Happenings
Division 93 Recognizes 2023 Q4 Award Winners
Coach of the Quarter
Melissa Mayson, a lead claims processor in the Pricing Support Department, is Division 93’s Coach of the Quarter for the final quarter of 2023. She promotes quality excellence in her department through her willingness to help team members understand procedures and instructions. Her coworkers appreciate her patient and understanding coaching skills and know they can count on her for guidance, so they meet all metrics. Melissa also participates in team discussions and decisions and is always willing to assist teammates who need help.
Associate of the Month—October
The October Associate of the Month is Taryn Herrmann, a medical reviewer III and sole clinician in Benefit Integrity. Taryn reviews medical records submitted by providers who are being investigated. Since joining the department in 2020, she has completed 324 reviews and achieved a 100 percent quality score on all of them. Her work resulted in the reversal of more than $2.6 million in overpayments. Taryn’s coworkers value her communication skills and appreciate her feedback during meetings and her initiative in addressing issues she discovers with the team. In addition to her regular responsibilities, Taryn has contributed to all the department process improvement initiatives and willingly helps with reviews when the Appeals area needs assistance.
Associate of the Month—November
Ricky Newton, a senior fraud analyst in Benefit Integrity, has been with Palmetto GBA for more than 20 years. The November Associate of the Month, Ricky is known for providing superior customer service and for being a reliable helping hand on special projects or when others need assistance. Ricky takes pride in his work and often takes the lead on projects. Because of his focus on quality, he always exceeds expectations on his projects. Ricky ensures his team members understand their roles and responsibilities and helps them meet many monthly metrics. Ricky is a great teammate who welcomes open communication, helps others in need and takes the initiative to run reports when others are out of the office, so they are completed on time. Not only has Ricky contributed to every process improvement the Benefit Integrity unit generates, but he is also instrumental in writing the analysis reports.
Associate of the Month—December
Sheila Thomas, a provider file specialist in Provider Enrollment, is an outstanding claims processor who maintained a 100 percent quality rating for 11 months and a 99.5 percent rating the other month. This performance earned her the December Associate of the Month award. In addition to maintaining the high quality of her own work, she is always willing to help the team complete other assignments when needed.
Team of the Quarter
Customer Service Leads
Team members: Lynette Brooks, Eileen Green, Tyrese Smokes, Christine Todd, Jocelyn Tucker, Erica Williams
The customer service leads team is the Division 93 Team of the Quarter because their exceptional performance ensures all required tasks are completed on time. The leads encourage customer service associates to use the resources available and play a critical role helping them answer questions so they can complete calls effectively and efficiently and meet quality standards. Despite having these extra responsibilities, most of the leads take customer and provider calls daily, which is critical to the area meeting average speed of answer metrics.
Process Improvement of the Quarter
Appealed Claims Reconciliation Process Automation
Team members: John Beckham, Dayna Bruce, Angela Bryant, Vicki Clack, Cassandra Davis, Gabriele Godbee, Edgar Herran, Terra Holt, Deborah Benning, Sawarnjit Jalli, Sheila Littleton, Mary Malaguti, Janet Pleiman, Vontrae Roach, Arrie Sanchez, Melanie Smith
In August, the Railroad Retirement Board (RRB) Appeals Department began work on requests to reconcile claims that had been purged from the database and discovered that some were very large and would take staff many hours to process. To increase the process efficiency, the Appeals team worked with the automated claims processing system developers on a two-step solution that would unpurge the claims and then automate adjustments. First, the developers created a script that unpurged claims from the system. Then the team created a script with the developers to run a spreadsheet through the system to automate adjustments.
Prior to the improvements, it took an appeals specialist one minute to unpurge each claim and one hour to process 12 claims. The automation saved the company nearly 6 hours and $83 to unpurge 331 claims in September. From September to November, the Appeals team processed 4,124 claims with the new improved process. Without the automation it would have taken an additional 344 hours and $5,649.T he projected yearly saving for this process improvement is roughly $22,500 and 1,369 working hours. The automation also reduced manual errors and staff burnout, improved morale and earned the RRB Appeals the Process Improvement of the Quarter award.
