Lori Beach
Bakersfield,CA
Summary
Dedicated Credentialing Manager with a proven track record at Dignity Health Management Services, excelling in compliance and risk assessment. Adept in staff management and performance evaluation, I drive operational excellence through effective teamwork and collaboration, ensuring adherence to industry standards while enhancing provider credentialing processes.
Overview
46
46
years of professional experience
Work History
Credential It Manager
Dignity Health Management Services
10.2017 - Current
- Oversaw compliance with regulatory requirements, ensuring adherence to industry standards.
- Led cross-functional meetings to align departmental goals with organizational objectives.
- Conducted periodic risk assessments to identify potential vulnerabilities in credentialing workflows and implemented corrective measures as needed.
- Maintained up-to-date knowledge of industry regulations, ensuring ongoing adherence to best practices in provider credentialing.
- Led team meetings to discuss progress toward goals, troubleshoot issues, and share best practices among colleagues.
- Established team priorities, maintained schedules and monitored performance.
- Evaluated employee performance and conveyed constructive feedback to improve skills.
- Assisted in organizing and overseeing assignments to drive operational excellence.
Practice Coordinator
DHMSO (Managed Care Systems)
02.2014 - 10.2017
- Coordinate the day to day operations of the practice management team
- Served as a conduit for communication between physicians and the V.P. Practice Management as needed, keeping both parties informed of important information
- Oversees physician credentialing process according to standards. Maintains insurance files, contracts, claim forms and current provider lists. Prepares and submits physician applications for hospitals, payers, malpractice and other insurance coverages
- Ensures compliance with policies and regulations relating to practice management and onboarding
- Coordinates all phases of setting up new practice facilities. contracts with vendors to supply various services. Maintains appropriate practice supply inventories.
- Performs special projects and other related duties as assigned
Data Entry Temporary Assignment
Apple One at Managed Care Systems
09.2013 - 02.2014
- Entering information into Qnxt computer system for insurance enrollment of new members
- Outbound enrollment verification calls to new members
- scanning documents into the computer and filing into electronic records system
Business Manager
Preferred Family Care Physicians
04.1997 - 04.2012
- Prepared monthly and annual financial reports for physicians and accountants
- Credentialed physicians for hospitals and insurance plans and negotiated insurance contracts
- Processed-payroll for all employees and coordinated all employee benefits
- Managed all accounts payables. Analyzed supply costs and compared to procedures to assure profitability
- Supervised the billing department including all aspects of patient and insurance billing and collection of account receivables. Audited adjustments and handled correspondence with insurance companies regarding claim denials.
- Hiring,supervising, training, disciplining and exiting personnel, outside consultants and vendors. Maintained personnel files.
- Maintained computer network, including installation of software and hardware. Trouble shooting problems, performing back ups and training staff in the use of software and equipment.
- Maintained knowledge of employment laws to ensure compliance and ensured compliance with all OSHA and HIPPARCHUS regulations.
- Performed various other miscellaneous duties as assigned by the physicians.
Bookkeeper Practice Manager
David Dougherty, M.D.
09.1988 - 03.1997
- Posting all charges and payments in the computer software program
- Prepare daily bank deposits
- Compile daily and monthly A//R and Financial reports
- Credential physicians for hospitals and insurance enrollment
- Insurance and patient billing and claims follow up and collections
- Process patient refunds
- Maintain employee personnel files
Office Manager
Dr’s Forney, Polson, Webb and Nelson
06.1979 - 06.1988
- Data entry of all charges and payments into computer software system
- Managed accounts payables and payroll
- Credentialed the physicians for insurance enrollment and IPA participation
Education
No Degree - Medical Office Assistant Program
Bakersfield College
Bakersfield, CAHigh School Diploma -
Shafter High School
Shafter, CASkills
- Reliability
- Verbal and written communication
- Staff management
- MS office
- Performance evaluation
- visual Cactus
- Google Suite
- Staff development
- Teamwork and collaboration
Timeline
Credential It Manager
Dignity Health Management Services
10.2017 - Current
Practice Coordinator
DHMSO (Managed Care Systems)
02.2014 - 10.2017
Data Entry Temporary Assignment
Apple One at Managed Care Systems
09.2013 - 02.2014
Business Manager
Preferred Family Care Physicians
04.1997 - 04.2012
Bookkeeper Practice Manager
David Dougherty, M.D.
09.1988 - 03.1997
Office Manager
Dr’s Forney, Polson, Webb and Nelson
06.1979 - 06.1988
No Degree - Medical Office Assistant Program
Bakersfield College
High School Diploma -
Shafter High School