Happenings
Division 28 Recognizes Outstanding Associates
Coach of the Quarter
Dan Stade
Division 28 recognized Dan Stade, an auditor II in Provider Audit, as the Coach of the Quarter for the second quarter of 2024. He is valued for his written and oral communication skills. Colleagues appreciate his constructive feedback, which includes positive guidance and clear instructions. The team enjoys learning from him because he takes the time to explain how to do something as well as the reasoning behind it. He is patient when answering questions and, if needed, will explain something several ways to ensure his fellow auditor fully understands the answer.
Dan provides the same dedication to educating providers. His emails to them are appropriately detailed to ensure comprehension and limited follow up. His review notes are similarly detailed and geared toward teaching rather than correcting. Dan is very supportive of his coworkers, willingly shares his knowledge with other auditors, finds innovative solutions to complex problems and always encourages staff to think critically and to collaborate.
Associate of the Month — April
Denise Phillips
Denise Phillips, a medical reviewer III, is described as the ideal teammate and a vital member of the Data Strategy team and has been named the April Associate of the Month. She consistently produces high-quality work and sets the standard for the clinical team. While handling her own complex workload she willingly offers to help others. Denise has exceptional problem-solving skills and because she is so approachable, she is the department go-to person for answers and guidance, and she is always happy to help. Denise is also great at boosting team morale and keeping the team connected.
Associate of the Month — May
Pamela Bethune
Pamela's ability to identify issues and offer teammates constructive feedback, combined with her strong work ethic has allowed her to consistently exceed goals, meet departmental quality objectives and complete tasks ahead of schedule. An auditor II in Provider Audit and Reimbursement, Pamela provides excellent customer service by promptly responding to providers' inquiries. Her leadership style of embracing change and adapting to new situations serves as a positive example for others. Pamela proactively assigned tasks to team members and maintains an assignment log daily. She also created a checklist that helps reviewers accurately complete reviews and effectively train team members. Through dedication and hard work, Pamela has made exceptional contributions to her team and the company. In recognition, she is the May Associate of the Month.
Associate of the Month — June
Leslie Wells
Leslie works efficiently, completes assignments on time and often volunteers to help teammates to ensure departmental timeliness goals are met. Described as approachable, Leslie, a medical reviewer III in Data Strategy, often initiates communication regarding daily workload and offers suggestions for improvement in completing Data Strategy workload. In addition to being the June Associate of the Month, Leslie is a contributor to this quarter’s Process Improvement of the Quarter and the automated letter process improvement project.
Team of the Quarter
Medical Review
Team members: Na-Tissha Jackson, Susan Matthews, Victoria Regrut, Ashley Stephens, Trina Williams, Debra Yates
This Medical Review team is comprised of six nurses: each review an average of 35 claims per day. They have been named Team of the Quarter not only because they have excellent communication skills and always meet their production goals, but they maintained it when they were short one nurse for more than a month. They also meet and often exceed their goal of processing claims within 35 days of receipt, which contributes significantly to provider satisfaction and higher quality scores.
Process Improvement of the Quarter
Quarterly Edit Effectiveness Report
Team members: Hannah Griffis, Albert Harrison, Leo Hartman, Janet Jackson, Denise Phillips, Molly Reynolds, Shavonne Samuel, Daliyl Skinner, Jennifer Williamson, Leslie Wells, Mary Evans Worley, Cathy Zhang
Each quarter members of the Data Strategy and the Medicare Statistical Analysis Departments write and publish an article required by the Centers for Medicare & Medicaid Services covering Palmetto GBA’s quarterly edit effectiveness metrics. Claim editing, also called auditing, is a step in the healthcare reimbursement process that ensures codes on medical bills are accurate.
Prior to this new report, the team pulled data from monthly reports to calculate quarterly metrics, which was a time-consuming process that increased the chance for human error. To increase efficiency and ensure accuracy, the team joined efforts to create the detailed, computer-generated Quarterly Edit Effectiveness Report. This report, selected as the Process Improvement of the Quarter, meets the requirements for reporting edit effectiveness, generates data for the required article and increases efficiency and accuracy by eliminating human calculation.
