Lolita Mason

Re-entering healthcare administration workforce as a seasoned healthcare professional with 19 years in Provider Network Development utilizing Quality and Clinical Outcomes, Value-Based Care, Financial and Operational Performance (Medical Loss Ratio, Cost Per Member Per Month, Reimbursement & Denial Rates, Utilization Management). Active roles ranging from managing others, physician recruitment, onboarding, credentialing, contracting, enrollment, provider issue resolution, fee schedule modeling and analysis.

Experience with various payment methodologies (Fee-For-Service [RBRVS], Per Diem, ASC Groupers, Bundle Payments (prospective and retrospective), DRG, Case Rates, Value Based and Capitation.

Experience with Stop Loss and Timely Filing as well. Worked with web based code auditing, reimbursement rules and clinical rationale.

Healthcare Provider Network Contract Manager - Optum - La Crosse, WI

(2021-10 - 2022-04)

• Recruited physicians and negotiated provider contracts, achieving financial performance targets and ensuring compliance with regulatory and organizational standards.
• Developed fee schedules utilizing Medicare RBRVS and employed Microsoft Power BI for comprehensive data analysis.

Provider Relations Consultant - WellStar Health System - Marietta, GA

(2016-11 - 2021-10)

• Educated physicians on contract interpretation, medical policies, billing processes, and appeals to improve compliance with state and federal regulations.
• Utilized software programs - EPIC and ECHO
• Developed fee schedule models utilizing rates from multiple health plans to enhance interdepartmental communication across hospitals.
• Managed physician contract intake, conducted audits, and trained new staff to streamline the provider onboarding process

Manager of Credentialing & Provider Enrollment - Benevis - Marietta, GA

(2015-03 - 2016-05)

• Directed a team of seven employees overseeing the medical staff credentialing, privileging, and provider enrollment processes for 500 offices nationwide within a $12 million budget.
• Possessed comprehensive knowledge of state and federal regulatory requirements and accreditation standards related to medical staff governance.
• Managed practitioner credentialing and privileging processes in compliance with Joint Commission standards and relevant federal and state laws.
• Collaborated effectively with Medical Staff Leadership, Medical Directors, Administration, Senior Leadership, and external agencies to support strategic decision-making.
• Exercised discretion and independent judgment in problem-solving and decision-making while maintaining confidentiality of medical staff and peer review information.
• Demonstrated strong multitasking, prioritization, and delegation skills to meet established deadlines and achieve optimal results.
• Adapted to a flexible work schedule, effectively handling frequent interruptions while maintaining strong communication and leadership capabilities.
• Utilized problem-solving skills to determine appropriate actions in response to changes or challenges, and communicated effectively through written materials and oral presentations.
• Managed business operations, including database management and credentialing software (Intellisoft), while maintaining proficiency in standard office equipment and report writing.
• Executed a range of administrative functions, including organizing, assigning, directing, and evaluating job performance, and developing action plans for special projects through to completion.

Employee Benefits Specialist - Morneau Shepell via Paramount Staffing - Atlanta, GA

(2014-08 - 2015-03)

• Assisted employees with online benefits enrollment and HR systems, resulting in improved enrollment accuracy and efficiency.
• Educated employees on healthcare benefits, enhancing compliance and contributing to increased customer satisfaction.

Bachelors - Business Administration, Specialization - HR Generalist - American Intercontinental University (2014-08)