“The executives of Pinnacle make up an exceptional team. Their collective knowledge base and broad expertise is impressive. Every issue was addressed quickly, concisely and accurately. I’m looking forward to our continued work together.” – Pinnacle Healthcare Consulting Client
Kelly Loya, CPhT, CPC-I, CHC, CRMA - Managing Director
Kelly joined Pinnacle Enterprise Risk Consulting Services as a managing director in 2016, bringing 25 years of administrative, operational and clinical experience in the health care field. With over 12 years serving in a consulting role, Kelly has leveraged her past experience in coding/billing, pharmacy, first responder and nursing studies to provide a solid foundation on which to tackle complex issues for clients. Kelly assists clients in identifying strategic solutions by targeting: project parameters to identify risk, opportunities for improved compliance with government payor requirements and operational efficiencies. She performs quality assurance and audit functions for a wide range of providers. Her diverse skills are often utilized in comprehensive assessment projects involving pharmacy billing and operations, durable medical equipment, ambulance services, physician (professional fee) and hospital outpatient charging concepts. Utilizing data analysis and industry intuition, Kelly often provides multilayer data analysis for highly complex reviews with unique characteristics. Kelly is a Certified Pharmacy Technician (PTCB), Professional Coding Instructor (AAPC), Certified in Healthcare Compliance (HCCA) and Certified in Risk Management Assurance (IIA). Kelly has contributed to articles and spoken for several national organizations as well as contributed to a joint venture text from AHLA and AAPC.
Kelly Nueske, CIA, CMA, CPA, RN/ CHC - Executive Consultant
Kelly Nueske joins Pinnacle as an Executive Consultant of Pinnacle Enterprise Risk Consulting Services, bringing expertise in internal audit, compliance program development, implementation and assessments, billing compliance, investigation/defense support and risk mitigation services. Kelly has over 25 years of healthcare operations experience and has served in various management, compliance and internal audit roles. She is knowledgeable in revenue cycle processes, billing and reimbursement for hospitals, physicians, reference laboratories, retail pharmacy, hospice, homecare, skilled nursing facilities and ambulance.
While working at an integrated health system, Kelly was as a registered nurse specializing in cardiology and neurology and also held positions as quality management specialist, utilization management specialist, internal audit director, patient financial services director, and system implementation director. As internal audit director and managing director in a national consulting firm, she was responsible for operational, financial, integrated and billing compliance audits for hospitals, clinics, homecare, hospice, durable medical equipment, ambulance, skilled nursing facilities and reference laboratory services.
Kelly’s strong ability to anticipate risk and regulatory issues was critical in developing successful mitigation strategies for a $300 million electronic medical record (EMR) implementation. She served as the compliance director overseeing the EMR implementation while the organization was under a corporate integrity agreement as well as chargemaster director during the design and implementation of a single chargemaster and consolidated fee schedules.
Kelly has proven success in designing and implementing strategic initiatives focused on improving operational efficiency, maximizing revenue, and reducing cost. She is skilled in process improvement, leading cross functional teams, managing systems, facilitating change, and has extensive experience identifying strategic opportunities, developing plans and implementing improvements in a short time frame.
Professional Designations and Affiliations:
- Certified Public Accountant
- Certified Internal Auditor
- Certified Management Accountant
- Certified in Healthcare Compliance
- Registered Nurse
- MBA, Finance, University of St. Thomas, Minneapolis
- BS, Accounting, University of Wisconsin – River Falls
- Associate Degree in Nursing, Inver Hills Community College
Jodi Nayoski, CPC, CCS-P, CPC-I, CHC, CDIP - Managing Consultant
Jodi joins Pinnacle as a Managing Consultant of Pinnacle Enterprise Risk Consulting Services (“PERCS”), bringing over 18 years of experience working with various provider types in the healthcare industry. She is a certified coding instructor and an experienced compliance auditor with a background in teaching physician facilities. Jodi’s expertise includes implementing large scale compliance plans for physician groups, physician education, compliance auditing, and developing training curriculum. Jodi’s coding expertise includes: primary care, urgent care, pediatrics, evaluation and management across all specialties, ICD-9-CM and ICD-10-CM coding.
Prior to joining PERCS, Jodi was a manager of ICD-10-CM education, coding, billing and documentation for physicians and professional coding for Altegra Health clients and staff. In her role as manager of ICD-10 education and physician education, she managed internal and external ICD-10-CM education implementation, by both developing the curriculum and performing the training. She also managed and performed all provider education, including post audit results, group trainings and health plan risk adjustment. As the manager of professional coding, she was responsible for overseeing multiple client audits. This included performing comprehensive professional coding audits for provider groups, academic medical centers and health plans. She analyzed documentation for correct usage of CPT and ICD-10-CM codes, and confirmed compliance with applicable local and federal regulations. Jodi additionally provides clients assistance with evaluating reimbursement and denial patterns.
Jodi has held the position of Senior Coding Analyst at Blue Cross Blue Shield of Illinois. In this position, Jodi managed project implementation of edit disclosure software and composed over 1,800 guidelines for appeal units to handle individual ClaimCheck edit inquiries. In addition to this, she was responsible for reviewing medical records for appeals denied due to edit system and medical necessity, then ruled whether the denial was upheld or overturned. She was the main resource for answering all coding inquiries from medical directors and staff.
In her history as an educator, Jodi has instructed students in most specialties of medical coding using her personally developed educational materials used with Professional Medical Coding Curriculum (PMCC). She has also developed and delivered many training programs and seminars for local and national healthcare organizations such as the Healthcare Compliance Association (“HCCA”) and American Academy of Professional Coders (“AAPC”).
Professional Designations and Affiliations:
- ICD-10-CM Trainer, American Academy of Professional Coders and American Health Information Management Association
- Certified in Healthcare Compliance, Health Care Compliance Association
- Certified Coding Specialist- Physician, American Health Information Management Association
- Certified Professional Coder and Instructor, American Academy of Professional Coders
- Bachelor of General Studies, University of Dayton, Dayton, Ohio
Sally Eagan, BS, RHIT, CCS, AHIMA, Approved ICD-10-CM / PCS Trainer - Managing Consultant
Sally joins Pinnacle as Managing Consultant of Pinnacle Enterprise Risk Consulting Services (PERCS), bringing over seventeen (17) years’ experience in coding, auditing, coding professional mentoring and management. Sally is responsible for assisting and leading PERCS inpatient and outpatient facility auditing, reimbursement projects, billing compliance, HIM operational assessments.
Sally has consulted for the healthcare industry since 2010. Prior to joining Pinnacle, she performed comprehensive coding reviews to assure correct, compliant coding practices for a variety of healthcare provider types including; acute hospitals, emergency rooms, outpatient facility, long-term acute care facilities and rehabilitation facilities. Sally has also performed documentation gap analysis assessments for ICD-10 coding during the recent Centers for Medicare and Medicaid implementation phase. Sally has performed one-on-one and group coding mentoring for clients during the implantation phase. She has assisted clients in reviewing accounts subject to scrutiny by the Recovery Audit Contractors (RAC) and other third party insurance reviewers and prepared responses and/or appeals to inquires when warranted.
Earlier in her career, Sally was the coding manager for the Facility Coding Services at Altegra Health. There she managed multiple clients and coders nationally. She has served as the Acting Compliance Officer for a veteran’s hospital, during which time she assisted in the completion of the annual compliance report and the completion of the narrative for the annual report. During her time at the VA, she participated in a VERA coding audit that resulted in the identification of a potential loss of one- million in revenue via the VERA funding model for the VA. She has also served as a DRG validator for the Florida QIO, where she performed DRG validation services for the state of Florida and California. Prior to starting her auditing career, Sally was one of a select number of coders responsible for coding of complex trauma and Medicare charts at a Level 1 Trauma/Teaching facility.
Professional Designations and Affiliations:
- Registered Health Information Management Technician (RHIT), American Health Information Management Association.
- Certified Coding Specialist (CCS), American Health Information Management Association.
- ICD-10-CM/PCS approved trainer, American Health Information Management Association.
- BS, Health Services Administration, DeVry University
- AS, Health Information Management, Broward Community College
Jeannie Kelly, RN, MHA, LHRM - Senior Consultant / Clinical Nurse Reviewer
A skilled and accomplished healthcare consultant with over 25 years of experience, Jeannie possesses extensive experience in healthcare provider quality of care and Medicare payment safeguard functions, including Medicare policies and procedures, coverage and subrogation as well as case management, risk management, reconsideration and appeals, fraud and abuse, compliance, and provider and beneficiary education. She worked at a Fiscal Intermediary as an Operations Manager, managing Part A and Part B programs. Jeannie has directed a variety of Medicare projects, including program integrity verification and validation projects, Medicare secondary payer, Medicare medical review (including medical necessity reviews), reconsideration and appeals, fraud and abuse, and DMERC (a.k.a. DMEPOS) program operations, as well as claims research and claims scripting for 1-800-MEDICARE.
While serving as a Quality Assurance Officer for a consulting firm, Jeannie oversaw QA initiatives for a variety of client projects related to Medicare and Risk Management. She served as Subject Matter Expert on federal and state quality requirements for inpatient hospitals, ambulatory surgery centers and other healthcare providers, and developed a variety of successful business opportunities with optimal returns. Jeannie is a Subject Matter Expert in CMS Two Midnight Rule and medical necessity determinations.
Professional Designations and Affiliations:
- Registered Nurse – Florida, Rhode Island and California
- Licensed Healthcare Risk Manager – Florida
- Notary Public – Florida
- MS, Healthcare Administration, Simmons College
- BA, Economics, University of Massachusetts
- AD, Nursing, Laboure College
Federally trained and certified to conduct surveys of the following entities:
- Ambulatory surgery centers
- Acute care hospitals
- Long term care facilities (SMQT)
- Home health agencies
- End stage renal disease
- Intermediate care facilities
Leah Fuller, CPC - Associate Consultant
Leah joined Pinnacle Enterprise Risk Consulting Services, LLC as an Associate Consultant in 2016. Leah brings to the PERCS team, a meticulous attention to detail, intuitive reasoning and a unique perspective to projects. She is responsible for coding medical record documentation for professional-fee services to verify the accurate application of CPT, ICD-9-CM/ICD-10-CM and HCPCS codes. In addition to her coding knowledge, Leah has performed or assisted in reviews involving the reimbursement analysis for paid services. Prior to her coding career, she worked as an Administrative Assistant. In this role, she was responsible for technical structure, format involving coding, audit and consulting project result work papers, executive summary reports and other deliverables for a large healthcare consulting firm serving healthcare and law firm clients. This experience has provided her the opportunity to gain valuable insight for projects with highly complex issues and solutions.
Leah is a Certified Professional Coder with the American Academy of Professional Coders (“AAPC”). She serves in a production coding role however, can assist with highly complex investigational audits. Her ability to perform extensive research allows her and the team to be well informed regarding regulatory and commercial contract guidelines for coding and billing compliance.
Valerie Ivy Fitzgerald - Associate Consultant Administrator
Valerie joined Pinnacle Enterprise Risk Consulting Services (“PERCS”) in 2016 as an Associate Consultant Administrator. Valerie brings over 20 years’ experience in operational excellence to the organization. Her experience includes executive administrative support with revenue cycle, valuation, compliance, reimbursement / advisory, coding and auditing services. Valerie’s broad understanding of the healthcare industry and its special regulatory requirements, along with her coding knowledge, provides a unique skill set which complements our team’s expertise. She is proficient with managing invoicing, accounts receivables and superior customer service, making her an invaluable member of our team.
Prior to joining PERCS, Valerie held the roles of office manager and executive assistant for both small and large consulting firms. In these roles, she administered human resources, payroll, IT, billing, and accounts receivables departments – managing processes, workflow and staff to ensure efficiency and accuracy. In addition, Valerie directed large administrative projects including new employee training, development of policies and procedures; office relocations, implementation of new billing systems and website design and upkeep.
Sharon Blackwood, MT (ASCP), MBA, CHC, CHPC – Chief Compliance Officer
Sharon is a former Chief Compliance Officer and currently a national consultant. She has a clinical background and over 13 year of compliance and privacy experience with concentrations in Corporate Integrity Agreement (CIA) remediation, IRO services for focus arrangements, audit, and revenue cycle. Sharon has experience with national, publicly–traded systems and non-profit, multi-facility organizations. Sharon currently serves in interim Compliance and Privacy positions, develops Compliance and Privacy Programs, performs Program assessments, provides Board, physician and workforce training, risk assessments, and lead audit functions. She has experience in due diligence, acquisitions & mergers, litigation support and working with government entities.