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 market levels.- Effectively communicate, build, and execute improvement plans at the practice levels based on areas of opportunities identified.- Collaborate with Sr. Director of Operations to identify and engage with potential network primary care providers who would benefit from participating in Wellvana's value-based care agreements. - Facilitate meetings with providers regarding patient follow-up after unplanned admissions and ER visits.-Provide excellent customer service and establish good working relationships with the providers and staff. - Serve as the primary contact to providers for performing activities designed to establish and maintain positive and productive relationship with Wellvana network providers.

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.• Maintains up to date knowledge related to HEDIS, Risk Adjustment, and Accountable Care Organization measures.• Worked with Independent Insurance Marketing Organizations who provides contracted agents to our existing health plans. The agents provide the most comprehensive solutions in the Medicare Health Insurance Market. • Participate in provider forums.• Obtain and analyze quality metrics and reports for care opportunities, support practice, identify action plans for providers to improve cost, quality, and patient experience. • Assist Care Coordinators, Managers, and Physicians on HEDIS compliance and data collection. • Work with internal departments in developing and making recommendations to resolve issues. • Assist in the process of credentialing providers, site visits, obtain missing documents and conduct new provider orientation and training.• Develop strong relationship with office staff and providers to promote their growth in the network.

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 the plan among providers.• 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.• Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time.• Identified potential claims trends and follow up with providers and internal departments to ensure resolution of problems. • People skills with the ability to work in a challenging environment and participate as an independent contributor with little supervision or as an active team member. • Identifies network access and deficiencies and develops strategies to overcome obstacles. • Helps new and existing team members with projects and training. Collaborates with other departments to work on specials projects and resolve any operational issues.• Recruits new groups to participate in our share savings program that rewards providers for practicing efficient, preventive, high-quality and cost-effective health care.• Works with Quality Management Team on Healthcare Effectiveness Data and Information Set (HEDIS), Value Base Program (VBP), Medicaid Quality Incentive Program (MQIP), Provider Quality Incentive Program, (PQIP) measures ensuring that our members are receiving the necessary services and that the care gaps are being closed.

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. • Created and maintained information required to support the network development process.• Managed the function relating to credentialing and re-credentialing of the provider network, troubleshot credentialing concerns, and oversaw provider visit tracking. • Oversaw the processes related to provider denials, sanctioned activities and terminations to ensure applicable due process for appeals was forwarded. • Oversaw monitoring and coordination of outreach to non-responsive providers during credentialing and re-credentialing. • Verified all incoming documents and scanned them into the system for all providers who were starting the credentialing process and going through the re-credentialing process, or any provider who was making any new changes.

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. • Communicates with Hospital based Case Manager as necessary to ensure prompt resolution of pre-existing, non-covered, and re-certification issues. • Utilizes Meditech account notes and Collection System account notes as appropriate to cut-n-paste benefit and pre-authorization information and to document key information. • Meets/exceeds performance expectations and completes work within the required time frames.