Rhonda Stacy, BSN,RN, RAC-CT
Knox,IN
Summary
Exceptional clinical, operational, and reimbursement management expert with an unmatched leadership prowess and the ability to build teams and strategies from the ground up to achieve aggressive goals and deliver rapid results. Multi-faceted and compassionate nursing professional with exceptional clinical, didactic, and leadership skills.
Transformational and strategic clinical reimbursement executive and operations leader with differentiated career path marked by success building innovative reimbursement strategies that optimize clinical revenue, transforming teams into powerhouse leaders, and significantly increasing per diem rates, Upper Payment Limit Rates, while maintaining excellent pass rates on audits via strategically implemented programs.
Applauded track record of defining and executing strategic and innovative initiatives that deliver rapid impacts on health care quality ratings, appeals management, clinical performance, and regulatory compliance. Dives deep into both financial and clinical problems to build and deploy rapid solutions, programs, and internal functions.
Overview
24
24
years of professional experience
Work History
Director of Clinical Reimbursement
Magnolia Health Systems
07.2021 - Current
- Defines tools, processes, and technology needed to perform in-depth and accurate fee-for-service reimbursement in alignment with documentation and billing standards.
- Lead a talented team of up to 20 healthcare facilities - rebuilding reimbursement operations, clinical metrics, and strategies while deepening team knowledge of all applicable rules and regulations.
- Partner with cross-functional leaders to examine operations, uncover gaps, and ensure alignment between compliant processes and procedures.
- Champion implementation of PDPM review calls to deliver end-to-end coverage of reimbursement in alignment with regulations and rules - reducing regulatory findings, enhancing clinical revenue, and bolstering clinical programs for funding opportunities.
- Collaborate with interdepartmental leaders in compliance, billing, and health services in policy development that enhanced and streamlined processes.
- Develop and direct quality measures improvement program - resulting in payment incentives from state value-based programs, including QIPP and NM SNFVBP.
- Develop and direct quality measures improvement program – resulting in payment incentives from state value-based programs, including QIPP and NM SNFVBP.
Vice President of Clinical Reimbursement
Magnolia Health Systems
03.2015 - 07.2021
- Led all corporation facilities as the expert consultant in utilization review, clinical reimbursement, and regulatory compliance and identify solutions to address high-risk areas.
- Partnered with both corporate and facility-based teams and stakeholders to uncover reimbursement requirements and opportunities and refine forward solutions.
- Navigated both clinical and billing demands of Medicare and managed care contracts and processes.
- Built a high-performing team of 13 while driving revenue, appeals, and quality measure project demands.
- Developed policies and procedures for cross-functioning departments - later utilized in key clinical programs and projects.
- Oversee, Manage and Educate MDS consultants, Case Managers, MDS Floats, & MDS Coordinators.
- Communicate with State & Federal Departments as needed
MDS Consultant
Magnolia Health Systems
08.2001 - 03.2015
- Engaged in and implemented sound and strategic clinical operations surrounding new acquisitions - Increasing reimbursement, improving quality measures and increasing audit rates.
- Fostered rapid growth opportunities and maintain regulatory compliance.
- Supervised up to 80+ healthcare staff and 40 Skilled Nursing facilities
- Recognized early as a high-performer - selected President of company to be promoted to VP of company
MDS COORDINATOR
Magnolia Health Systems - Wintersong Village
12.1999 - 08.2001
- Transitioned from Assistant Director of Nursing to DIrector, while continuing to drive clinically sound and financially strategic processes surrounding the RAI process.
- Spearheaded the complete scope of the RAI process and enhanced patient care through in-depth comprehensive care planning.
- Drove increased focus on coding accuracy - cultivating a more data-driven and performance-focused environment.
- Developed a robust daily PPS program.
- Spearheaded risk management programs to maintain high ratings in quality measures and desired clinic outcomes.
- Recognized early as a high-performer - Promoted to MDS Consultant.
Education
Bachelor of Science - Nursing
Bethel College
Mishawaka, IN05.2004
Associate of Science - In Nursing
Purdue University - North Central
Westville, IN12.1995
Skills
- Executive Leadership
- Supervise and Educate Clinical Reimbursement
- PDPM/Case-mix/ Upper Payment Limit (UPL)
- Clinical Program Strategy & Development
- Clinical Appeals and Denials Management
- CMS Star Ratings Improvement
- Communication & Public Speaking Team Building
- Analytics/Performance
- Supervise Case Management
- Monitor and Educate on Improvement of Quality Measures
Timeline
Director of Clinical Reimbursement
Magnolia Health Systems
07.2021 - Current
Vice President of Clinical Reimbursement
Magnolia Health Systems
03.2015 - 07.2021
MDS Consultant
Magnolia Health Systems
08.2001 - 03.2015
MDS COORDINATOR
Magnolia Health Systems - Wintersong Village
12.1999 - 08.2001
Bachelor of Science - Nursing
Bethel College
Associate of Science - In Nursing
Purdue University - North Central
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