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Medical Corporate Compliance Professional

Accomplished w Client Centered w Detail Driven w Leader w Mentor w Innovative w Highly Effective

      Extensive and progressively responsible experience as a manager in regulatory and medical billing and coding environments

      Excellent communicator with demonstrated ability to collaborate with staff, management, business partners and others at all organizational levels

      Outstanding blend of organization, prioritization, leadership and interpersonal skills

      Proven ability to lead and supervise team members, manage a wide range of duties simultaneously and coordinate multi-level directives within medical billing and compliance management roles

      Mentor and lead teams by example and with integrity to deliver services excellence

      Consistent success is rooted within the concept of quality, continuous improvement and effective process enhancements

Key Strengths

Selected Key Achievement

         Received Q1 2017 All for One Excellence Award for discovering and identifying a coding issue that reduced held billing $3M.

McKesson, Medical-Surgical, Richmond, VA, 12/2003 present

Project Manager, McKesson Patient Care Solutions, (beginning date present)

         Proficiently represent the Compliance Department and Chief Compliance Officer as an integral member of the project team transitioning the business from its propriety order intake/ revenue cycle management system to Brightree cloud-based business management software.

         Efficiently document, communicate and escalate when necessary any identified risk arising from platform transition. Collaborate with various departments to leverage Brightree strengths, improve workflow, and create efficient processes to mitigate identified financial and compliance risks.

         Provide Medicare/Medicaid/Tricare regulatory, documentation, billing, coding and reimbursement/denial guidance, and oversight. Recommend additional system enhancements and SOPs to ensure regulatory compliance as well as adherence to best practices.

Manager, Corporate Compliance, (beginning date ending date)

         Received quarterly award for discovering and identifying designated fields within clinical wound tab effectively reducing held billing $3M. (Q1 2017 All for One Excellence Award)

         Defined and developed tools enabling McKesson Patient Care Solutions (MPCS) employees to ask better questions of referral sources and patients to translate to proper coding before the fact, resulting in enhanced and ongoing improvement in patient intake processes and claims for coding purposes.

         Closely monitored daily reports, analyzed and provided guidance and solutions to business leaders.

         Regularly conducted quality assurance and functional training for certified professional coding staff.

         Assessed internal staff qualifications; identified an internal coder certified for an unusual need; retrieved that function from an outsourced provided to bring that function back in-house.

Continued

Natalie M. Coniglio, Page 2 of 2

Professional Experience, continued

Manager, Corporate Compliance, Medimart National, (beginning date ending date)

         Proficiently educated and provided guidance to business leaders and employees in matters including ethics, compliance, Federal Health Care Program requirements, State and Federal False Claims Acts, Anti-kickback Statutes, Medicare Accreditation Standards and other regulations and requirements.

         Effectively researched Medicare, Medicaid and Commercial Insurance coverage criteria including medical documentation and billing requirements for an array of category classifications.

         Continually reviewed legislative, regulatory and contractual changes and requirements for business use.

         Provided guidance and recommendations resulting in successful implementation of ICD-10-CM with minimal disruption to the business or its revenue flow.

         Monitored reimbursement practices and programs to ensure compliance with laws and regulations.

         Researched and resolved complex coding or billing issues, enhancing payments and preventing lost revenues.

Manager, Corporate Compliance, Sterling Medical Services, LLC, (beginning date ending date)

         Efficiently monitored Sterling s adherence to Corporate Compliance Program, Code of Conduct and Medicare Accreditation Quality Standards. Conducted employee Compliance and HIPAA Training.

         Provided sound consultative advice in matters concerning applicable federal statutes.

         Successfully prepared and led Sterling and its Massachusetts office through several successful Medicare, Medicaid and CHAP inspections and accreditations.

         Effectively researcher Medicare and Medicaid policy updates, changes and billing requirements; disseminated the information to those with the need to know.

         Credentialed and enrolled Sterling in Medicare and several Medicaid programs.

         Conducted compliance investigations, determined appropriate action, developed response plans.

         Coordinated and conducted internal and external audits in all types of functional issues, reported findings.

         Monitored the company s responses to product recall notices and communication to affected customers.

Director, Commercial Insurance and Government Programs, (beginning date ending date)

         Led several departments, 4 managers and 60 staff members focusing on call center, insurance verification, authorization and medical documentation.

         Developed and executed workflow efficiencies, resulting in greater productivity, decreased operational costs and increased profitability.

         Created and implemented an internship program. Supported staff and consistently enhanced retention goals.

         Served on the Corporate Compliance Committee focused on reviewing Federal and State regulations.

Director, Verifications, (beginning date ending date)

         Efficiently managed 2 supervisors and 20 staff members in managing the daily operations of Verifications.

         Interviewed, hired, trained and evaluated all employees, developed professional development plans.

         Developed and implemented LEAN Project Plan to create a paperless call center process.

Manager, Third Party Compliance, (beginning date ending date)

         Closely reviewed all new insurance contracts. Obtained all reimbursement, documentation requirements.

         Monitored and secured Medicare, Medicaid and Commercial Insurance fee schedules; ensured accuracy.

         Researched and resolved contractual issues; monitored and communicated Medicare, Medicaid, Commercial Insurance, coding, billing, documentation and reimbursement updates.

Earlier Professional Experience

         Medical Coding and Billing Instructor- Evening Continuing Education Division, Mercer County Community College, West Windsor NJ

         Assistant Billing Manager/Medical Coding Instructor, Capital Imaging Associates, Mercerville, NJ

         Senior Compliance Auditor National, Site Operations Director, Team Manager, Per-Se Technologies, Alpharetta, GA

Bachelor of Science in Business Administration, Georgian Court University, Lakewood, NJ

         Minor in Marketing

Certified Professional Coder, 2000, ICD-10-CM Proficient AAPC, Salt Lake City, UT