Joshua Anderson, MS, RHIA
Bloomer,Wisconsin
Summary
Strategic liaison eager to apply project management skills to help organization achieve objectives. Strong problem-solving and critical thinking skills and familiar with industry-specific regulations and compliance requirements. Articulate with excellent written communication skills.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Information Systems Contracting Specialist
Essentia Health
04.2022 - Current
- Train all Information System managers and department hires on contract management database
- Financial modeling, performance, reporting, and data analysis on all technology related contracts
- Work collaboratively to update policies, procedures, and workflows for the IS Contract process
- Coordination with contract owners and external partners to meet deadlines
- Responsible for contract throughout its lifecycle
- Coordinate with legal representatives to prioritize information system contract review order
- Work independently to manage Information System department contract and vendor portfolio.
Senior Provider Relations Contracting Specialist
Group Health Cooperative of Eau Claire
08.2021 - 03.2022
- Ensure State of Wisconsin health plan contract regulatory requirements are satisfied
- Manage initial provider network and credentialing NCQA accreditation and certification tasks
- Health plan clinic and provider network development
- Research inpatient and outpatient claim reimbursement issues, appeal results and resolve
- Negotiate contract terms and reimbursement for health plan participants
- Audit provider and reimbursement information in SQL database.
Provider Relations and Credentialing Supervisor
Group Health Cooperative of Eau Claire
02.2021 - 08.2021
- Identify healthcare trends, innovations, government requirements and update network accordingly
- Present network details at monthly operations meetings with C-suite and board of directors
- Create and modify job descriptions, hire new employees, supervise, and train employees
- Implementation of revised credentialing and contract workflows to follow best practices
- Negotiate high dollar single case agreements, impactful contracts, and network expansion efforts
- Meet with all partners to provide contact to ease administrative burden when concerns arise.
Provider Relations Specialist
Group Health Cooperative of Eau Claire
09.2020 - 02.2021
- Health plan network development, contract modeling, and beginning-to-end contract support
- Charge Master analysis to determine provider reimbursement rates from health plan
- Process, research, and respond to all provider network documents sent to health plan
- Point of contact for provider revenue cycle department for reimbursement and contract inquiries
- Create and post monthly provider relations update on website
- Negotiate all contracts for all providers, vendors, in and out of network.
Provider Relations Coordinator
Group Health Cooperative of Eau Claire
01.2019 - 09.2020
- Maintain and update provider clinician information in SQL database
- Process HEDIS and Quality related medical records requests
- Draft contracts, amendments, and addendums to provider reimbursement agreements
- Maintain documentation of all medical records requests, network applications, changes, closure.
Member and Providers Service Representative
Group Health Cooperative of Eau Claire
09.2016 - 01.2019
- Ensure HIPAA and legal compliance with regulations when discussing PHI
- Understand all policies, plan benefits, medical coding, and billing practices
- Research claim denials, reimbursement details, and coding to ensure proper benefit resolution
- Audits of claim payment history to ensure proper and consistent reconciliation
- Provide training and function as mentor for new hires
- Review EOB, OOP, EOP and IDN with members and providers, relaying claim data.
Mortgage Loan Processor
CCF Bank
02.2016 - 09.2016
- Subject matter expert on secondary market FHA Home Loans
- Ensure mortgage product and timeline remain competitive and satisfy customer needs
- Facilitate communication between loan officer and loan servicer
- Audit, investigate, and resolve documentation irregularities from borrowers prior to loan close.
Call Center Representative/Personal Banker
CCF Bank
11.2014 - 02.2016
- Create list for personal bankers to offer new product to existing members who qualify
- Process personal loan applications
- Train and mentor new team members
- Technical Support for online banking applications
- Investigate, research, and resolve questionable or fraudulent transactions.
Education
Master of Science - Health Information Management
The College of St. Scholastica
Duluth, MN01.2021
Bachelor of Science - History
University of Wisconsin – Superior
Superior, WI05.2013
General Studies -
University of Wisconsin – Barron County
Rice Lake, WI01.2010
Skills
- Communication
- Self-Directed
- Ability to Prioritize
- Presentations
- Flexibility
- Project Management
- Regulatory Compliance
- Time Management
- Contract Negotiation
- Contract Administration
- Problem Solving
- Workflow Management
Certification
AHIMA Registered Health Information Administrator (RHIA)
Software Technology
- SQL
- R studio
- Proficient with MS Office Suite (Word, Excel, Outlook, PowerPoint, Visio)
- SharePoint
Timeline
Information Systems Contracting Specialist
Essentia Health
04.2022 - Current
Senior Provider Relations Contracting Specialist
Group Health Cooperative of Eau Claire
08.2021 - 03.2022
Provider Relations and Credentialing Supervisor
Group Health Cooperative of Eau Claire
02.2021 - 08.2021
Provider Relations Specialist
Group Health Cooperative of Eau Claire
09.2020 - 02.2021
Provider Relations Coordinator
Group Health Cooperative of Eau Claire
01.2019 - 09.2020
Member and Providers Service Representative
Group Health Cooperative of Eau Claire
09.2016 - 01.2019
Mortgage Loan Processor
CCF Bank
02.2016 - 09.2016
Call Center Representative/Personal Banker
CCF Bank
11.2014 - 02.2016
Master of Science - Health Information Management
The College of St. Scholastica
Bachelor of Science - History
University of Wisconsin – Superior
General Studies -
University of Wisconsin – Barron County