Happenings
Division 93 Celebrates Q4 Award Winners
Associate of the Month — October
Kellie Warren
Kellie Warren, a senior provider education consultant in Medical Review, is Division 93’s 2024 Associate of the Month for October. Known for her dedication and willingness to assist her colleagues, Kellie plays a crucial role in contacting providers for Comprehensive Error Testing Rate (CERT) and Targeted Probe and Educate (TPE) education calls. Her collaborative spirit was evident when she stepped in to help a supervisor during the manager's vacation, successfully resolving a provider's inquiry regarding their TPE experience.
Kellie's expertise extends beyond her people skills; she is also an Excel wizard, creating graphics and spreadsheets that help managers monitor inventory levels and staff productivity. These tools have proven invaluable in setting assignments and developing departmental goals. Currently, Kellie is working on a continuous process improvement project related to CERT, further highlighting her commitment to enhancing the department's efficiency and effectiveness.
Associate of the Month — November
Earlene Marshall
Earlene Marshall, a document control clerk in Augusta, has been honored as the November Associate of the Month. Earlene’s knack for finding efficient methods without compromising accuracy, coupled with her accountability and sound judgment, makes her a standout team member. Over the past year, she demonstrated her dedication and excellence by maintaining a 100 percent quality score. With a 45-year tenure at Palmetto GBA, Earlene is known for her friendly demeanor and initiative-taking approach. She consistently exceeds expectations, contributes to process improvement initiatives and is always willing to step up when the workload increases.
Associate of the Month — December
Donna Phelan
While Donna Phelan has only served as a medical reviewer III in the Benefits Integrity Department since July 2024, she has proven to be a prized team member. As the sole review clinician, she has been very skilled in uncovering incorrect payments. Her close attention to detail and deep understanding of complex fraud schemes have been instrumental in her role. Donna's commitment to her duties and her ability to explain complex issues clearly make her a vital member of the team.
Coach of the Quarter
Janet Pleiman
When the Benefit Integrity Department filled its sole clinician position in July, Janet Pleiman, a medical reviewer III in the Appeals and Hearings Department, stepped up to assist with training. Having worked as a benefit integrity clinician before, Janet was well-equipped to explain all relevant policies and procedures effectively to a new clinician. She also conducted quality reviews on the clinician’s work to ensure accuracy and provide feedback for necessary improvements. Thanks to Janet’s excellent training and coaching, the new clinician has maintained a 100 percent quality score since completing the training. Janet continues to be available to answer questions, demonstrating her commitment to supporting her colleagues. Her outstanding performance has earned her the Q4 Coach of the Quarter award.
Team of the Quarter
Augusta Hurricane Response Team
Team members: Lynette Brooks, Astrid Castillo, Myra Christian, Christina Harper, Selena Haskins, Coni Hutt, Ysabel Lace, Sheila Littleton, Earlene Marshall, Yvonne Marshall, Barbara Naugle, Matthew Royan, Arrie Sanchez, Cathy Stroud, Priscilla Testi, Christina Todd, Tammy Turner, Chanice Ward
On September 27, Hurricane Helene hit Augusta, Georgia, and Aiken, South Carolina, causing widespread damage that included Palmetto GBA facilities. With the offices closed due to water, power and communication outages, a group of staff members, despite personal losses, volunteered to travel to and work in the South Carolina offices in Columbia and Camden. Within two days, this dedicated group, called the Augusta Hurricane Response Team, made great strides in restoring operations for our Railroad Retirement Board Specialty Medicare Administrative Contractor beneficiary and provider call and operations centers. By day four, the team reached full capacity for calls and document processing. Despite all the challenges and limited staff, the team maintained high service levels and met all metrics, demonstrating dedication and resilience.
Process Improvement of the Quarter
Spreadsheet Revision for the Daily Claim Line Determination Report
Team members: Kellie Warren and Robin Elliott
The Q4 Process Improvement of the Quarter was created to improve the daily claim determination reports. The improvement involves adding data to daily reports on the number of claims reviewed and completed the previous day. They took this data and broke it down by employee to display how many claims each associate completed and the types of documentation completed. This helps management keep track of the workload and support team members. This change has improved efficiency and communication, leading to increased confidence and satisfaction among the team.
