JULIE ANDERSON, RN

Currently the Hospital System Representative to Avera and Sanford, as well as the other Hospital, PCP/Specialists, Ancillary & Pharmacy providers in NW IA. Joined Team at “GO-LIVE”. Developed New Provider Orientation. Presented the ITC New Provider Orientation presentations at locations across the state introducing us to Iowa Providers. Helped providers with all of the issues at go-live: Contracting, Credentialing, Data Management & Claims. First rep to take my territory to no monthly claims issue meetings. Consistently exceeded provider monthly visit goals. Created provider partnerships so Quality and Network could easily come in and work with them on P4P and Network Expansion. Was the VBC Liaison for the PR Team, attending the VBC meetings and reporting back to my team. Worked on the team helping to advise on creating our Iowa Provider Scorecard, where we can show providers at a glance their successes and failures in prior authorizations, claims accuracy, and Quality opportunities. Presented Statewide In-Person (Video, during Covid) presentations via Annual State Training each year. Assisted with new employee training and mentoring of team. Consistently received high provider satisfaction scores.

Took a sabbatical to care for terminally ill parents as well as attend all of my kids' activities. volunteering with our school, church, nursing home, Special Olympics, United Way, and other organizations. Continued with Leadership, Communication as well as Negotiation skills in this role.

Contract/Provider Relations/Quality rep: Responsible for recruiting and contracting providers for new Iowa Medicaid MCO. Coordinated Credentialing information, and provider changes/updates. New Provider Orientations & website training. Pulled, delivered and explained HEDIS reports and payments. Worked with office staff on claims and coding issues.

Partnered with Wellmark BCBS in Iowa and South Dakota supporting provider offices in Quality: Disease Management, Case Management, Wellness and Advocacy Services. Recruited provider offices to participate in this program designed to improve patient outcomes by embedding health coaches in offices. Became Health Coach certified to train these offices in Health Coaching for their patients.

Liaison to over 2000 providers in Iowa for new Managed Care Company partnering with McFarland Clinic. Created and delivered: New Provider Orientations, Provider Manuals and monthly provider newsletters. Credentialing site visits performed, contract spot deals, and supported Quality with HEDIS office chart reviews. Solved claims and coding issues that arose. Consistently high satisfactions scores.

Managed medical and business office staff for family practice clinic for a large multi-specialty organization. Scheduling of staff, inventory, billing and coding for Family Practice, Radiology, Lab and Physical Therapy. Also worked as floor nurse as needed.

Brand new managed care clinic, created to on-site at a manufacturing plant to decrease health care costs for the Frigidaire company. Responsibilities included hiring staff, scheduling, inventory, budgets, developing P&Ps for a new clinic. Management of Nursing, Radiology, Laboratory, PT/OT, Billing/Coding and reception staff. Admin of new medical records beta program. Provided Nursing staff coverage for Occupational Health Department of on-site manufacturing plant.