Summary
Overview
Work History
Education
Skills
Timeline
Generic

Nicole Hughes

Copperas Cove,TX

Summary

Skilled in client relationship management, problem-solving, and strategic planning. Known for collaborative teamwork and delivering results in dynamic environments. Proven ability to adapt to changing needs and ensure project success.

Overview

26
26
years of professional experience

Work History

Implementation Consultant

R1RCM
01.2022 - Current
  • Lead implementations of R1 Entri products including Schedule Maximizer, Order Facilitator, Looker, Auth Create/Acquire, and Appointment Reminders (voice, text, email).
  • Manage database builds and testing to ensure successful go-lives.
  • Facilitate client workflow discussions, recommend solutions, and conduct product training.
  • Collaborate cross-functionally with operations, client delivery, and external teams.
  • Mentor new hires and provide supplemental training on internal tools.
  • Travel as needed for go-lives and project milestones.

EMPI Data Integrity Specialist

R1RCM
01.2018 - 01.2022
  • Identify, research and correct data integrity issues within the Master Patient Index (MPI).
  • Communicate MPI data integrity issues to all impacted ancillary departments.
  • Analyze medical records for legal health record deficiency.
  • Audit accuracy of electronic and manual entry and resolve any discrepancies of data.
  • Serve as a liaison to physicians and other medical support staff to facilitate accurate health information.
  • Audit electronic health records for accuracy and deficiency.
  • Obtain and submit birth registration information to the state for newborns following state guidelines.

Patient Access Representative

R1RCM
11.2013 - 01.2018
  • Greet patients and visitors, respond to questions/concerns and directs them to appropriate locations.
  • Provides on-going communication with clinical staff regarding patient status.
  • Register patients, collect and enters all necessary demographic, clinical, billing and insurance information from patients or responsible parties.
  • Explains processes and forms to patients prior to securing signatures and ensures that all documents are properly signed and witnessed as required.
  • Performs scanning functions on documents while maintaining integrity of batch assembly and monitoring images for completeness and legibility.
  • Reconcile patient charts, ensuring accuracy and entirety.
  • Determines payment due using appropriate diagnosis codes and IDC-10 codes.
  • Collects payments; including co-pays and deductibles.
  • Ensures medical necessity compliance by obtaining necessary data, reviewing compliance system, communicating information to patient or guarantor and obtaining necessary signatures.
  • Protects financial integrity of the facility by collecting patient liability, establishing payment arrangements, discussing payment options and screening for eligibility.
  • Verifies insurance eligibility and benefits and ensures all notifications and authorizations are completed within the required timeframes.

Owner

Razor Sharp Cleaning
10.2012 - 08.2018
  • Create and maintain a clean environment for customers.
  • Responsible for customer liaison, invoicing, accounts receivable
  • Lay out routes for optimal efficiency
  • Negotiate rates for fair customer pricing while balancing needs of business
  • Create end of month customer invoices.
  • Maintain supply inventory.

Return Authorization Coordinator

Sears Teleserv
06.1999 - 10.2012
  • Process and issue employee paychecks and statements of earnings and deductions
  • Review employee time sheets, work charts, wage computation, and other information in order to detect and reconcile payroll discrepancies.
  • Verify attendance, hours worked, and pay adjustments, and post information onto designated records.
  • Assist with new hire interviews.
  • Issue and record adjustments to pay related to previous errors or retroactive increases.
  • Design and implement new policies and procedures to ensure that quality standards are met.
  • Perform quality monitors on recorded calls from the parts rep.
  • Give feedback/training when needed.
  • Review replacement requests for un-repairable customer products.
  • Submit approved replacement requests to the original equipment manufacturer.
  • Work closely the customer’s local store to have replacement products delivered.
  • Instruct stores on how to return un-repairable products to the manufacturer for credit.
  • Responsible for tracking and analyzing monthly and year total of money the RA process saved Sears utilizing excel spreadsheets and charts.
  • Answer inbound calls from service technicians in the customer homes.
  • Locate part number, information, pricing and stocking information for the technician using a variety of tools web sites, micro-fiche cards, manufacturer service manuals and Sears information databases.

Education

Associate of Arts - General Studies

Central Texas Community College
Killeen, TX
12.2018

Skills

  • Registered Customer Service Specialist with ETA-I professional certification
  • Over 20 years of customer service
  • Call center, medical and healthcare experience
  • Productive in a high volume, high stress environment
  • Proficient in the use of Microsoft applications
  • Great communication, organization skills, leadership and teamwork
  • Demonstrated ability to meet deadlines
  • Experienced with ICD-10 codes

Timeline

Implementation Consultant

R1RCM
01.2022 - Current

EMPI Data Integrity Specialist

R1RCM
01.2018 - 01.2022

Patient Access Representative

R1RCM
11.2013 - 01.2018

Owner

Razor Sharp Cleaning
10.2012 - 08.2018

Return Authorization Coordinator

Sears Teleserv
06.1999 - 10.2012

Associate of Arts - General Studies

Central Texas Community College

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