Happenings

Division 4M Spotlights Associates Who Excel

Rachel Payne, staff development manager, Home Health Review Choice Demonstration Support

Coach of the Quarter

Rachel Payne

In addition to being described as her team’s biggest cheerleader and an exceptional manager, Rachel Payne is now the Division 4M Coach of the Quarter. As the staff development manager for the Home Health Review Choice Demonstration (HH RCD) Support Department, she manages the Training and Quality Assurance team. Rachel recognizes and praises individuals and the entire team when they achieve goals. She stands out as a coach because she not only recognizes successes, she also acknowledges the effort. A big advocate of team building, Rachel created a committee that plans team activities.

When she sees the need for improvement, she coaches with encouragement and constructive criticism by focusing on the issue rather than the person. Rachel has great confidence in her team’s abilities, and she encourages them to excel and grow in their roles, which sometimes includes stepping outside their comfort zones. When the department is faced with challenges, she seeks input from her team, validates everyone’s concerns and persists until the issue is resolved.

Corey Adkins, medical reviewer II, Home Health Review Choice Demonstration

Associate of the Quarter – January

Corey Adkins

Corey Adkins is a medical reviewer II in the HH RCD Department but is the January Associate of the Quarter for her exceptional skills in her additional duties as a preceptor to new hires. Described as a ray of sunshine with a great sense of humor, Corey is great at putting others at ease. She is also receptive to questions and feedback and her answers are always backed up with a reference. Corey is a huge asset to Palmetto GBA and embodies all the corporate values, but excels in communication, responsibility and integrity. She is reliable, trustworthy, honest and always respectful of others’ opinions. Corey is observant and challenges her preceptees with meaningful goals and encouragement. She makes a positive difference in her department and division.

Shanda Wahab, operations analyst, Review Choice Demonstration

Associate of the Quarter – February

Shanda Wahab

Since joining the RCD operations analyst team two years ago, Shanda Wahab has been a hard-working team player who ensures that work is completed right the first time. She is the February Associate of the Month because of her attention to detail and high-quality performance. It is also why she trains new associates on claims processing. She is always eager to learn and takes the initiative to pull data to ensure it is compliant before being submitted to CMS. She is also diligent with communication, so people are kept apprized of projects even when they are out on leave.

Loreliza (Liz) Painter, operations analyst, Review Choice Demonstration

Associate of the Quarter – March

Loreliza Painter

Loreliza (Liz) Painter, an operations analyst in RCD Support, is prized for her willingness to take on additional responsibilities, learn new skills and help teammates to ensure metrics are met. She is the March Associate of the Month because in addition to mastering the rules and requirements of all the contract types, Liz is a great coach and trainer to her teammates. Her deep understanding of the contracts makes her an invaluable resource to all her colleagues. “Due to her willingness and knowledge to learn new things, I feel comfortable knowing that when I take vacations, she will monitor everything to ensure things get completed timely,” said Leigh Tedder, claims operations manager. “Liz is one of my go-to people!”

Process Improvement of the Quarter

Implementation of Home Health Computer-Assisted Review of Documentation

Team members: Ken Arenz, Amy Bailey, Mary Alice Barth, John Chambers, Clinton Griffin, Jim Goodwin, Mieorka Lites, Eric Meadows, Amanda Moye, Lillian Pais, Amy Rhodus, Sruthi Sagi, William Simmons, Leigh Tedder, Reginald Tolbert, Karl Welch and Yubo Zou

The HH RCD Department planned to expand its services to additional states and wanted to do so without hiring additional registered nurses. The HH RCD team determined this could be achieved with a computer-assisted review of documentation (CARD) solution. The team developed a CARD algorithm that determines if a pre-claim review request is likely to be affirmed. If it is, the request bypasses manual medical review by a registered nurse. If CARD is unable to render an affirmation, the claim is sent to a registered nurse for manual medical review.

CARD was implemented in Illinois on November 1, 2023. It substantially reduced the workload for medical reviewers working on those claims giving them the needed time to review claims from other states. Given the success of CARD, this initiative was named Process Improvement of the Quarter.