ad146c@r.postjobfree.com 404-***-****

Nigel Rhone *** Serenity Point, Lawrenceville, GA 30046

PROFESSIONAL SUMMARY:

Confident, results driven leader, financial consultant, and organizational developer specializing in areas that provides exceptional customer service, written communication, interpersonal skills, teamwork and leadership, and planning and evaluation. Extensive experience with a variety of healthcare computer applications and EMR systems.

EDUCATION:

Master of Public Administration

Columbus State University

May 2007

Bachelor of Science

Albany State University

May 2005

CORE COMPETENCIES:

Revenue Cycle/Denial Management: Review, utilize and manage the basic tools required for making financial decisions based off payer denials. Measure and compare risks across financial opportunities.

EPIC Super-User/Trainer: Worked with EPIC Builders and Consultants during Go-Lives and Upgrades. Provided Shoulder to Shoulder and in-class training to Inpatient and outpatient department representatives.

Process/Workflow Improvement: Experienced at spotting process and workflow flaws and providing recommendations and solutions for improvement.

PROFESSIONAL EXPERIENCE

Assistant Director May 2023 – Present

Natera

Revenue Cycle/Prior Authorization

Atlanta, GA

Oversee the Revenue Cycle and PA department. Vendor management

Responsible for Vendor management, department audits and strategic management

Managing a team of 27- Team consisting of revenue cycle analyst and PA analyst.

High focus on Genetic lab testing PA denials

Organized Vendor continuous audits

Updated SOP’s, Job aids for in house PA submissions

Cross functioned with other departments for weekly executive read outs.

Managed daily PA cancelled cases by vendors.

Manage daily denied cases by vendors.

Manage and updates status and reason as needed.

Built department morale.

Increased revenue by updating workflows and reorganizing personnel.

System used. Glidian portal, LIMs, Authlink portal and Careviso portal

Updated billing and PA configurations

Enforce quality from vendors and not just production numbers.

Senior Account Manager, Revenue Operations January 2017 – May 2023

McKesson Corporation

U.S. Oncology

Atlanta, GA

Manage and oversee multiple oncology clinics in different regions of the United States. Remote position with travel.

Responsible for monitoring, analyzing, and processing clinic revenue (over $300M) and ensuring revenue operations are adhered to by clinic staff.

Evaluate financial reporting systems, accounting or collection procedures and make recommendations for changes to procedures, operating systems, budgets, or other financial control functions.

Utilize analytical tools to address issues such as claim construction or optimization, performance measurement, attribution, profit and loss measurement, or pricing models.

Performs a monthly denial review of 80% of gross denied charges for the practices I support.

Investigate over $30M worth of insurance claims and report findings to Vice President of Revenue Cycle Operations.

Increase denial success/recovery rate from 67% to 87% within five years.

Oversee completion of end of cancer treatment audits by all practices in my assigned region.

Monitors, tracks, and reports key metrics.

Monitors practice revenue adjustments and bad debt write-offs

Monitors practice charge lag and days to file percentages.

Performs front end revenue cycle workflow analysis.

Manage and monitor Denials, KPI’s, GCR, Payer Mix, Aging, and daily Charges & Cash.

Provide a high level of customer service.

System used: GE Centricity Practice, G4

Radiation and Medical Oncology

Manager

Vantage Oncology June 2015 – December 2016

Billing/Collections & IVU

Atlanta, GA

Responsible for managing, directing, and orchestrating the activities of direct billing/follow up operations as well as our Insurance Verification Unit. 18 direct reports.

Developed, recruited, and retained operational talent required to deliver excellent and consistent AR resolution and reporting to our joint ventures.

Successful at identifying trends and patterns in all clients AR.

Worked closely with VP to develop and track key processes to eliminate waste and increase revenue.

Monitored charge posting, billing and collection operations for compliance with established policies, regulations, procedures, and standards.

Responsible for running month-end reports as well as reports on billing and collection activities.

Managed actions relating to delinquent accounts, collection agencies, special adjustments, and write-offs.

Enforced compliance with HIPAA Privacy laws and regulations.

Ran and monitored AR reports for high balanced, aged accounts.

Responsible for running denial reports to focus on top denials and trends.

Responsible for maintaining a good rapport with Joint ventures, clinics, and clinical staff members.

Alerted staff of any changes or updates as well as holding weekly meetings.

Worked closely with S&I team and credentialing.

Monitored EFT system daily.

Enforced organization and thorough follow-up skills.

Advocate of cross-training.

Systems used: Navicure, Relay Health, NextGen, GE Centricity, G4, payer sites, Availity, PaySpan, Aria.

Patient Financial Services Supervisor

Emory Healthcare November 2013 – June 2015

Atlanta, GA

Managed from 20-75 team members while developing team performance including performance evaluation, training, and coaching.

Responsible for the daily management and supervision in the Patient Financial Services Department/Physician billing including claims, follow-up, denial management, patient access, self-pay collections, customer service and cash posting.

Collaborated with other team members to improve departmental targets and patient services.

Partnered with leadership to develop policies and procedures to support the department and the provision of quality patient account management.

Trained staff on understanding and proper reading of EOB's.

Ensure department exceeded monthly collection goal of $750,000 each month.

Gained experience with UB-04 and HCFA 1500 claim billing and follow-up functions both electronic and manual.

Use KRONOS system to manage staff time and for payroll purposes.

Completed annual Performance Reviews.

Performed monthly one-on-one meetings with staff for individual development and growth.

Monitored on-line payments and checks by phone.

Enrolled qualified patients into the Charity Care program, following all write-off guidelines.

Performed in-services on contractual adjustments, allowed amounts and patient responsibility.

Exhibited knowledge of CPT, ICD-9 coding, revenue codes and terminology for hospital billing.

Utilized technology systems, such as GPR, IDX and GE centricity.

Assisted in dialer testing and implementation (AVAYA).

Financial Counseling Supervisor October 2010 – November 2013

Dekalb Community Service Board

Atlanta, GA

Generated daily fund source report to locate private-pay clients.

Responsible for training new employees on workflow and procedures.

Schedule appointments to meet with private pay clients to discuss potential benefit options (Food Stamps, Medicaid, Social Security).

Supervised 10 direct reports.

Ensured benefits unit produced over $250k per month.

Reviewed over 200 Medicaid applications per month.

Provided clients with tangible documents pertaining to homeless services, help with rent and utilities, general clothing, food pantries, transitional housing/shelter.

Assisted clients with benefit applications, obtaining vital records and documents needed for applications.

25% weekly travel to multiple facilities to meet with clients and/or representative payees.

Aided eligible clients secure Medicaid, SSI, SSDI, and food stamps.

Continued education on all state and federal funded programs. S.O.A.R training completed – 03/29/2012 in Savannah, GA. Certificate received.

Maintained organized filling system to secure client files and documentation.

Lead Access Coordinator/ EPIC End-User Trainer July 2008 – Present

Children’s Health Care of Atlanta

Atlanta, GA

Assisted Builders and EPIC Consultants in our 2008 Epic Launch and Go-Live

Assisted in our 2010 Epic Upgrade.

Trained new employees on workflow and EPIC.

Executed insurance verification of benefits and encounter authorization.

Performed check-in and arrive out-patient appointments (MRI, Ultrasounds).

Produced daily Admissions and PCP reports.

Analyzed, reconciled, and balanced charges $200k+ for the department.

Participated in 3 EPIC hospital implementations.

PAS Registration EPIC(ADT/PRELUDE) Super-User

Provided shoulder to shoulder and in-class ADT and Radiant End–User Training.

Credentialed Epic ADT –Prelude and Radiant Trainer.

Completed the Daily 12 Hour Admissions Report.

Completed quality assurance on emergency room registrations and hospital admissions.

Attended weekly EPIC meetings with management.

Organized training sessions for end-users.

TRAININGS:

Certified Financial Counselor, 2012

SSI/SSDI Outreach, Access and Recovery (S.O.A.R) Certification, 2012

EPIC Credential Trainer, 2008

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