In this episode of the MGMA Insights Podcast, Sr. Editor and host Daniel Williams spoke with Carol Ittig, MBA, FACMPE, Practice Administrator at Children’s Orthopaedics and Scoliosis Surgery Associates in St. Petersburg, Florida. Carol shared her journey into healthcare leadership, the transformative power of mentorship, and how adopting a go-giver philosophy has shaped her approach to management.
She also shared practical strategies for solving payer challenges, leveraging collaboration, and navigating prior authorization hurdles — all critical issues for medical practice leaders today.
A Career Sparked by Early Healthcare Experiences
Ittig’s interest in healthcare began in high school, where a medical skills class introduced her to patient care. “One of the questions was, who was your favorite teacher in high school? And that would have to be Mrs. Warner," she reminisced. "She was a nurse, and she had this medical skills class."
Through this program, Ittig worked as a dietary aide in a retirement home, an experience that shaped her career aspirations. “I just really, really enjoyed talking to the retirees," she added. "They became like a second family to the point where they were like my grandparents. I had like a hundred of them.”
This early exposure led Ittig to major in healthcare administration and join a co-op program in college. “As I was getting towards the end, I started doing little interviews with different people in the field," she said.
One conversation changed everything: A seasoned executive advised her to start in medical group management — a concept that was completely unfamiliar to her at the time. That recommendation set her on a trajectory that began with an entry-level role as a medical receptionist and ultimately led to her current position as a practice administrator.
Lifelong Learning and Innovation in Practice Management
Ittig described herself as a lifelong learner who embraces new challenges. “One of the things about being a practice administrator is you’re kind of jack of all trades, master of some," she said. "And I find myself to be like one of those lifelong learners.”
This mindset has driven significant innovation in her practice. “This year, I dove into three new things in my job here that I’ve never done before," Ittig explained. "We started a research department ... a foundation called CH Ortho Cares that helps with pediatric orthopedic research ... a real estate holding company because the doctors are buying the building that we occupy here in St. Petersburg.”
She credited her network for providing guidance and expertise when venturing into unfamiliar territory. “Whenever I dive into something like that, I have to rely on my peers and my network,” she said.
These connections have been instrumental in problem-solving and innovation, from understanding compliance requirements for research programs to structuring real estate deals for physician-owned facilities. “If I did not have that network of peers, either at MGMA or AAOE, I wouldn’t be able to do my job today,” she added.
The Transformative Power of Mentorship
Mentorship didn’t just influence Ittig’s career, it completely reshaped it. When she joined a leadership organization for orthopedic executives, she accepted an offer to be paired with a mentor. That decision introduced her to Debbie Mitchell, a seasoned leader who would become a pivotal figure in Ittig’s professional journey.
“Debbie Mitchell changed my life,” Ittig said. “She was funny. She called me and said, ‘I’m going to take you all around Chicago to the best bars … and we’re going to dinner with all the best vendors, and you’re going to meet everybody.’ And she was true to her word.” What began as a lighthearted introduction evolved into a mentorship that taught Ittig critical lessons about leadership and resilience.
Ittig went on to say that Mitchell’s guidance was a lot more than mere networking: “She taught me through her mentorship that boundaries are healthy. You don’t have to allow behavior from people that isn’t healthy. And she didn’t care if people liked her. She cared if she got the job done.”
For Ittig, this was a revelation — that effective leadership isn’t about popularity; it’s about accountability and results.
This mentorship relationship also opened doors to new opportunities. During a vacation to Florida, Mitchell encouraged Ittig to interview for her own position, which ultimately led to Ittig’s current role. “Once I met the doctors here and saw how giving they were and how they valued their employees, I had never really had an employer like that before. And it was that way because of Debbie.”
Mitchell’s influence extended into technical expertise as well. “She really taught me everything she knew about revenue cycle management,” Ittig explains. That knowledge sparked a passion that continues today: “If I ever get out of administration, I’m going to just do revenue cycle management because I love it."
"It’s fun because you get to fight with the payers and eventually, hopefully win,” she added, smiling.
Adopting the Go-Giver Philosophy
Ittig’s leadership style aligns closely with the principles outlined in The Go-Giver by Bob Burg and John David Mann — a book that she says gave her the language for instincts she was already following. “I had already been leading that way — giving value first, helping others without keeping score — and the book gave me the language for my instincts,” she explained.
For Ittig, generosity comes with boundaries. “Being generous doesn’t mean letting yourself get drained. It’s giving in ways that empower people, not enable them.”
She emphasized that this mindset is not just a personal philosophy but a necessity in healthcare.
“The go-giver mindset is very important in health care because it’s the second most regulated industry in the country right behind nuclear energy," she said. "It’s impossible to self-teach your way through it, and we need each other."
"Collaboration isn’t optional. It’s survival," she said, emphatically.
Ittig also shared how the book’s five laws — value, compensation, influence, authenticity, and receptivity — resonate with her leadership approach. “The law of receptivity, the key to effective giving is staying open to receiving," she said. "I can tell you through the relationships I’ve made and this philosophy of mine that I have received back tenfold."
She added, "I’m involved in a couple of really cool projects right now that I would have never been involved with if I hadn’t engaged in this behavior.”
Collaboration as a Tool for Problem-Solving
Ittig’s commitment to collaboration isn’t theoretical — it has delivered tangible results. She shared a striking example from her work in revenue cycle management. “I started a billing listserv for orthopedic billers," she said. "One of the things that came up on that listserv was we were all getting the same denial on casting supplies. The denial was saying that casting supplies were inclusive in fracture treatment and that it was a new NCCI edit. And none of us… remembered anything changing.”
As the conversation unfolded among peers, the scope of the problem became clear. “We started communicating, okay, now I’m getting it with Humana. Now I’m getting it with Aetna. Now I’m getting it with Cigna. And what we found out is that there is one company that serves 90% of the payers in the country on their claims editing software, and they had incorrectly interpreted an NCCI rule and implemented a rule to all of their payers that was incorrect.”
The impact was staggering. “My practice alone had 1,200 claim lines denied over like $50,000 worth of claims denied… We were able to work with AAOS… They wrote a strongly worded letter to this third-party vendor, letting them know that their edit was wrong, and they were able to turn the edit off.”
Without that collaborative network, Ittig said, the issue might have persisted indefinitely.
Navigating Prior Authorization and Emerging AI Challenges
Prior authorization remains one of the most frustrating pain points for practices, and Ittig is tackling it head-on through collaboration and technology. Working with Dr. Paula Ballester, she explored innovative solutions to streamline approvals. “She became very frustrated with this prior auth process and started talking about coming up with a software that would help providers… bumping up the payer policies against the documentation to see if there were any deficiencies.”
The concept is simple but powerful: compare payer requirements with clinical documentation before submitting an authorization request. “It might say, okay, yeah, it looks like this patient is ready for you to submit prior auth except for like the payer requires six weeks of physical therapy and six weeks of NSAID and you don’t have that documented," Ittig explained. "So then you take the minute to go back and you find the physical therapy records and do an addendum to the note and record the NSAID usage.”
She also warned of emerging challenges tied to artificial intelligence in payer processes: “The AI that I see is that the payers are probably sharing edits or being suggested edits by their third-party vendor, which is not good," Ittig said. "In my opinion, probably it's probably along the lines of antitrust.”
To this point, practice leaders must stay vigilant and proactive in managing those payer relationships.
MGMA Podcasts Get An Unsolicited Plug (No, really!)
“I really don’t have the time to read a bunch of emails and comb through the website," Ittig said.
Her solution? MGMA Insights podcasts. "I listen to your podcast every week," she shared. "That’s really how I’m learning about all the different things MGMA has to offer.”
Resources Mentioned
- Carol Ittig on LinkedIn
- Orthopedic Executives Association (AOE)
- CHORTHO Cares Foundation
- The Go-Giver by Bob Burg and John David Mann
- MGMA Membership
- MGMA Mentor Program
- If you're interested in joining the MGMA Book Club, reach out to Daniel at dwilliams@mgma.org.
