Nicole Augustus, Mba Email & Phone Number

Baton Rouge, Louisiana, United States

Supervises the auditing of eligibility enrollment of all Medicaid programs statewide.Plans, coordinates, and controls small or less complex statewide program(s).Plans, develops, implements and monitors comprehensive Medicaid program policies.Conducts and directs studies/special projects pertaining to the programs assigned.Analyzes the impact of federal, state, and local legislation; advises agency officials; prepares position statements; presents testimony at hearings; writes legislation.Reviews and analyzes complex data and system reports to ensure compliance with program regulations.Administers the day-to-day operational functions of the Medicaid fee for service programs. Assures that program policy and procedures are properly applies in accordance with federal and state laws and regulations.Develops and writes agency rules and regulations governing the administration of all supervised Medicaid programs and submit them for publishing in the official state publication in accordance with the requirements of the Administrative Procedures Act.Implements Medicaid regulations directing provider participation standards and recipient benefits. Analyzes multi-mullion dollar Medicaid claim data and project the fiscal impact for budget forecasting.Identifies, verifies and analyzes the various revenue sources for the program(s). Determines and/or confirms match requirements. Monitors availability of revenue sources and promptly identifies existing or potential financing problems.

Baton Rouge, Louisiana, United States

• Managed data integrity for member enrollment records and remittance files, coordinating monthly reconciliation processes and resolving eligibility discrepancies to enhance reporting accuracy. Supervised a team of 4 Quality System Analysts and 2 Eligibility Specialists, fostering a collaborative environment to streamline enrollment issue resolutions and improve team productivity.Investigate and resolve state complaints, preparing and submitting the plan’s responses to ensure compliance with state regulations. Support internal departments, providing critical data insights and quick resolutions to membership enrollment issues, enhancing service quality and member satisfaction. Quality System AnalystInvestigated and resolved complex data issues related to member eligibility and enrollment, utilizing advanced SQL and BI tools to analyze and interpret problems, leading to a 15% reduction in recurring data errors.Maintained expert knowledge of State of Louisiana's Member Enrollment file (834 files), ensuring accurate and compliant data handling which improved state reporting accuracy by 20%.Developed and implemented manual correction files and operating policies that enhanced the efficiency of the Eligibility & Enrollment department, resulting in a 25% improvement in process speed.Audited existing procedures to monitor and recommend enhancements, significantly improving the operational efficiency of the Eligibility & Enrollment department by 30%.Served as the subject matter expert for all eligibility and enrollment processes, leading strategic initiatives that promoted operational and financial improvements within the healthcare plan. Researched and resolved escalated complex enrollment issues, decreasing turnaround time for high-priority problems by 40%.Led the department in adapting to system upgrades and automation of work tasks, which streamlined operations and reduced manual processing by 50%.

Baton Rouge, Louisiana

Baton Rouge, Louisiana Area

Conducted detailed financial analysis of monthly profit and loss statements, federal and state tax returns, identifying key financial trends and variances to aid strategic decision-making.● Reviewed monthly operating sales revenues, costs, and expenses, utilizing advanced Excel tools to resolve variances and ensure accurate financial reporting.● Applied rigorous data analysis methodologies to provide professional judgments on financial assessments, enhancing the reliability of financial insights.● Consulted with external stakeholders to collect essential source documents such as general ledgers, tax schedules, payroll records, and 1099s, ensuring comprehensive data availability for analysis.● Managed and organized client files efficiently, enabling quick retrieval and consistent data accuracy for ongoing financial assessments.● Developed and utilized sophisticated Excel tools to analyze operational information, tracking revenue trends and patterns to pinpoint critical financial variances.● Reviewed source documentation meticulously for potential errors and signs of fraud abuse, safeguarding financial integrity and compliance.● Performed thorough bank reconciliations to detect discrepancies between monthly and annual financial statements, promptly addressing issues to maintain financial accuracy.● Delivered insightful financial reports with proposed modifications based on in-depth analysis, supporting senior management in financial planning and adjustments.● Collaborated closely with the Senior Financial Analyst and management team to apply expert judgment on complex financial issues, ensuring high-quality final analysis.● Assisted team members in resolving challenging financial analysis issues, fostering a collaborative environment and enhancing team capability in financial diagnostics.

Managed billing and collections processes for patient accounts, liaising with third-party payers to ensure timely and accurate claims resolution, which reduced average receivable days by 25%.● Conducted in-depth financial counseling for patients, explaining billing processes and available payment options, thereby increasing payment compliance rates by 20%.● Developed and implemented effective collection strategies that aligned with healthcare regulations, ensuring ethical practices while improving recovery rates.● Monitored and reconciled patient accounts, detecting and resolving discrepancies in billing and payments, which enhanced patient satisfaction and trust in billing accuracy.● Trained and supported new staff on billing software and patient interaction protocols, strengthening team efficiency and consistency in patient financial services.

Baton Rouge, Louisiana Area

Managed billing and collections processes for patient accounts, liaising with third-party payers to ensure timely and accurate claims resolution, which reduced average receivable days by 25%.● Conducted in-depth financial counseling for patients, explaining billing processes and available payment options, thereby increasing payment compliance rates by 20%.● Developed and implemented effective collection strategies that aligned with healthcare regulations, ensuring ethical practices while improving recovery rates.● Monitored and reconciled patient accounts, detecting and resolving discrepancies in billing and payments, which enhanced patient satisfaction and trust in billing accuracy.● Trained and supported new staff on billing software and patient interaction protocols, strengthening team efficiency and consistency in patient financial services.

Master Of Business Administration (M.B.A.), Business Administration, Management And Operations

Bachelor Of Science (B.S.), Accounting And Related Services

Activities and Societies: Phi Beta LambdaNational Association of Black Accountants

Master Of Business Administration - Mba, Business Administration And Management, General