Coach of the Quarter – Sheila Littleton

Sheila Littleton has been with the company for over 13 years. Although her title may be Appeals Specialist, she does so much more and does it with a smile and great attitude. Recently, Sheila started testing for the new Palmetto Automated Correspondence System (PACS) and updated the Quality Management System (QMS) 360 documents for the department. The team counts on Sheila’s dedication and support. Fellow teammate Vicki Clack says, "Sheila is very pleasant and delightful to work with. Her great attitude shines through every day, and she makes the days even more enjoyable.” Congratulations to Sheila for being awarded our Division 93 Q1 Coach of the Quarter. 

Team of the Quarter – Augusta Document Control Leads

The Leads Team for Augusta Document Control consists of Myra Christian and Cathy Stroud. Supporting eight lines of business, this duo is instrumental in achieving departmental, team, and company goals.

Cathy is quick to volunteer for additional projects and regularly serves as the direct point of contact for community outreach activities. Her attitude is contagious, and she is committed to the company's goals of 100% excellence. Cathy juggles many tasks but makes sure they are completed on time and with exceptional quality.

Myra is well-rounded in her knowledge of all processes needed, from start to finish, to complete the work. She is eager to learn and willing to share her knowledge and experience with others to drive the team’s success

This team puts in the hard work with excellent results, earning the Augusta Document Control Leads Team our Q1 Division 93 Team of the Quarter.

Team Members: Myra Christian and Cathy Stroud

Process Improvement of the Quarter – Medicare Beneficiary Indicator (MBI) Partial Letter Indicator

To safeguard the Medicare Trust Fund, the Benefit Integrity department routinely requests records from providers to perform claim reviews to determine whether fraud, waste, or abuse has occurred.

There are usually several beneficiaries listed on the record request. Occasionally, the provider will fail to send records for all the beneficiaries. In this situation, the Benefit Integrity associate will send a letter to the provider indicating which beneficiary records are missing. This allows the provider to send in the records before all the claims are denied for missing documentation.

To allow for an automated alert when the records are past due and have not been returned, two columns were added to the Benefit Integrity pending spreadsheet, when the partial letter was sent, and when the records are due back. The Benefit Integrity associate can proceed with either denying the claims for a non-response or preparing the additional records for the clinical review. This improvement provides 100% quality for timely reviews.

Team Members: Van Dixon, Taryn Herrmann, Tammy Keel, Ricky Newton, Becky Stroud, and Debra Watson

Associate of the Month (January) – Tricia Alfano

Tricia Alfano is the lead associate for the Office of Personnel Management (OPM) contract. At the end of 2021, the department experienced an unexpected increase in the daily receipt of claims. Tricia evaluated and identified reasons for the anomaly in the workload. Tricia's knowledge and experience helped her to determine that some claims were now requiring manual review but should not have been. She worked together with Tech Support to modify the system logic to auto-reject these claim receipts for manual review. Within a couple of weeks of this new implementation, the daily workload was stabilized, and operations resumed as usual. This willingness to better her team and department and maintain quality work earned her our Division 93 Q1 Associate of the Month for January 2022. 

Associate of the Month (February) – Daniel Toson

Daniel Toson, a Document Control Clerk, has worked in the Augusta Document Control Center for over 13 years. Daniel handles all incoming letters for the Jurisdiction J Medical Review (MR) Appeals and Medicare Secondary Payer (MSP) and backs up multiple other teams. He wears many hats within the department and does it with ease, accuracy, and expertise. One of Daniels' most remarkable qualities, according to his team, is that "his positive attitude is contagious and spreads as he goes from department to department." For his dedication, assistance with other teams, and quality of attitude, we are excited to announce Daniel Toson as our Q1 Division 93 February 2022 Associate of the Month.

Associate of the Month (March) – Yvonne Marshall

Yvonne Marshall, a Document Control Clerk, has been a part of the company for over 16 years. She is a dedicated and hard worker who excels in her job daily. She is solely responsible for all incoming faxes and ensures that they are completed within two days of receiving them. She is quick to find and implement new processes to streamline her job duties and increase the quality of work. In addition to her role with faxes and indexing, she also supports multiple other departments. Yvonne plays a key role in the success of the Document Control team. We would like to congratulate her on being awarded our Division 93 March 2022 Associate of the Month for this quality and hard work.