About Beth

BETH C HEROLD

Email: beth@bethsmanyhats.com

 

Summary of Skills:

 

  • Emphasis on communicating technology concepts in layman’s terms to executive staff and officers of the company.
  • Able to synthesize strategic initiatives with practical administrative and business challenges to accomplish corporate and departmental directives.
  • Experienced in interviewing end users, assessing requirements, establishing data flow and business rules.
  • Very strong at finding commonalities in disparate situations and applying problem solving skills to find workable solutions.
  • Ability to manage multiple work groups, entry level, professional, and supervisory.
  • Ability to coach and direct work groups to achieve desired goals and objectives.
  • Excellent interpersonal skills and professional in all communications.
  • Self managed and highly motivated.

 

Experience:

 

NORTHWEST PHYSICIANS NETWORK                                                             Tacoma, WA

Director of Information Systems             05/07 – 10/08

Manager of Data Administration              07/99 – 04/07

Database Administrator                           03/98 – 07/99

 

  • Working with CEO and COO established the Data Administration Department to respond to corporate growth by centralizing report development, report processing, and EZ Cap system configuration.
  • Responsible for management of staff who handle procurement, installation, implementation and support of all network hardware, software and applications, including telephony.
  • Managed network rebuild during facilities move.
  • As the HIPAA Security Officer, create and maintain all applicable Policies and Procedures related to EPHI, network security access controls, user training and education materials, and security incident logs.
  • Project team member for the creation and implementation of The Network, a community access secure messaging portal used by clinicians, ancillary providers and patients across multiple Western Washington counties.
  • Responsible for the initial design and management of ongoing EZ Cap database configuration to allow for capitation payment and claims adjudication and payment based on IPA contracts and plan benefits.
  • Developed training materials and Policies and Procedures used by department staff for maintenance of EZ Cap tables to ensure proper benefits and pricing of referrals and claims.
  • Manage team responsible for design and development of reports and applications used to show compliance with regulatory requirements, assist in the financial management of the IPA, and assist in the fulfillment of operational goals the organization.
  • Strong background in various reimbursement methodologies including, capitation, fee for service, DRGs, case rates, per diems, and RBRVS fee schedules.
  • Participation in Operations Consistency Team for cross-departmental issue resolution and information sharing.

 

 

MEDALIA HEALTHCARE                                                                                  Seattle, WA

Database Administrator                                1996 –1998

Claims and Referral Coordinator                  1995 – 1996

 

  • Responsible for ongoing configuration and troubleshooting of Managed Care department’s EZ Cap system to ensure correct benefit allocation and contract pricing of referrals and claims.
  • Handled claims repricing for contracted hospital facilities based on contract provisions and acted as liaison between hospital business office and Managed Care department to resolve discrepancies.
  • Generated claims payment summary and detail reports to Finance Department for check processing and distribution.
  • Coordinated utilization review in conjunction with Utilization Review Committee members for all outside authorizations on managed care risk contracts per established protocols. 
  • Coordinated hospitalizations, surgical procedures and treatments for managed care patients to ensure efficient and cost effective service with appropriate use of resources. 
  • Maintained correspondence with managed care patients to answer questions and resolve discrepancies with referrals and access to care.

 

FRANCISCAN MEDICAL GROUP                                                                       Tacoma, WA

Patient Accounts Representative                    1993 – 1995

 

  • Responsible for managing for patient responsibility accounts A/R and clearing A/R within established timelines.
  • Mailed patient responsibility statements to clinic clients.
  • Worked with patients to establish and honor payment agreements based on insurance benefit determination.
  • Answered patient inquiries health plan explanations of payment and how patient responsibility amounts were determined.
  • Tracked and mailed delinquent notices to patients and referred accounts for collection based on established corporate and state criteria.

 

WHITTON BOUTROS AND ASSOCIATES                                                          Auburn Hills, MI

Assistant Business Manager                               1990 – 1993

Accounts Representative                                  1987 - 1990

 

  • Project team for selection, implementation and training of Medical Manager practice management system.
  • Handled electronic billing and verification of receipt of files for physical therapy services to Medicare for reimbursement.
  • Responsible for managing for physical therapy insurance accounts A/R and clearing A/R within established timelines.
  • Worked with attorneys, liability carriers and insurers to obtain correct payment of services.
  • Worked with patients and clinic staff to coordinate proper referral receipt for therapy services.
  • Established system protocols for collection of delinquent balances and filing in district small claims courts for judgments.

 

Associations:

 

  • Point B CIO Council Member                                                2006 – Present
  • EZ Cap Advisory Council Member                                         2004 – 2008
  • Venturi Associates CIO Council            Member                   2000 – 2005
Northwest Health Information Network                                   2006 - 2008


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