgmt
04.2000 - 12.2004
Senior Accounting Clerk
Montefiore Medical Center
08.1998 - 03.2000
Hospital Corpsman-Third Officer Petty Class
Naval Med Center San Diego
04.1994 - 03.1998
Master of Business Administration - Major
University of Phoenix Online
Certified Professional Coder - Inpatient Billing/Ambulatory Surgery
The Roxbury Institute
Bachelor of Business Administration - Major Management
Berkley College