Coach of the Quarter – Gina Metts

We are thrilled to announce that Gina Metts, Medical Review Supervisor, has been named Coach of the Quarter for Division 4M. Gina is a skilled leader who is always available, approachable, honest,  and supportive. Her team appreciates her strong organizational skills and her willingness to engage with them, taking the time to understand their feedback. According to team members, Gina values and respects each team member, making working on projects and tasks rewarding. Congratulations to Gina for her exceptional leadership and team-building abilities!

Team of the Quarter – Outpatient Prior Auth Department Medical Review Team

Division 4M’s Outpatient Prior Authorization Department (OPD) Medical Review team has dedicated itself to providing excellent prior authorization services over the last few months. This team, consisting of five medical reviewers, has seen a rise in the number of prior authorization requests submitted. Despite the increase in work, the team was well-prepared to handle the new workload. They have gone to great lengths to ensure that the quality of work remains high while also providing excellent customer service to providers. Congratulations to this team for being named Division 4M Team of the Quarter.

Team Members: Ayanna Douglas, Christina Gilbert, Mary McCoy, Christina Walls, and Stephanie Wood

Process Improvement of the Quarter – Med Review ADR Address

Before the process improvement, the Review Choice Demonstration (RCD) and Outpatient Prior Authorization (OPA) Additional Document Requests (ADR) letters had two addresses. The main Medicare Administrative Contractor (MAC) address was on the first page, while the RCD or OPA address was on the second. This resulted in manual work to ensure that the ADR letters were sent to the correct location.

To address this issue, the operations and technical support teams, collaborated to find a solution. They successfully implemented an update to the system that ensures the correct address populates ADR letters in the future. They generated ADR test cases, reviewed letters, and made necessary corrections for production. Now, all new ADR letters have the correct mailing address on pages 1 and 2, eliminating the need for separate addresses. This new process has increased efficiency and reduced manual work. Congratulations to the team for their attention to detail and commitment to improving efficiency.

Team Members: James Castillo, Betty Davis, Brandalyn Dedonis, Octavia Griffin, Anan Lee, Erica Mason, Amanda Moye, Jason Rhodes, Leigh Tedder, and Leigh Tollison

Associate of the Month (April) – Margo Stilley

Margo Stilley works as a Medical Reviewer II and is a compassionate and organized member of her team. Recently, Margo  organized a care package and offeredsupport to a team member who experienced a personal loss in their family. Thanks to Margo's dedication, her team was able to provide the care and support that their colleague needed. We applaud Margo's compassion and drive to ensure that her team supports each other. Congratulations for being named our Division 4M associate of the month.

Associate of the Month (May) - Laura Strutko

Laura Strutko is an invaluable asset to the Quality Assurance (QA) team as the Quality Assurance and Training Coordinator. She frequently leads multiple trainings and handles classes with ease, no matter how large or small the size. Laura does an amazing job answering any questions she receives and takes the time to ensure that the answer is well understood. She is also a true team player, making her colleagues laugh daily and promoting an  honest work environment. One member of her team even said that Laura has the biggest, most giving heart. Congratulations, Laura, for being named Division 4M associate of the month!

Associate of the Month (June) – Tatum McCallum

Our Division 4M Associate of the Month, Tatum McCallum, is a Medical Reviewer II.  Tatum is known for her hardworking and supportive nature. She is friendly, smart, and always willing to lend a helping hand when needed. Recently, she has taken on the role of preceptor, assisting in training and one-on-ones with other team members. Her peers have praised her for taking on every challenge presented to her and excelling in its completion. We congratulate Tatum for her outstanding work ethic and dedication to helping others succeed.