Promoting and Mentoring Professional Growth Names Our Coach of the Quarter

As a Claims Operations Manager, Lori Holsinger is a trusted leader for her team. Along with taking on new duties and responsibilities, Lori still makes sure to provide positive feedback, encouraging her staff to not only perform at their best, but also to keep raising the bar to meet new goals and challenges.

Even during a pandemic, where meeting face-to-face with her team is a challenge within itself, she still makes sure to keep the morale high by having weekly virtual meetings where she produces guidance, offers assistance and mentors her staff to ensure that all associates are cross-trained and well prepared for any task that may arise. Being a leader means accepting feedback, adjusting, and redirecting the team if necessary and Lori does just that.

Lori’s ability to promote professional growth, recognize the strengths of her team, mentor and lend assistance when needed, as well as boasting the team’s confidence, has earned her Shared Services’ Coach of the Quarter.

Improving System Codes brings in our Process Improvement of the Quarter

As part of the Part B Appeals and Part B Tech Support team, once a job is closed, a RSN (Reason) Code that best matches the work must be selected. This team noticed that the process was taking too long due to the volume of RSN Codes.

Working together, the team removed 247 RSN Codes. This was a vast improvement, as the average time it took to select a code was reduced from 25 seconds to an average of 15 seconds. Not only is time saved by eliminating or consolidating these codes, but also accuracy of closing redeterminations has increased. Over the course of the first quarter, a total of over 790 hours of time has been eliminated, accounting for over $17,000 savings.

The forward thinking, and perseverance of this group earned them Shared Services’ Process Improvement of the Quarter.

Implementing a New System for Prior Authorizations

The Outpatient Prior Authorization (OPA) Team is responsible for the successful implementation of CMS Outpatient Prior Authorization Model. The Team worked with CMS on weekly calls to establish new codes, edit and audit criteria. The teamwork maintained was essential in ensuring that all pieces of the process were covered to implement the model timely and accurately. The OPA Team was responsible for implementing manual work for services that were related to a Part A prior authorization service.

With only three months to get this process implemented, time was of the essence as specific new locations and edit/audits had to be created. This system update was necessary to process Part B claims, adding additional work to system logic and testing verification.

A step-by-step instruction guide was created and used as an essential part of training for processors and claims leads. The deliverables to CMS included maintenance screenshots, approvals for maintenance, audits, locations, procedure codes, testing and more.

Stepping up to the challenge and delivering an implemented request that meets CMS' expectations is why we're naming this team Shared Services’ Team of the Quarter.

Team Members:
Monica Williams, Brenda Ray, and Angie Culver

Associate of the Month

September – Tammie Myers

Tammie Myers, a Claims II Processor, is constantly striving for top team and individual performance. To continue at this level, Tammie goes above and beyond to make sure that the team is prepared by assisting support staff with training and helping her peers with any questions they may have.

During the work-from-home transition, Tammie hosted screen shares to assist colleagues as well as encouraging a group interaction setting where everyone is able to share their thoughts, recommendations and gain understanding of why a certain determination was made. A constant push for excellence is a call for Tammie Myers as Shared Services’ Associate of the Month.

November – Jeannette Norris

As a Training and Quality Assurance Coordinator, Jeannette Norris is always looking forward toward achieving department goals. Jeannette has gone beyond the call of duty by focusing on doing her job at her best, as well as being a supportive member of her team. With a proactive mindset, she has taken the lead, hosting extensive training sessions as well as creating and implementing training materials for her department.

December – Nikki Jacobs

Nikki Jacobs, a recently promoted Business Analyst III, is recognized as an Associate of the Month in part for developing strategies to accomplish new department goals, as well as taking a proactive approach to meet claim deadlines by identifying and targeting vulnerable status locations for aged claims. Even during this work-from-home transition, Nikki has successfully handled her regular workload as well as assisting with other challenges, such as training new staff and creating reports. Nikki is an invaluable member of her team, ensuring that they perform exceptionally.