Nina Terése Palucci
Venice,United States
Summary
I thrive in navigating the complexities of projects, conquering challenges with a blend of precision and creativity. Beyond the day-to-day, my commitment is unwavering—I'm steadfast in embodying company values with a strong work ethic and relentless drive. Equipped with strong research and problem-solving skills, I adeptly juggle multiple tasks, using resourcefulness and critical thinking to deliver exceptional results. As an organized and dependable collaborator, I bring a positive attitude, always ready to embrace additional responsibilities for the success of the team.
Overview
20
20
years of professional experience
Work History
Membership L&D Enrollment and Billing Specialist
Elevance Health
05.2023 - Current
- Efficiently addresses diverse enrollment inquiries, managing verification, record modifications, and system rejection resolutions
- Administers premium billing, conducts audits, and communicates effectively with clients for prompt issue resolution, expertly documenting outcomes for accurate tracking and analysis
- Screening and processing forms from Sales and Underwriting for new and re-classified groups, I leverage my deep understanding of benefits to identify our groups and member needs in our system
- This enables me to make informed decisions in approving or denying benefits for the Underwriting team, collaborating with relevant parties to address any missing information
- Currently contributing to the seamless transfer of group benefits data from our source database to the target database during our division's transition to a new company, ensuring data integrity and security
- Skilled and resourceful in navigating such programs as Salesforce and Compass Medical and Billing.
HEDIS Healthcare Program Representative II
Elevance Health
02.2023 - 05.2023
- Data collection and analysis lie at the heart of quality improvement in healthcare
- I coordinate and execute all aspects of the HEDIS (Healthcare Effectiveness Data and Information Set) program, including data collection, analysis, and reporting
- Communicates directly with various health care providers, to measure and help improve quality by requesting medical record requests, helping providers coordinate the exchange of secure files in a seemless and timely manner
- Responsible for assisting data abstractors by utilizing research within the company's claims and medical record systems and locating where and when members received care
- Skilled and resourceful in navigating such programs as Member360, Cotiviti and Reveleer.
Insurance Verification Coordinator
Unified Women's Healthcare
02.2019 - 10.2022
- Nina Terése Palucci - page 1
- Verified medical insurance for our OB/GYN and Urogynecology offices across multiple locations
- Investigated, cross-checked, and updated medical benefits for providers and patients
- Proficient in medical ICD-10 and CPT codes for investigating, extracting and updating patient benefits
- Competently utilized Athena Medical Records and various medical insurance verification portals
- Extensive knowledge of PPO, POS, HMO, Medicaid, Medicare Advantage, and Supplemental Medicare plans.
Lead Insurance Verification Specialist
Holistic Recovery Centers
03.2018 - 01.2019
- Supervised the insurance verification and authorization/referral team to ensure accurate and timely performance of their duties
- First point of contact for daily inquiries, guidance, and training on insurance verification, authorizations, and referrals
- Acted as a subject matter expert on insurance plan participation, plan selection in billing systems, authorization/referral requirements, and plan benefits
- Ensured team members followed proper documentation and notation procedures, adhering to tasking requirements
- Assessed, piloted, and implemented technology to enhance verification and authorization processes, optimizing workflow efficiency
- Maintained insurance resources and offered guidance on insurance Masterfile upkeep when needed.
Insurance Verification Specialist
Sprout Health Group
06.2016 - 03.2018
- Provided professional and timely substance abuse and mental health insurance verification for Detox
- Residential, Partial Hospitalization, and Intensive Outpatient levels of care across 5 different facilities
- Properly analyzed various payer eligibility responses to efficiently complete verifications
- Skilled in accurately cross-referencing insurance verifications with Availity and similar health database portals
- Adept in navigating advanced electronic health record platforms, including KIPU
- Skills: KIPU
- Salesforce
- Microsoft Outlook
Office Manager
Jack The Bike Man Children, Bicycle
02.2014 - 03.2016
- Provided office and administrative assistance to Jack the Bike Man Charity
- Nina Terése Palucci - page 2
- Contributed to the organization's mission of distributing bikes to underprivileged children, the homeless, individuals re-entering society and people living below the poverty line
- Proficient in Microsoft Word, Excel, and QuickBooks to maintain donor data and track sales.
Visual Merchandiser
Housing Works
11.2011 - 03.2014
- I helped spread the mission of how Housing Works, engaging in an array of advocacy strategies to further our mission of ending the twin crises of AIDS and homelessness
- I strived for our visual merchandising team to have a high quality of excellence and innovation
- I helped direct and curate our events for Fashion for Action and Design on a Dime
- I effectively managed all visual merchandising for our Chelsea Housing Works Flagship location and directed all aspects of on-line auctions
- With love for fashion and art I curated a wide assortment of merchandise, inducing vintage couture fashion, high end antiques, fine jewelry
- To drive sales of our donations I photographed and arranged placement on our website
- I managed office administration as well as donations and membership solicitations.
Visitor Services Representative and Film Desk Specialist
The Museum of Modern Art
06.2007 - 07.2011
- With my knowledge, enthusiasm and passion for art and film, with excitement I welcome an exuberant amount of guests over the years
- In a friendly and professional manner, I effectively assisted visitors, resolved any questions and issues regarding the museum's permanent and special exhibitions
- I promoted a high level of membership enrollment in interactions with existing and potential members utilizing logistics to support phone, walk-in and web registration
- Professional and gracefully helped with many of the MoMA events and parties, which included high profile artists, historians, benefactors, researchers, and celebrities.
Visual Merchandiser
The Museum of Modern Art
01.2004 - 01.2007
- I used my artistic creativity to visual merchandise and helped with amazing presentations for the new opening and expansion of the MoMA's Design Store
- Created, maintained, and refreshed all visual merchandising including in-store displays as well as window presentations of merchandise including fine jewelry, tech, office, home design, and art books which in return helped with the financial prosperity of the Museum of Modern Art
- Nina Terése Palucci - page 3
- Designed a data catalogue system for all paper products including all fine are prints that helped sales specialist effortlessly restock and reorder products.
Education
Bachelor of Fine Arts - BFA - Painting And Art History
Purchase College
Purchase, NY05.2004
Skills
- Data Analysis
- Analytical Thinking
- HIPAA Compliance
- Electronic Health Records
- Insurance Verification
- Data Entry Proficiency
- Conflict Resolution
- Medical Coding Knowledge
- Audit Procedures
- Billing Systems and Software
- Records Organization and Review
- Customer Engagement
Timeline
Membership L&D Enrollment and Billing Specialist
Elevance Health
05.2023 - Current
HEDIS Healthcare Program Representative II
Elevance Health
02.2023 - 05.2023
Insurance Verification Coordinator
Unified Women's Healthcare
02.2019 - 10.2022
Lead Insurance Verification Specialist
Holistic Recovery Centers
03.2018 - 01.2019
Insurance Verification Specialist
Sprout Health Group
06.2016 - 03.2018
Office Manager
Jack The Bike Man Children, Bicycle
02.2014 - 03.2016
Visual Merchandiser
Housing Works
11.2011 - 03.2014
Visitor Services Representative and Film Desk Specialist
The Museum of Modern Art
06.2007 - 07.2011
Visual Merchandiser
The Museum of Modern Art
01.2004 - 01.2007
Bachelor of Fine Arts - BFA - Painting And Art History
Purchase College
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