Michelle Nichols

• Supervise program staff, managing and evaluating performance to provide high-quality services to program participants.
• Develop and implement program goals and objectives, establishing specific and measurable outcomes aligned with the organization's overall mission.
• Schedule and supervise staff meetings to discuss new ideas and update participants on program details and milestones.
• Monitor program performance to identify areas for improvement.
• Establish program policies and procedures to comply with regulatory requirements.
• Maintain and update project-related documents.
• Organize and update databases, records, and other information resources.
• Identify opportunities to streamline processes and improve office operations and efficiency.
• Create reports, presentations, and other materials for executive staff.
• Build and manage processes for tracking and monitoring department performance.
• Supervise staff by providing training opportunities, scheduling work assignments, evaluating the performance of incumbents, and reviewing and approving administrative actions.
• Facilitate Data Team data-pulls and algorithms so that appropriate projects are happening consistently. Research, prepare, and submit data provided through desk and onsite provider reviews to the Agency Director, medical providers, and other state entities to determine fraud, waste, and abuse of Medicaid programs.
• Consult weekly with Optum contractors via meetings and training to stay abreast of changes impacting Medicaid and other health service programs and proposed data projects.
• Maintain electronic files of terminated, sanctioned, and excluded medical providers from the Arkansas State Medical Board and Centers for Medicare and Medicaid (CMS) authorities.
• Facilitate the annual Centers for Medicare/Medicaid Services (CMS) Review.
• Provide technical assistance for provider suspension, debarment, exclusion, and enrollment processes, review and analyze special projects, and oversee new program implementation recommendations.
• Administrative Actions: compose and facilitate exclusion and suspension letters of Medicaid providers. Maintain electronic files of terminated, sanctioned, and excluded medical providers from the Arkansas State Medical Board and Centers for Medicare and Medicaid (CMS) authorities.
• Respond to various inquiries regarding Medicaid programs, denied claims, provider billing, and procedure code reimbursement guidelines and regulations.
• Work with agency administrators on the submission of state plan amendments and establishing and implementing short- and long-range program goals and objectives.
• Legislative Bill Tracking—actively monitors daily activities of the legislature during the session to identify bills that impact the Medicaid program or DIG.
• Knowledge of state and federal personnel policies, practices, and procedures including state and federal Medicaid fraud procedures.
• Facilitate the Outpatient Behavioral Health Service (OBHS) Reporting. EOMB Compliance Checkstracking trends monthly to identify mistakes/fraudulent billing.
• Facilitate the annual AR Annual False Claims Certification. This legislation includes a policy on whistle-blower protection and internal fraud reporting procedures in addition to financial attestation.
• Manage and Facilitate Agency Recoupment and Provider Awareness Letter Initiatives. Communicate Agency policy standards/statutes to Medicaid providers, including guidance on the proper use of billing codes and best practice modifications in general.
• Conduct Desk Reviews of identified Medicaid providers for purposes of recoupment and mass adjustment Knowledge of medical reimbursement codes and terminology.
• Compile and submit required data to DHS for Mass Adjustment processing of recoupment claims.
• Writes various monthly, quarterly, and annual reports, explaining findings of research for audits and various projects.

• Conduct desk reviews (focused audits) of Medicaid providers to determine fraud or to process an appeal.
• Manage and facilitate agency letter initiatives and recoupment.
• Evaluate Reconsideration Requests/Appeals to determine an outcome and deliver a decision.
• Communicate legal statutes to Medicaid providers to establish the basis for an audit.
• Administrative Actions: compose and facilitate exclusion and suspension letters of Medicaid providers.
• Interpret audit data and billing code usage to Medicaid providers to influence best practices.
• Compile and submit required claims data to DHS for Mass Adjustment
• Analyze data gathered from internal data mining, official record requests, or referrals for audit projects and/or fraud investigations.
• Process Beneficiary Fraud Referrals: run reports on demographics, billing activity, eligibility status,

and algorithm participation.

• Audit LEIE checks: legal background checks of Medicaid providers to include suspensions, exclusions,

and adult and child maltreatment.

• Bill-tracking during the legislative session for potential legislation relevant to the DIG agencies.
• Facilitate the annual AR Certification of Compliance with the False Claims Act Initiative.
• Produce/Edit OMIG quarterly and annual reports.
• Develop presentations for training/education within the agency and for state and national conferences.
• Interview business owners to understand needs and explain audit scope.
• Identify control gaps in processes, procedures, and systems through in-depth research and assessment and suggested methods for improvement.
• Develop and implement corrective actions to bring business areas in line with standards.
• Prepare working papers, reports, and supporting documentation for audit findings.

• Developed the initial TAP pilot sites around the country, specifically Jonesboro and Fort Smith AR,

working with clusters of schools, districts, etc.

• Conducted cluster-group training for teachers and administrators.
• Supervised AR TAP network lead teachers and provided structured feedback.
• AR Program liaison for the University of Arkansas and respective school sites.
• Formal reporting of program data to Milken Foundation, Dean of Ed., and school district administrators
• Worked closely with management to provide effective assistance for specific aspects of business operations.
• Created and updated physical records and digital files to maintain current, accurate, and compliant documentation.
• Established team priorities, maintained schedules, and monitored performance.
• Evaluated employee performance and conveyed constructive feedback to improve skills.
• Assisted in organizing and overseeing assignments to drive operational excellence.
• Established performance goals for employees and provided feedback on methods for reaching those milestones.

• Maintained annual budgets and production of departmental financial reports.
• Executed the college budget and presented finance reports to department heads or college Deans as needed.
• Facilitated the college work-study program and directly supervised all participants.
• Wrote and edited presentations and speeches for the Dean and Associate Dean.
• Developed electronic filing procedure for college staff.
• Facilitated meetings and conferences with university Deans, financial donors, community leaders,

and lawmakers.

• Compliance reviews and hiring committee coordinator.
• Established electronic filing systems for financial and administrative audits.
• Organized College events, award ceremonies, receptions, and annual giving luncheons.
• Completed forms, reports, logs, and records to quickly handle all documentation for human resources.
• Created and maintained detailed administrative processes and procedures to drive efficiency and accuracy.
• Continually sought methods for improving daily operations, communications with clients, recordkeeping, and data entry for increased efficiency.
• Interacted with vendors, contractors, and professional services personnel to receive orders, direct activities, and communicate instructions.
• Volunteered to help with special projects of varying degrees of complexity.
• Supported company leaders by managing budgets, scheduling appointments, and organizing itineraries.
• Transcribed and organized information to assist in preparing speeches and presentations.