Dorcina Sherman-Clark
Chicago,IL
Summary
Highly motivated, well organized, and hard-working health care professional, with a track record of streamlining systems and procedures for physician practices with intent to maximize productivity, minimize cost and directly contribute to the organizational goals. Resourceful in meeting challenging deadliness and solving problems in a professional and timely manner. Work well under pressure. Proactive, creative, and goal-oriented professional with over 10 years of progressive Healthcare Administration experience. Expert in tackling the complex challenges of driving continuous improvement.
Overview
9
9
years of professional experience
Work History
CREDENTIALING SPECIALIST II
ERIE FAMILY HEALTH CENTER
Chicago, IL
12.2020 - Current
- Initiate and Manages Credentialing, Delegation, Recredentialing and Privileging of License Independent Practitioners (LIP) and other Licensed and Certified Practitioners (OLCP) credentialing related activities for Newly hired and established. [Comprised total of 475]
- Responsible for processing provider applications and re-applications data entries into the database tracking system Credential Streams by ensuring compliances are met including required regulations and standards.
- Ensure and Prepare credentialing files to make available for review by Director of Credentialing, Chief Clinical Officer, and Board Quality Improvement Committee each month along with resolving outstanding issues prior to committee review.
- Maintain Provider information in Provider Database-CredenitalStreams/Verity Stream CVO. Review/Perform Queries/reports to maintain data accuracy/corrections.
- Perform Primary Source Verifications to ensure compliance is met, renewals of all Provider licenses Professional, DEA, Controlled Substance, BLS/CPR Certificates, Board Certification, Hospital reappointments, any additional credentialing elements that are subject to expire.
- Perform a 20+ point checklist to ensure 100% accuracy and completeness of credentialing files.
- Serve as a liaison by working closely with Provider Enrollment Department/third party vendor. By identifying and communicating related requirements to reduce enrollment time as it relates to Provider credentialing including Licenses, Board Certifications, State of Illinois Applications, IMPACT/Medicaid form completion, along with additional requests by the Provider Enrollment Department.
- Monitor/Maintain National Practitioner Data Bank (NPDB) within Credential Stream Database, Adverse History findings, and Hospital Affiliations with working closely with Director of Credentialing.
- Review of Employment Agreements/Contracted Agreements for onboarding providers. Compiles Collaborative Agreements/IDPRF Delegated Authority renewals/termination process.
- Serves as a Liaison with working closely with Director of Credentialing with helping to develop and implement policies and procedures and workflows within Credentialing Department.
MANAGER, REVENUE CYCLE
ERIE FAMILY HEALTH CENTER
CHICAGO, IL
04.2019 - 12.2020
- Managed Billing and Insurance collections including Claim rejection management, Claim denial management, and ERA and manual posting.
- Provided insight into existing and emerging insurance coverage, reimbursement, and billing. Provided insight for pre-adjudication edits and follow-up/account resolution activities. Monitor productivity standards, quality improvement and metrics for outstanding accounts receivable. Identified and established rules and methods to eliminate back-end denials through an initiative-taking approach towards revenue management; by correcting errors before they are denied by payers. Ensured billing systems were fully optimized and meeting required benchmarks toward account receivables.
- Provided ongoing feedback to physicians and support staff to improve clinical and operational performance.
- Developed and compiled On-boarding Provider Packages. Managed Enrollment for a total of (238) Providers, (13) FQHC's Health Centers/Site Enrollment. Managed the Provider Credentialing/Enrollment functions for Commercial/Managed Care/ State/Government Plans. Created and revised provider enrollment and credentialing policies, procedures, and workflows to ensure alignment with compliance according to regulatory Joint Commission/HRSA requirements. Conducted oversight of the delegated credentialing process for appropriate subcontractors for Provider Enrollment. Responded to non-routine and difficult Provider Enrollment issues.
- System experience: Alliance/CENTRICITY EMR
MANAGER, REVENUE CYCLE
PRIME CARE COMMUNITY HEALTH
CHICAGO, IL
09.2018 - 04.2019
- Responsible for Billing and Collections for Medicare, Medicaid, Insurance, and Self Pay Patients for all FQHC Medical and Dental clinics.
- Supervised Billing Specialists-Team. Ensured patient account billing process was performed according to Billing and Collections guidelines. Supervised Patient Service/Call Center Representatives.
- Established productivity/benchmark requirements. Proactively developed billing processes competencies, along with implementation of process improvements.
- Monitor/Maintain CAQH/Perform Provider Enrollment-Medicaid/PECOS/Commercial Plans/NPPES process.
- Provider Enrollment: Created and revised credentialing policies, procedures, and workflows to ensure compliance with all regulatory and contractual credentialing requirements. Conduct oversight of delegated credentialing for appropriate subcontractors. Responded to non-routine and difficult credentialing issues.
- System Experience: ATHENA EMR experience/CAQH-Council for Affordable Quality Health Care
REVENUE CYCLE, CLINICAL ANALYST
ILLINOIS COLLEGE OF OPTOMETRY/ILLINOIS EYE INSITUTE
CHICAGO, IL
07.2016 - 09.2018
- Clinical Revenue Cycle of billing and insurance collection including claim rejections management, claim denial management, and ERA/EFT setup/Payment Posting. Provided insight on existing Insurance coverages, Reimbursement guidelines and Billing. Provided and performed pre-adjudication edits and follow up on account resolution activities. Monitor productivity standards, quality improvement metrics for outstanding account receivables. Ensured Billing system fully optimized and leverages of technology to ensure staff had adequate knowledge and tools to support department standard benchmarks. Provided ongoing feedback to Physicians, Clinical Operation Managers, and Support staff to improve clinical operation performance. Managed and coordinated the maintenance/repair of Biomedical equipment within clinical sites.
- System Experience: NextGen EMR
Education
Master of Science - Health Services Administration
National Louis University
Chicago, IL06.2019
Bachelor of Science - Healthcare Leadership
National Louis University
Chicago, IL06.2016
Associate of Science - Medical Billing And Coding
Taylor Business Institute
IL11.2005
Certificate of Completion - Credentialing Specialists Certification Prep Cours
TMG University
Glen Carbon, IL01.2022
Certificate of Completion - Credentialing Specialists Certification Prep Cours
NAMSS
Washington, DC05.2022
Skills
Technical Skills:
Verity Health Streams/Credential Streams
Privileging Software Database
PECOS/NPPES/IMPACT/MEDI/
CAQH-Council for Affordable Healthcare
CVO management
Compliance/Regulations:
NPDB-National Practitioner Data Base
National Committee on Quality Assurance
Credentialing Standards-NCQA
Joint Commission/HRSA-Health Center Program/CMS/Regulations/Standards
Credentialing Verifications:
AMA-American Medical Association Verifications
ANCC-APRN Board Verifications
ABMS-American Board Verifications
NPDB-National Practitioner Data Base
Timeline
CREDENTIALING SPECIALIST II
ERIE FAMILY HEALTH CENTER
12.2020 - Current
MANAGER, REVENUE CYCLE
ERIE FAMILY HEALTH CENTER
04.2019 - 12.2020
MANAGER, REVENUE CYCLE
PRIME CARE COMMUNITY HEALTH
09.2018 - 04.2019
REVENUE CYCLE, CLINICAL ANALYST
ILLINOIS COLLEGE OF OPTOMETRY/ILLINOIS EYE INSITUTE
07.2016 - 09.2018
Master of Science - Health Services Administration
National Louis University
Bachelor of Science - Healthcare Leadership
National Louis University
Associate of Science - Medical Billing And Coding
Taylor Business Institute
Certificate of Completion - Credentialing Specialists Certification Prep Cours
TMG University
Certificate of Completion - Credentialing Specialists Certification Prep Cours
NAMSS