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Marysville, OH 43040
937 . 243 . 3392 / rfniel sen@ emba rqmail. com

Healthcare Financial Consultant / Financial Services Manager

Highly accomplished leader backed by expertise in continued process
improvement, technology innovation, high-volume credit and
collections, reimbursement and rate negotiations within the
healthcare industry. Offers proven ability to understand and develop
resolutions to complicated and/or intense questions related to variety of
benefits and customer needs.
Consistently demonstrate cross-functional leadership, initiative and
strong troubleshooting skills as well as an effective combination of
operational and financial management qualities necessary to exceed
goals; implement effective processes and identify areas of needed
change. Lead with big-picture, consultative approach, to secure buy-in
from staff and management.

Relationship Building
IT Needs Assessment
Medicare/Medicaid Expertise
Reimbursement Troubleshooting
Policy/Procedures Development
Staff Training / Development
Startup / Turnaround
Employee Relations
Healthcare Consulting
Financial Management
Quality Assurance


1992 to 2014

Interim Healthcare is the nations largest provider network of Home Care and Medical staffing. The Salo Organization (TSO) is an
independently owned and operated franchisee of Interim Healthcare, and is the largest privately held network within the Interim
system, operating 35 locations in Ohio, Indiana, Kentucky and Pennsylvania.

verification and processing for approximately 300 field employees. Key activities included processing of commercial
and government payer billing for services rendered; maintaining verification of benefit eligibility with all payers;
underwriting credit risk of private pay accounts and managing Medicare/Medicaid regulatory knowledge and change.
Reviewed Account Receivables for late payment activity; managed staff performance, analyzed/follow-up on
billing denials before determining appropriate course of action. Addressed authorization issues, changing
authorization process when needed and/or requesting additional authorizations to cover services rendered.
Provide feedback to sales team on new cases regarding viability to receive payment.
Calculated net sales by office week-to-date or year-to-date against budgeted figures, sales, margin and collections by
office. Computed sales gross and net margin on weekly basis and provided highlighted narrative of business activity
for 4 branch locations including 8 departments, main office and TSO Management. Worked with Sales/Operation to
draft and prepare budget for four locations, computed sales gross and net margin, reporting to Columbus team, Vice
president and TSO Management weekly.

Maintained average of .25% of bad debt expense against industry average of 5%, against $10M budget and
delivered 66% under industry average of 59 days for Accounts Receivable days.
Reduced non-billable salary spend from $2,500 per week to approximately $1,100 per week while adding
.5% to overall weekly sales margin by establishing productivity standards for salaried clinical staff
centered on guideline for acceptable number of billable vs. non-billable visits per week.
Instrumental in reducing bad debt (from approximately 5% of sales) and slashing accounts receivable days,
from 100 upon starting position to average of 17 days consistently for the past eight years.
Significantly improved overall productivity and realized net income impact of approximately $10K per
month, doubling net margin for subsequent seven years by introducing electronic billing to Columbus
office, subsequently adopted by all locations; lowered borrowing-related costs.
Eliminated need for manual cash deposits on major payers while enhancing timeliness of deposits and
reducing number of unidentified payments by establishing electronic funds transfer agreements with
Medicare, Medicaid, V.A., Tricare and other major health insurance carriers.
Enabled rapid eligibility / homecare-specific benefit quote for new customers by developing new program
entitled QCA (Quick Credible Answer), a free network of direct payer contacts. Program provided numerous
benefits including benefit verification, payment status, and denial clarification process


email: rfnielsen@ embarqmail. com

Improved reporting to Owner, Vice President and Managers including those for weekly key progress status
on episodes of homecare to enhance process flow while supporting Interims unique revenue recognition
model for more timely billing of cases and reduction in A/R Days. Report adopted in other offices and
Start of care (request for advance payment submission); end of episode (status); tally of weekly final
claims; sales volume in final claims and episode closing status.
Led pursuit and securing of Single Case Service Agreements with numerous payers on long-term extensivecare required cases by directing quoting and negotiating with payers across the U.S. and Canada. Secured
agreements for various types of services and rates depending on variety of services not typically covered
and/or alternate care plans.
Streamlined and strengthened Credit Management function to enable evaluation and quote of terms and
financial conditions for private pay and commercial payers. Instituted security deposit policy for private pay
cases and educated clients and internal staff on purpose of policy and successful incorporation with
opening a new case.
Discovered five-year old judgment for $6000 previously not collected by reviewing old caseload of dormant
legal collections for a closed office.
Spearheaded new system implementation in Columbus office with new MIS/EDI system designed to
improve operational efficiencies in documenting client intake, episode of care details and payer information
as well as assurance of HIPAA compliance and stronger commitment to regulatory requirements.
Slashed number of charge verification errors while saving administrative costs by championing revenue
recognition and verification process to reduce compliance risks and volume of late adjustments to sales,
payroll and invoicing.
Assumed leadership over difficult/sensitive cases including one involving a child needing over $200K in
annual benefits by pursuing all legal remedies, earning clients trust and support. Despite initial
resistance and delicate situation, the matter was resolved without any interruption of the childs care.
Identified deficiencies in accuracy of a Medicare v e n d o r reimbursement and recovered $ 70,000 by
performing collections follow-up and leading special audit of p a y e r claims payments over previously 15
months and sharing error with both the vendors Executive team and Interim corporate leadership.
Successfully initiated one of the largest Taft Patient Protection Act appeal in the State of Ohio ($195k)
resulting from questions regarding cases medical necessity and despite continued denial of appeals by
utilizing Independent Review Organization and working with outside counsel to achieve favorable outcome.
Increased collections related to sizable Medicare payments while increasing rate of payment, a significant
component of weekly sales margin, by working with IT vendor in development of unique coding that
recognized Medicare sales per visit during care and made adjustments upon final payment received.
Successfully negotiated fee increases on high yield cases. Initiated Single Case Agreements and provided
guidance to clinical managers on case values, costs and margin needs.
Served as primary contact with outside legal counsel for 15 years concerning collection matters and as
point person for other legal matters as required, including those regarding client records, employee
records and pay histories.
Directly impacted additional net income and operated under budget by acting as primary office contact
for annual financial audit, focusing on doubtful receivable items and payment disposition leading to a routine,
systematic review of any unpaid Account Receivables.
Defended numerous payer audits and developed appeals.
Successfully on-boarded many direct and indirect reports; focused on talent training and management.

Marysville, OH 43040
937 . 243 . 3392 / rfn ielsen@ embarq mail. com