Happenings
Division 28 Recognizes Q1 Award Winners
Associate of the Month – January
Ashley Baker
Ashley Baker, a senior medical reviewer, has been a reliable and helpful resource to her colleagues in the past several months. As the only coding validator on her team, she must process every claim that requires validation. During this period, the entire team has seen a workload increase. Despite the heavier workload, Ashley has had a great attitude and continues to help others when needed. To recognize her contributions, she has been named the January Associate of the Month.
Associate of the Month – February
Sammy Strickland
On multiple occasions Sammy Strickland, a medical reviewer II, has stepped up to help answer provider questions regarding the intricate Inpatient Rehabilitation Facility (IRF) reviews. Several providers have mentioned how helpful and friendly he is when they’ve contacted him for clarification. Sammy also recently joined an impromptu education call to answer specific IRF reviews. His team appreciates his willingness to help others with a smile and named him the February Associate of the Month.
Associate of the Month – March
Sheila Bell
Sheila Bell is a senior operations analyst and March Associate of the Month. With more than 20 years of experience at Palmetto GBA, her expertise makes her a point of contact for major implementations and workgroups. Sheila is appreciated for being friendly, dependable and reliable, and her colleagues know they can count on her for guidance. Described as a patient teacher, she uses real examples to explain concepts and ensures others understand the material. Sheila is considered a pivotal part of her division and an asset to the company. Her contributions have improved her division’s overall effectiveness and efficiencies.
Team of the Quarter
Home Health and Hospice Medical Reviewers
Team members: Rebecca Anderson, Sherri Black, Lacy Branham, Megan Chappell, Jennifer Conway, Brenda Dixon, Melissa English, Daisy Godwin, Dana Hardin, English Hawkins, Chasity Martin, Sylvia Moreland, Katie Morris, Deshonda Smith, Ginger Taggart, Jennifer Williams, Mandy Williams, Ashley Young
In the fall of 2024, weather emergencies (hurricanes) produced an initial work slowdown but by February resulted in a surge of claims that had to be completed in a tight 4-week timeframe. The Home Health and Hospice Medical Reviewers, named the Team of the Quarter, distributed the workload based on each team member’s strengths. The team committed to working the extra hours required to review the nearly 4,000 claims by the deadline. Despite the heavy workload, the team continued to meet its other responsibilities and quality scores.
Process Improvement of the Quarter
Medical Review Data Strategy
Team members: Sheila Bell, Lynne Culler, Chantel Warren
Prior to this improvement, a nurse in the Medical Review Department made a list of certain types of claims that needed to be moved to a specific location. To simplify the process, the team used the automated claims processing system to create a report to identify these claims. The process, which originally took 30 minutes when it was manual, was reduced to eight minutes. In addition to being more efficient, this Process Improvement of the Quarter lowered the cost.
