Beth Crain Email & Phone Number

Dallas, Texas, Us

- Regulatory compliance with state and federal laws and regulations along with client contracts- Write and maintain policies, procedures, workflows and contracts- User access creation and audits- Capitation payment calculations and disbursement- Oversee multiple departments: Auditing /Compliance (2016), Eligibility (2017), Benefit Systems (2018), Credentialing (2018) and Provider Operations (2018)- Develop and conduct internal audits of claims processing, ODAG Table 3 reporting, encounter submissions, QI studies, contracts, provider records, and maximum out of pocket; oversee external audits- Assist other departments in streamlining their processes- Assisted IT with ICD-10 conversion and x12 conversion- Played a key role in several large client startups and company acquisitions- Previous acting Corporate Privacy Officer for approximately 250 employees- Started as Compliance Auditor at Sage Technologies. Sage Technologies was acquired by Arcadia Healthcare Solutions in June, 2015 and went through rebranding, changing their name to Arcadia.io, in 2018. The Value Based Services division was later acquired by Guidehealth in December, 2023.

Boston, Massachusetts, Us

- Regulatory compliance with state and federal laws and regulations along with client contracts- Write and maintain policies, procedures, workflows and contracts- Capitation payment calculations and disbursement- Oversee multiple departments: Auditing /Compliance (2016), Eligibility (2017), Benefit Systems (2018), Credentialing (2018) and Provider Operations (2018)- Develop and conduct internal audits of claims processing, ODAG Table 3 reporting, encounter submissions, QI studies, contracts, provider records, and maximum out of pocket; oversee external audits- Assist other departments in streamlining their processes- Assisted IT with ICD-10 conversion and x12 conversion- Played a key role in several large client startups- Previous acting Corporate Privacy Officer for approximately 250 employees- Started as Compliance Auditor at Sage Technologies. Sage Technologies was acquired by Arcadia Healthcare Solutions in June, 2015 and went through rebranding, changing their name to Arcadia.io, in 2018. I was promoted to Manager of Compliance & Value Based Services Auditing in May, 2016, Senior Manager of Auditing & System Compliance Operations in 2020 and Director of Contractual Oversight & Performance in 2022. The corporate office is located in Boston, MA.

- Be able to quote the Federal Register 2560.503 and the DOL FAQ's associated with the law- Analyze patient accounts within hospital billing systems- Write properly formatted federal ERISA law appeals- Follow-up phone calls and appeals with insurance companies and employers- Keep detailed notes of phone conversations and organized case files

- Oversee Billing and Collections for 4 different states- Data Entry into Billing Software- Invoicing - Post payments- Account Reconciliation - File appeals with insurance companies - End of month financial reporting and auditing - Contracting Services with payers and nursing facilities - ICD-9 & HCPCS compliance - Assist Dispatch, Human Resources and IT - Paperwork compliance for Ambulance and Wheelchair transports - HIPAA Compliance Officer - HIPAA & Documentation Educator - Experience as an EMT-B and EMD- Company operates as Priority One in Indiana and as Carolinas Medical Response (CMR) in North Carolina and South Carolina.

- Obtain freight quotes and schedule freight carriers - Create all paperwork for domestic and international shipments - Handle freight damages and claims for incoming and outgoing shipments - Audit freight invoices - Sign for and inspect incoming shipments

Associate Of Science (As), General Education

Criminal Justice

High School Diploma, General Education