Julia Conley
Valdosta,Georgia
Summary
Fifteen years diversified experience in the clinical and revenue cycle management setting. With six of those years in a Healthcare IT Company providing RCM services. Motivated self-starter who takes great pride in work and is results driven. Detail oriented with an excellent figure aptitude: keen ability to recognize and correct discrepancies. Strong interpersonal communication, organizational, and problem resolution skills. Competent at implementing procedures to support efficiencies and productivity levels. Experience in multiple software platforms: Hartland, McKesson Series, PCON, Meditech, CPSI, Prognosis, Azalea Health, Amazing Charts, Greenway, Athena, JIRA, Salesforce, Quadax, Imspro (Exclaims), Trizetto, Rycan, DashboardMD, PowerBI, Qlickk. Selected by Upper Management to participate in the Subject Matter Expert program for Hospital Billing. I have also been acknowledged by Azalea Health RCM as Employee of the Quarter for Q4 2021 by being awarded the "Strike First, Strike Hard". I was also awarded the "Rockstar of the Year" award from ModMed BOOST department in my first year within the company in 2023.
Overview
10
10
years of professional experience
Work History
RCM Client Advisor
Modernizing Medicine
12.2022 - Current
- Serve as the primary point of contact for enterprise-sized medical practice clients and develop and maintain strong client relationships to understand their unique RCM needs and challenges
- Conduct routine client meetings to review business metrics, progress, recommendations and other proactive topics to ensure high quality delivery of contracted services on a weekly basis in addition to monthly, quarterly and annual business reviews.
- Provide a high-level of valued customer service to enterprise client practices by identifying and efficiently working with RCM operations and the client to resolve insurance and other billing-related issues
- Manage and monitor the end-to-end RCM process for clients and track RCM KPIs for clients, ensuring alignment with organizational goals.
- Collaborate with internal RCM operations and global team to improve client metrics and ensure seamless service delivery
- Conduct regular audits and assessments to proactively identify areas for improvement and optimization and collaborate with operational functions on aggressive strategies to facilitate positive client outcomes related to revenue cycle
- Establish, implement and manage Practice Performance Plans that identify, quantify and resolve issues that are impacting service levels and/or delivery of contractual obligations, as needed
- Review and analyze customer accounts; identify trends and issues, recommend and implement solutions and see through to a successful resolution.
Hospital RCM Service Manager
Modernizing Medicine
12.2022 - Current
- Providers leadership, management, and oversight for all assigned staff including productivity, turn around times and other key performance indicators
- Regularly review all key components of the revenue cycle process through dashboards, reports, queries, and other audit tools, Analyze and interpret financial data, employ benchmarking techniques, and follow trends to ensure profit maximization for Azalea RCM clients
- Proactively identifies sources of issues and communicates these to the appropriate parties
- In conjunction with the Client internal RCM staff
- Maintains ongoing issues and priority list for Clients
- Completes analysis of issues for action, presents this information and assists the Client in implementing action plans
- Works with development resources and product managers to identify related workflow issues that impact the effectiveness of RCM service processes
- Facilitates new Client discovery, implementation, and onboarding procedures to ensure a smooth transition and high customer satisfaction
- Provides assistance and support to the Azalea Sales organization as a subject matter expert and may speak directly to potential RCM customers as needed
- Compile financials for invoicing clients based on Statement of Work (SOW) or Contract
- Assist in transfer of data for successful software implementation
- Established EDI connection, file transfer and testing while assisting in ERI/ERA and EFT enrollments
- Create and build billing rules for claims based on state regulations, CMS guidelines and specific payer rules
- Review and advise patient collections processes and work with 3rd party collection agencies and transfer approved files to agencies
- Effectively monitored and communicated RCM stats and KPIs for hospital based clinics and RHCs
- Communicates with the Client Relations and Finance departments as it relates to Azalea clinical software inquiries, customer invoicing, and churn activities
- Effectively monitors and audits RCM activities being performed by 3rd party subcontractors both domestic and overseas.
Enterprise Account Coordinator
Azalea Health Innovations
08.2019 - 12.2022
- Regularly review all key components of the revenue cycle process through dashboards, reports, queries, and other audit tools, Analyze and interpret financial data, employ benchmarking techniques, and follow trends to ensure profit maximization for Azalea RCM clients
- Proactively identifies sources of issues and communicates these to the appropriate parties
- In conjunction with the Client internal RCM staff
- Maintains ongoing issues and priority tracking for Clients
- Completes analysis of issues for action, presents this information and assists the Client in implementing action plans
- Works with development resources and product managers to identify related workflow issues that impact the effectiveness of RCM service processes
- Facilitates new Client discovery, implementation, and onboarding procedures to ensure a smooth transition and high customer satisfaction
- Provides assistance and support to the Azalea Sales organization as a subject matter expert and may speak directly to potential RCM customers as needed
- Compile financials for invoicing clients based on Statement of Work (SOW) or Contract
- Assist in transfer of data for successful software implementation
- Established EDI connection, file transfer and testing while assisting in ERI/ERA and EFT enrollments
- Create and build billing rules for claims based on state regulations, CMS guidelines and specific payer rules
- Review and advise patient collections processes and work with 3rd party collection agencies and transfer approved files to agencies
- Effectively monitored and communicated RCM stats and KPIs for hospital based clinics and RHCs
- Communicates with the Client Relations and Finance departments as it relates to Azalea clinical software inquiries, customer invoicing, and churn activities
- Effectively monitors and audits RCM activities being performed by 3rd party subcontractors both domestic and overseas.
Hospital RCM Service Manager
Azalea Health Innovations
04.2018 - 08.2019
- Providers leadership, management, and oversight for all assigned staff including productivity, turn around times and other key performance indicators
- Regularly review all key components of the revenue cycle process through dashboards, reports, queries, and other audit tools, Analyze and interpret financial data, employ benchmarking techniques, and follow trends to ensure profit maximization for Azalea RCM clients
- Proactively identifies sources of issues and communicates these to the appropriate parties
- In conjunction with the Client internal RCM staff
- Maintains ongoing issues and priority list for Clients
- Completes analysis of issues for action, presents this information and assists the Client in implementing action plans
- Works with development resources and product managers to identify related workflow issues that impact the effectiveness of RCM service processes
- Facilitates new Client discovery, implementation, and onboarding procedures to ensure a smooth transition and high customer satisfaction
- Provides assistance and support to the Azalea Sales organization as a subject matter expert and may speak directly to potential RCM customers as needed
- Compile financials for invoicing clients based on Statement of Work (SOW) or Contract
- Assist in transfer of data for successful software implementation
- Established EDI connection, file transfer and testing while assisting in ERI/ERA and EFT enrollments
- Create and build billing rules for claims based on state regulations, CMS guidelines and specific payer rules
- Review and advise patient collections processes and work with 3rd party collection agencies and transfer approved files to agencies
- Effectively monitored and communicated RCM stats and KPIs for hospital based clinics and RHCs
- Communicates with the Client Relations and Finance departments as it relates to Azalea clinical software inquiries, customer invoicing, and churn activities
- Effectively monitors and audits RCM activities being performed by 3rd party subcontractors both domestic and overseas.
Patient Account Representative / Insurance Follow Up
Colquitt Regional Medical Center
10.2016 - 04.2018
- Review, research, and process claims in accordance with contracts and policies
- Determine the extent of liability and entitlement for the facility
- Review denials and coordinate with patients, staff, and ordering physicians to ensure the claim is processed correctly to ensure prompt payment
- Successfully maintained the goal for Accounts Receivable of accounts over ninety days in under one month
- The goal for accounts over ninety days is nineteen percent, in a month's time I was able to decrease the percent from thirty six percent to fourteen percent and maintain a percentage between eleven percent and sixteen percent.
Technical Denials Coordinator
South Georgia Medical Center
06.2016 - 10.2016
- Reviews and analyze denied claims and determines the denial status
- Appeals all technical denials for Commercial and Medicare Advantage payers in the following departments: oncology, inpatient, and wound care, observation, imaging and surgical
- Experience with Humana Tricare, as well
- Processes all appeals for Medicaid and Managed Care Programs for Emergency Room flat rate denials
- Ensures proper entry and documentation of all denials, underpayments and audits are entered in tracking software, and monitor to ensure appropriate follow-up per contracts
- Fulfill RAC and HEIDIS audits for Commercial and Medicare Advantage payers
- Coordinates required audit action with the Clinical Denials Coordinator and Compliance, Case Management, Medical Record department, Patient Financial Services, members of the medical staff and other departments to confirm notifications and appeals are sent in a timely manner
- Mitigates losses and future audits by ensuring timely resolution of audits for Commercial payers and Medicare Advantage.
Managed Care Analyst
South Georgia Medical Center
08.2013 - 05.2016
- Acknowledged by management for recovering $202,180.96 in lost reimbursements for the months of December 2015 and January 2016
- Commended by management for my 'tactical approach,' 'out of the box thinking,' and 'ability to work smarter not harder.' Ensured facility recovered full reimbursement according to contracts by identifying processing errors, total denials or underpayments and submitting needed information for appeal or claim reprocessing by phone, or in writing
- Completed adjustments for our contracted payers to maintain accurate Accounts Receivable as well as patient balances
- Maintained regular correspondence with insurance providers and scheduled educational meetings with staff and provider representatives to ensure current insurance contract information pertaining to reimbursement was available.
References
References available upon request.
Timeline
RCM Client Advisor
Modernizing Medicine
12.2022 - Current
Hospital RCM Service Manager
Modernizing Medicine
12.2022 - Current
Enterprise Account Coordinator
Azalea Health Innovations
08.2019 - 12.2022
Hospital RCM Service Manager
Azalea Health Innovations
04.2018 - 08.2019
Patient Account Representative / Insurance Follow Up
Colquitt Regional Medical Center
10.2016 - 04.2018
Technical Denials Coordinator
South Georgia Medical Center
06.2016 - 10.2016
Managed Care Analyst
South Georgia Medical Center
08.2013 - 05.2016