Julia Dailey Email & Phone Number

Dallas-Fort Worth Metroplex

- Collaborate with the Operations and Care Management team to align clinical programs with Value-Based Care objectives, using data analysis and reporting to identify patients with high-risk conditions.- Work closely with the Wellvana Operations team to optimize the use of corporate resources and achieve Key Performance Indicators at both practice and.

Dallas/Fort Worth Area

• Work with the following Single point of contact for Group Physicians, Independent Physician, Clinics, Specialist, and Hospitals.
• Liaison between the Health Plan, Practice Administrators, Office Managers and Physicians.
• Tracks progress of programs and prepares status reports to management or senior management.
• Build Client Networks and sustain positive relationships with physicians and administrative staff and effectively managed the Dallas/ Fort Worth Area.
• Recruit Primary Care Physicians and Specialist.
• Delivered orientation, and ongoing education to physicians and staff on Health Plan policies, procedures, and resources.

Hanover, Maryland

• Provided support of plan providers and staff including orientation, education, and the scheduling of On- site visits as well as incorporating plan’s policies and procedures and for fostering a positive perception of.
• Build Client Networks and sustain positive relationships with physicians and administrative staff.
• Recruits providers to build a cost effective, high quality provider network in accordance to our network requirements goals.
• Facilitate provider enrollment, contracts, credentialing and re-credentialing.
• Provided support to the physicians advocating on their behalf, presenting their concerns on reimbursements, covered and non-covered services, and negotiating/renegotiating contracts.
• Manages and conducts all face to face meetings along with on-site trainings.

Augusta, Georgia Area

• Served as a liaison to providers and was responsible for performing activities designed to establish and maintain positive and productive relationship with AMERIGROUP network providers.
• Responded to telephonic and written inquiries from providers.
• Identified and monitored provider issues and concerns, recommended solutions, and worked with local and corporate staff to resolve the issues.
• Analyzed provider network for adequacy in addressing member's medical needs and assisted in the identification and recruitment of key providers where network gaps or needs exist.
• Provided expertise and assistance with guidelines relative to provider billing and payment.
• Ensured that provider relationships with the plan are positive and productive.

El Paso, Texas Area

• Retrieves reservation/notification of scheduled admission from gatekeeper.
• Performs pre-registration and insurance verification within 24 hours of receipt of reservation/notification for both inpatient and outpatient services.
• Follows scripted benefits verification and pre-certification format in Meditech custom benefits screen and record benefits and pre certification information.
• Contacts physician to resolve issues regarding prior authorization or referral forms. Performs electronic eligibility confirmation when applicable and documents results.
• Contacts patient via phone with as much advance notice as possible, preferably 48 hours prior to date of service to confirm or obtain missing demographic informing.
• Utilizes Meditech MOX communication system to facilitate communication with hospital gatekeeper.