Coach of the Quarter – Kathy Kardules

Kathy Kardules, a Claims Customer Service Director has 40 years of tenure with the company. Kathy has a tremendous amount of experience and is always ready to help her team members with helpful information, direction, and assistance with projects and tasks. She has a positive attitude and encourages her team, motivating them to achieve their goals and meet deadlines. In addition to her job responsibilities, Kathy oversees the Shared Services divisional community impact initiative. According to her team, Kathy is "a leader who knows the way, goes the way, and shows the way."

Team of the Quarter –  JM Part A Appeals HHH/ HHPCR Team

Due to some required process changes, the workload for the JM Part A Home Health and Hospice team has increased. A normal production requirement is five to seven claims per day for home health and hospice. To meet the CMS metric of closing every claim within 60 days of receipt, the daily production requirement increased to eight to nine claims per day, and in some cases, reach fifteen claims per day.

To complete this new workload, the team received assistance from the JM Medical Review (MR), Review Choice Demonstration (RCD), and JJ Part A teams. The MR and RCD hospice reviewers helped review and make decisions on claims, while the JJ Part A team members researched, labeled records, and built worksheets. Quality Assurance (QA) coordinators and the supervisors composed and assembled letters, disposed of the lines of each claim, and ensured that they were mailed appropriately.

Understanding the problem, implementing a solution, and calling for help when needed is an important step towards becoming efficient and achieving optimal performance. This team strived to keep our standards high and meet all metrics. 

Team members: Candice Allison, Logan Autry, Kathleen Barbato, Victoria Bryant, Tamara Bryant, Nora Burk, Christy Calloway, Sylvia Clingman, Samantha Cloud, Beth Eskridge, Georgia Ford, Cheri Hagood, Crystal Hancock, Susan Harrelson, Paula Hemphill, Carmen Hernandez, Tabatha Huffmaster, Jessica Klein, Wendy Littleton, Christina Metcalf, Jeannette Norris, Bonnie Poore, Sidney Roberson, Danny Scott, Chandra Thomas, Camilla Toney, Sandra Trzesniowski, Ben Turner, Latisha Williams, and Mandy Williams

Process Improvement of the Quarter – Daily auto-load of pending Part B  (PTB) Claims Processing files

The Centers for Medicare & Medicaid Services (CMS) recently required that 99.5% of pending claims in the Multi-Carrier System (MCS) be processed within 45 days. The claims processing team didn’t have an easy way to determine the total volume of pending claims or the breakdown of the number of claims greater than 45 days until the month-end reports were available. This caused issues because claims processing would have to manually research the MCS age files and other reports daily to obtain the necessary information.

Claims processing and the Medicare systems teams collaborated to monitor and determine which claims are due in 45 days. A solution to extract data from daily pending age files was based on the specification for the monthly reports. Once this information was pulled and exported to a Comma-Separated Values (CSV) format, the claims processing team could see the total pending claims. This new file allows for the filtering of claims and improves efficiency considerably. The new implementation has saved, on average, 60 hours a month. 

July Associate of the Month: April Stenstrom

April Stenstrom, a Training and Quality Assurance Coordinator, goes the extra mile to help anyone who needs assistance. She researches projects endlessly so that she can complete tasks at the highest quality. April takes the time to coach other teammates and trains them to learn the ropes. Conducting teammates quality assessments allows April to see everyone’s strengths and identify areas for improvement. She uses this information to develop training plans tailored to each team member. April's care for her work and the development of her team is the reason we're excited to announce her as our July Associate of the Month!

August Associate of the Month: Toccora Wilson

Toccora Wilson is an Appeals Analyst who excels at meeting timeliness and quality standards on large master cases. She is known to pitch in and help others with projects. Toccora is a true team player with a positive attitude. Her team describes her as "an outstanding asset to the JJ Part A Appeals team”. Her positivity and dedication to quality work set her apart from others. Toccora also consistently receives praise for her hard work from leadership. This dedication to her job and team makes Toccora our pick for the August Associate of the Month.  

September Associate of the Month: Logan Autry

Logan Autry, a Senior Medical Reviewer, is a go-to resource for her department. She is always available and eager to answer any questions and give helpful insights on tasks and projects. Recently, Logan was led on a project where she trained nurses and team members on warm and cold transfer calls for the Provider Call Center. She is extremely diligent in her work and normally finishes well before the deadlines while maintaining high work quality. Logan is a valued member of her team and department. Logan, we congratulate you as our September Associate of the Month.