Kelly Loya


Associate Partner


Charlotte, NC


Kelly is an Associate Partner and joined Pinnacle Enterprise Risk Consulting Services 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 textbook from AHLA and AAPC.


  • Billing Utilization Data Analysis for Focused Investigations, 38th AHIA Annual Conference, September 15-18, 2019
  • Drip Drop - Infusion Auditing Made Simple, HCCA's 23rd Annual Compliance Institute, April 9, 2019
  • The Great Internal Audit and Compliance Mystery, Presented with Kristen Taylor of Pinnacle Enterprise Risk Consulting, SCCE 17th Annual & Ethics Institute, October 21, 2018
  • National Scrutiny Surrounding Urine Drug Screening & Testing (Track C3), Presented with Leah Fuller of Pinnacle Enterprise Risk Consulting Services, Association of Healthcare Internal Auditors (AHIA), August 26, 2018
  • More than 25 years of healthcare experience including operational, administrative and clinical
  • Tackles complex issues including coding/billing, first responder, pharmacy, and nursing
  • Identifies/mitigates risk, improves compliance adherence, and drives operational efficiencies
  • Leveraging expertise and industry intuition, she provides multilayer data analysis for complex reviews