Julie A. JacobsPROFESSIONAL SUMMARY

Healthcare administration professional with financial and CIS experience within the provider, payer, and vendor settings. Strong skill set allowing identification of abnormal details relating to quality and delivery of care, database development, and the creation of business processes to meet regulatory guidelines. In-depth knowledge of the informatics sector of the field. Subject matter expertise includes Medicare/Medicaid cost reduction strategies. Additional experience with Claims Cycle Analysis (Facets and QNXT), Operational Reporting, CMS Billing Practices, Tableau Analytics, Coordination of Benefits Auditing, and Database Administration. Six Sigma Green Belt Certified.

Areas of expertise include:

• Medicaid billing policies and procedures

• Comprehensive health industry knowledge• Experience documenting business workflows

and process mapping• Process Improvement (SSGB Cert)• Claims Analysis and Reporting using Tableau,

SQL to pull from QNXT and Facets • Experience documenting business workflows

and process mapping

• Ability to apply industry background to the ongoing shifts in healthcare IT and healthcare software

• Strong interpersonal skills, problem solving skills and ability to quickly build lasting relationships

• Excellent presentation skills through use of Microsoft PowerPoint, Excel, Word, and Tableau Analytics

SELECTED ACCOMPLISHMENTS

Training and Development • Created & developed new payment error projects/reports using Microsoft Access, Tableau, and SQL to overlay

on Facets and QNTX claims processing platforms• Created Microsoft PowerPoint slideshow providing an overview of the Managed Care industry with specific

emphasis on CMS billing guidelines for Modifiers and DRGs• Created a Tableau software training program to train workers how to use the data analytics portion to pull in

member utilization data, helping to identify outliers in care• Created Microsoft PowerPoint slideshow providing an overview of the specific ICD-10 coding changes

Consulting • Worked directly with the C-level execs of a commercial health insurance plan to create a monthly reporting

“book” which identified trends relating to claims turnaround time from provider to payer, which were then used to plan financial reserves for upcoming months. Claims were pulled from both QNXT and Facets.

• A core member of a Medicare Advantage Improvement Plan team which was able to identify a $24.1 million savings for the upcoming fiscal year through research.

• Analyzed current provider and member trends for Medicare Advantage health plan which was used to develop bid for upcoming fiscal year.

• Created and maintained a daily grid to track testing phases that were underway for a new Medicaid claims processing system (QNXT).

• Used QNXT and Facets to identify delays in claims processing, and then researched abnormalities. Findings were documented and used as a process improvement project.

Project Coordination• Created and maintained quantitative Excel spreadsheets with volume, charge, budget, and reimbursement

statistics, and targets for a large PHO; updated monthly

• Prepared revenue and expense budgets pertaining to divisional clinical and administrative activities as well as the supporting budget schedules and financial forecasts, utilizing Hyperion

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• Tracked the day to day timeline for a 12-month Medicare Advantage savings initiative • Worked on a vendor-selection team to identify specific vendors that would bring the most value to Managed

Care organization

Business Analyst • Developed Microsoft Access databases to pull data from various data warehouses to complete state regulatory

reporting requirements for 14 Medicaid and Medicare plans such as Facets, JIVA, and EXP Macess Service Modules

• Performed data verification through trending, benchmarking to ensure data integrity• Identified and researched data abnormalities • Provided oversight for the divisional billing functions of a hospital department, including charge entry, edit

corrections and accounts receivable follow-up, as well as detailed monthly bank reconciliation deposits for the clinical accounts

• Investigated medical claim data and/or medical records to identify payment errors • Analyzed and validated audit findings according to both payer processing guidelines / provider contracts

PROFESSIONAL EXPERIENCE

FluidEDGE Consulting, Malvern, PA August 2015-presentStaff Consultant

Clients: TMG, Jessup PANetwork Health Plan, Menasha, WIIntegra Partners, New York, NY

AmeriHealth Caritas, Philadelphia, PA June 2014-August 2015Regulatory Reporting Analyst

Thomas Jefferson University Hospital, Philadelphia PA August 2012-June 2014Financial Analyst, Department of Urology Data Analyst, Department of Surgery

Connolly Healthcare, Conshohocken, PA August 2010-August 2012Coordination of Benefits, Junior Auditor

EDUCATION and CERTIFICATIONS

Masters of Health Administration (MHA); 2016Saint Joseph’s University, Philadelphia PA Focus: Health Informatics

Bachelors of Science; 2010James Madison University, Harrisonburg, VAMajor: Health Services Administration

Six Sigma Green Belt Certified; 2016

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