Overview –
Nicole King is a registered health information professional with over 15 years of experience in the health industry and participates on the national Healthcare Consulting Practice team, which focuses on disputes, investigations, and litigation support. Her clients include provider-based organizations, payers, and law firms. Ms. King’s specialties include healthcare operations, forensic analytics, litigation support, payer reimbursement disputes, medical record and claim audit, healthcare charging and reimbursement methodologies, regulatory compliance, investigations, and related government mandated claims and transactional reviews. Ms. King has served in leadership roles related to hospital revenue integrity, quality and risk management, risk adjustment and government reporting requirements.
Experience +Performing documentation and billing practice assessments for matters related to diligence, disputes, investigations, and litigation in healthcare specialties such as pathology, immunology, diagnostic services, surgical services, rehabilitation services, medical supplies and implants, and FDA regulated tissues.
Serving as Provider Representative for an annual payment update determination appeal with the Provider Reimbursement Review Board.
Serving as independent monitor for compliance with Certificate of Need requirements as set forth by the Connecticut Office of Health Strategy, which involves conducting periodic assessments of quality and patient safety initiatives and performing reviews of adherence to cost restraint agreements and monitor participation in Advanced Payment Models.
Produced expert reports for healthcare payment disputes to opine on accuracy and reasonableness of charges and allowed amounts.
Developed state Medicaid discovery production request criteria for a class action dispute involving damages associated with the use of talcum powder.
Provided forensic analysis of pain management supply and medication sales, distribution, and usage data related to fraud and abuse allegations.
Provided support related to False Claims Act investigation related to a qui tam matter with multiple allegations of improper billing, including adherence to “incident to” guidelines, diagnostic screening tests, and credentialing/payer enrollment practices. Assisted with identification of key data for discovery production, leveraging the Freedom of Information Act for independent sourcing of data, forensic data analyses, and assessment of applicable conditions of payment regulations.
B.S., Health Informatics and Information Management: Boise State University, 2007, Magna Cum Laude
Registered Health Information Technician
American Health Information Management Association
Idaho Health Information Management Association
Health Care Compliance Association
