Nicole M. Provost
Southampton,MA
Summary
Dynamic Clinical Compliance Nurse Auditor with a proven track record in evaluating medical claims, ensuring adherence to healthcare regulations, and enhancing revenue cycle integrity. Expertise in conducting thorough assessments of medical necessity while maintaining high compliance standards and supporting interdisciplinary teams. Recognized for identifying billing discrepancies and collaborating effectively with healthcare professionals to implement corrective actions that drive operational efficiency.
Overview
2026
2026
years of professional experience
1
1
Certification
Work History
Clinical Compliance Nurse Auditor,
Baystate Medical Center
05.2022 - Current
- Utilized clinical expertise to conduct detailed reviews of patient records, treatment plans, and medical billing documentation, ensuring adherence to healthcare standards and regulatory requirements.
- Analyzed external audit findings and denial activity, preparing responses to support appeals, compliance, and reimbursement accuracy.
- Partnered with departments to perform root cause analyses, identify contributing factors, and support corrective actions.
- Conducted detailed reviews of claim submissions to identify discrepancies, enhance revenue integrity, and reduce reimbursement risk.
- Leveraged advanced clinical knowledge of diagnoses and treatment protocols to validate documentation accuracy and support hospital and ancillary charge integrity.
- Developed and implemented training materials and corrective action plans to standardize best practice in documentation and auditing procedures.
- Analyzed billing practices to identify discrepancies and recommend corrective actions.
- Collaborated with clinical staff to ensure accurate documentation and coding practices.
- Addressed and resolved complex billing discrepancies through close coordination with finance teams, ensuring precise and accurate representation of hospital services.
- Utilized electronic medical record systems to store, retrieve, and process patient data.
Cardiology Triage Nurse
Baystate Health
09.2021 - 05.2022
- Performs telephone triage, answering questions, screening and determining need for immediate care for Heart and Vascular patients.
- Obtains case history and gathered triage information to determine appropriate avenue for care.
- Relay triage information and facilitated communication between provider and patient concerning patient disposition.
- Maintains strong knowledge of medical terminology, diseases and conditions and procedures.
- Perform additional clinic and non-triage nurse duties such as starting IV's, instructing patients in general and specific medical care and health issues and administering or dispensing medication.
- Responsible for management and triage of admissions and discharges for 20-bed pre and post operative/ interventional heart and vascular unit.
- Communicate with Heart and Vascular OR, along with other various department to optimize throughput and efficiency
- Independently examines staffing
- Collaborates care with Anesthesia, Vascular surgeons, Cardiac surgeons and other interventional units to identify needs of patients and provide appropriate levels of triage care.
- Delegates and prioritizes appropriate levels of care and creates appropriate RN assignments to ensure patient safety.
- Obtained case history and gathered triage information to determine appropriate avenue for care.
- Performed additional clinic and non-triage nurse duties such as instructing patients in general and specific medical care and health issues and administering or dispensing medication and injections.
Heart and Vascular Nurse Navigator
Baystate Health
05.2019 - 09.2021
- Responsible to complete initial review and triage of patients charts. Uses clinical expertise for placement of new patients to Cardiology.
- Audits and assess medical records to determine healthcare plan for Cardiology patients
- Performed initial medical record review for appropriate inpatient follow up placement.
- Collaborates care with multidisciplinary team. Discusses patient cases with Electrophysiology, Heart Failure, General Cardiology and Adult Congenital clinic.
- Provides education and resource tools for over 27 staff members.
- Identifies process improvements in day-to-day functioning of department.
- Coordinates appropriate and efficient delivery of healthcare services to promote optimal outcomes by assessing and matching unmet needs with referrals and support services.
- Completes paperwork, recognizing discrepancies and promptly addressing for resolution.
R.N. Heart and Vascular CARE Unit/Triage Coordinator
Baystate Health
11.2011 - 05.2019
- Provides pre and post operative care for cardiac and vascular surgery patients (Aortic Aneurysm Repair, Carotid/ Femoral Endarterectomy, Amputations, peripheral interventions, TAVR and CABG)
- Provides care and support for diagnostic and interventional heart and vascular patients. (Cardiac Catheterization lab, interventional radiology, non invasive cardiology, and electrophysiology)
- Maintains critical thinking skills for optimal cardiovascular and peri-anesthesia nursing.
- Proficient in basic airway management for general anesthesia and monitored-anesthesia care patients.
- Cardiac rhythm interpretation and management.
- Highly proficient in starting and sustaining peripheral IV's.
- Monitors blood pressure via arterial lines.
- Responsible for hemodynamic monitoring and circulatory management, along with maintenance of critical care infusions.
- Proficient in sheath maintenance and removal.
- Responsible for groin management and stability.
- Educator for new employees.
- Responsible for telephone triage for patients having up coming surgery, Along with phone interviews for patients receiving anesthesia.
- Responsible for patient call backs in regards to ASPAN standards.
- Conducted continuous cardiac monitoring on patients stepping down from ICU care.
- Completed daily assessments and documented information in electronic medical records.
- Responsible for management and triage of admissions and discharges for 20-bed pre and post operative/ interventional heart and vascular unit.
- Communicate with Heart and Vascular OR, along with other various department to optimize throughput and efficiency
- Independently examines staffing
- Collaborates care with Anesthesia, Vascular surgeons, Cardiac surgeons and other interventional units to identify needs of patients and provide appropriate levels of triage care.
- Delegates and prioritizes appropriate levels of care and creates appropriate RN assignments to ensure patient safety.
- Obtained case history and gathered triage information to determine appropriate avenue for care.
- Performed additional clinic and non-triage nurse duties such as instructing patients in general and specific medical care and health issues and administering or dispensing medication and injections.
Clinical Coordinator CARE UNIT
Baystate Health
2013 - 05.2019
- Collaborates with anesthesia, Vascular/Cardiac surgeons for increased outcomes on cardiovascular patients.
- Responsible for organization of surgical and interventional patient bookings that come through for 21 BED unit.
- Utilizes problem-solving skills to identify improvements for risk reduction on patients having cardiac/ vascular surgery.
- Partners with other departments to facility appropriate care of patients.
- Manages UNIT charge tickets for billing purposes.
- Performed data entry of patient population.
- Established partnership with access services to maintain appropriate placement and bookings of patients through surgi-net.
- Collaborates with Mid-level provider and anesthesia providers to identify high-risk patient issues that need to be addressed in pre-admission testing.
- Assist in development of surgical schedules in collaboration with vascular cardiac departments
- Provides ongoing assistance to all patients to ensure implementation of appropriate treatment plan, adherence to quality model and utilization of services needed to achieve optimal outcomes.
R.N. Neonatal ICU
Baystate Medical Center
01.2005 - 11.2011
- Providing all aspects of care and support for patients and their families.
- Detailed clinical documentation to maintain medical compliance.
- Collaborating with multidisciplinary team of nurses, doctors, social workers, and specialists from all areas of medicine.
- Patient and family education for all home medical equipment including, oxygen therapy, nasogastric tube feeding, NJT, and gastric tube feedings.
- Utilizing advanced technology related to administration of hypothermia care including head cooling and EEG monitoring.
- Monitoring and maintaining central lines including, PICC, Broviac, and all umbilical lines (umbilical arterial catheter, and umbilical venous catheter).
- Blood pressure monitoring via umbilical arterial lines and radial arterial lines.
- Monitoring and maintaining all critical care drips.
- Vastly experienced with all types of mechanical ventilation including, conventional and oscillating equipment, and administration of nitric oxide.
- Monitoring and maintaining all types of non-invasive respiratory support including, CPAP, and SiPAP.
- Providing post-operative care for a vast array of medical conditions including, Spina-Bifida, Gastroschisis, hydrocephalus, and bowel surgery including colostomy care.
Education
Bachelors of Science - Nursing
American International College
Springfield, MA06.2004
Skills
- Denial Management
- Appeals and Resolutions
- Regulatory Compliance
- Critical thinking & Clinical Judgement
- Advanced knowledge of Medicare Guidelines (NCDs/LCDs)
- Proficient in ICD-10 and HCPCS coding standards
Additional Information
- Achieved 95% success rate in appeal resolution.
- Recovered $2M in hospital revenue through strategic denial management and appeals.
- Nursing Excellence Awards
Certification
- Massachusetts License R.N :2005- Current
- ANCC Cardiovascular Board Certified: 2017- Current
- ACLS:2011- Current
- BLS: 2005- Current
Timeline
Clinical Compliance Nurse Auditor,
Baystate Medical Center
05.2022 - Current
Cardiology Triage Nurse
Baystate Health
09.2021 - 05.2022
Heart and Vascular Nurse Navigator
Baystate Health
05.2019 - 09.2021
R.N. Heart and Vascular CARE Unit/Triage Coordinator
Baystate Health
11.2011 - 05.2019
R.N. Neonatal ICU
Baystate Medical Center
01.2005 - 11.2011
Clinical Coordinator CARE UNIT
Baystate Health
2013 - 05.2019
Bachelors of Science - Nursing
American International College