Julie Anderson
Evans,GA
Summary
Results-driven Administrative Health Care Professional with extensive experience collaborating with diverse health care teams to enhance patient care and drive organizational success. Demonstrated expertise in cross-functional coordination, analytical problem solving, and managed care compliance, leading to maximized reimbursement rates. Strong attention to detail and effective communication skills have fostered impactful relationships and achieved significant operational efficiencies. Committed to optimizing healthcare processes while ensuring excellence in service delivery.
Overview
25
25
years of professional experience
Work History
Managed Care and Compliance Coordinator/Office Executive
Champion Orthopedics
10.2019 - 10.2024
- Oversee various aspects of managed care contracts, including maintaining and periodically reviewing current managed care contracts, maintaining an active roster of insurance network lists that the practice is participating in and those that the practice is out of network with, maintaining fee schedules for carriers, and monitoring for compliance.
- Assist the Practice Administrator with negotiating contracts.
- Review and, once approved, establish new Workers' Compensation relationships and agreements, as well as monitor for compliance with agreements.
- Responsible for all insurance, managed care training for Front Desk, Call Center, Billing, Precert, and Surgery Coordinators, as well as web portal administration for all insurance carriers, TPAs, and prior authorization portals.
- Completing new provider and group credentialing, as well as re-credentialing, for 8 physicians and 4 physical therapists.
- Coordination of the Merit-based Incentive Payment System (MIPS) with all staff and providers to maximize reimbursement based on achieving positive payment adjustments.
- Provide support for the billing team to include claims escalations with insurance carriers.
Business Office Manager
University Extended Care- Kentwood
09.2014 - 09.2019
- Managed daily operations within the business office, ensuring efficient workflow and productivity.
- Ensured compliance with legal and regulatory requirements affecting the business office.
- Handled confidential information with discretion and integrity.
- Conducted the admission screening process for patient referrals to include clinical information, insurance, and other financial responsibilities, to determine acceptance into the facility.
- Worked with interdisciplinary team members to assist in achieving maximum reimbursement for the facility, while ensuring quality care to patients.
- Managed residents' personal funds in the absence of a resident representative.
- Coordinated with the billing team in the corporate office to maintain goals with aging reports.
- Completed month-end closing timely, per facility policies.
- Coordinated and managed the billing process, beginning with the referral and continuing throughout the entire stay in the facility, with multiple departments that played key roles in the reimbursement process.
- Worked with referral sources and community business partners to generate a positive image and encourage referral activity.
- Assisted in the training of new Admissions Coordinators and Social Workers to optimize workflow and efficiency with admissions and discharges.
Administrative Nutritional Manager
University Extended Care- Kentwood
09.2008 - 09.2014
- Monitored budgets and expenditures to ensure cost-effectiveness while maintaining quality standards.
- Ensured compliance with all applicable laws, regulations, industry standards.
- Managed vendor relationships by negotiating contracts and ensuring timely delivery of goods and services.
- Managed inventory levels to meet demand without overstocking, reducing waste.
- Oversaw daily operations, maintaining efficiency and quality standards.
- Worked with an interdisciplinary team on patient nutritional issues.
- Provided staff education and training for state and federal regulations, food quality, equipment, and safety.
Social Services Director
University Extended Care- Kentwood and Westwood
03.2000 - 09.2008
- Conducted assessments of client needs and developed plans for providing appropriate services.
- Ensured compliance with all state regulations concerning social service programs.
- Worked with an interdisciplinary team to develop a plan of care and ensure psychosocial needs were met.
- Worked with medical and community referral sources to generate and maintain quality working relationships.
- Assisted and educated patients and families with needs and resources within the facility and community upon discharge.
- Conducted clinical and financial screening of referrals to determine the level of care eligibility and appropriateness for admission.
Education
Bachelor of Science - Sociology
Georgia Southern University
Statesboro, GASkills
- Cross-functional coordination
- Analytical problem solving
- Attention to detail
- Excellent communication
- Learning and leadership in new position opportunities without previous training
- Results driven
Timeline
Managed Care and Compliance Coordinator/Office Executive
Champion Orthopedics
10.2019 - 10.2024
Business Office Manager
University Extended Care- Kentwood
09.2014 - 09.2019
Administrative Nutritional Manager
University Extended Care- Kentwood
09.2008 - 09.2014
Social Services Director
University Extended Care- Kentwood and Westwood
03.2000 - 09.2008
Bachelor of Science - Sociology
Georgia Southern University
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