Happenings
Division 93 Spotlights Q2 Award Winners
Associate of the Month — April
Sheila Littleton
An appeals specialist in the Division 93 Medicare Appeals/Hearings Department, Sheila Littleton is known for her smile, a willingness to help and great customer service. During the first five months of 2024, she maintained a quality score of 99.45 percent. She also contributed to several successful continuous process improvement (CPI) initiatives this year. Sheila is a great role model for effective and thorough communication, and she encourages teamwork and collaboration.
Associate of the Month — May
Kim Payne
Described as an intelligent, capable and reliable resource, Kim Payne, a claims analyst II in the Medical Review Department, provides superior service to our customers. With a 23-year tenure at Palmetto GBA, Kim is highly knowledgeable about claim processing and a vital member of the team. Kim is approachable and generous with her time and knowledge. When her colleagues request her help with a question, she will take the time, whether it’s ten minutes or 40, to provide a thorough answer, suggest a useful resource or even assist with research.
“I consider her a friend and a valuable resource in the Medical Review Department. She has contributed to empowering me in my job performance, said Nancy Cain-Sickafoose, a medical reviewer III. “I appreciate Kim Payne and all her contributions to the department.”
Associate of the Month — June
Ricky Newton
Ricky Newton, a senior fraud analyst in Benefit Integrity, has been with Palmetto GBA for more than 20 years. The June Associate of the Month, Ricky is known for providing superior customer service and a willingness to help others and to take the lead on special 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. In addition to implementing several of his own process improvement ideas, Ricky contributes to all process improvement initiatives generated by Benefit Integrity, often by writing the analysis.
Coach of the Quarter
Van Dixon
Known for his spirit-lifting smile, Van Dixon has a friendly demeanor that sets a positive tone for the office. Van, a fraud analyst in Benefit Integrity, is approachable and genuinely cares for others, which makes him a favorite among customers and staff. His excellent communication and active listening skills make him an exceptional collaborator and now the recipient of the Coach of the Quarter award.
Van’s attention to detail is commendable. He looks for ways to automate repetitive tasks, data extraction and analysis to save time and minimize errors. His efforts in process improvements have streamlined workflows and reduced manual efforts. As a department subject matter expert, Van’s knowledge, leadership, innovative thinking and proactive approach have led to significant process enhancements. His positive attitude, commitment to process improvement and his support of colleagues make him a valuable team member.
Team of the Quarter
Operations Support Team
Team members: Ingra Johnson and Barbara Naugle
The Operations Support team members—Ingra Johnson, a project assistant, and Barbara Naugle, a project administrator—are valued for their ability to adapt to new challenges and for their encouragement to others to do the same.
Both take a creative approach to complex situations and are great at identifying ways to improve processes and make them more efficient. This duo, the Q2 Team of the Quarter, excels at collaborating with others and takes on responsibilities to ensure the team’s success. They are eager to help their colleagues and make a positive contribution to the group dynamic. Their dedication to collaboration, quality and the success of the team is commendable.
Process Improvement of the Quarter
Instructions for Training and Quality Assurance Coordinator to Perform Quality Review
Team members: Dayna Bruce and Terra Holt
Dayna Bruce and Terra Holt in Appeals/Hearings noticed that there were no guidelines or instructions for training and quality assurance coordinators to follow while performing a quality review on clinicians. While all reviews were completed using the same form, only one field on the form was required. As a result, the level of detail in the reviews was inconsistent.
To remedy the situation, the team wrote step-by-step instructions that explain how to complete the clinical quality review process from start to completion. This established consistency and increased the level of detail provided in the reviews. The enhanced reviews led to a decrease in the number of rebuttals. The defined workflow also decreased the average review time by two hours.
