Happenings
The 2024 Annual Award Winners!
Associate of the Year
Rebecca Wagner
Rebecca Wagner, an appeals specialist, has been recognized as the Associate of the Year. With 21 years at Palmetto GBA, she is celebrated for her extensive knowledge and exceptional communication skills. Rebecca participates in the Part B Letter Development Committee to improve verbiage and is a go-to resource for system tips and guidance. Her detail-oriented and analytical approach ensures high-quality performance and productivity.
Key Achievements:
Performance Metrics: Consistently meets or exceeds standards, achieving 100 percent decision accuracy monthly in 2024 and maintaining a 100 percent Medicare Redetermination Notice letter quality rating for 11 months (99.7 percent in the remaining month).
Process Improvement: Submitted five educational referrals and enhanced a letter matrix process, reducing escalated questions by 5.03 percent.
Team Support: Promptly responds to coworkers' emails and calls, aiding in quick and accurate claim processing to meet customer expectations and team goals.
Process Improvement of the Year
Home Health Computer-Assisted Review of Documentation
Team members: Ken Arenz, Amy Bailey, Mary Alice Barth, John Chambers, Clinton Griffin, Jim Goodwin, Mieorka Lites, Eric Meadows, Amanda Moye, Lillian Pais, Amy Rhodus, Sruthi Sagi, William Simmons, Leigh Tedder, Reginald Tolbert, Karl Welch, Yubo Zou'
The Home Health Review Choice Demonstration (HH RCD) Department has been recognized for its innovative computer-assisted review of documentation (CARD) solution. To expand services to additional states without hiring additional staff, the HH RCD team developed a CARD process to automate a pre-claim review request and reduce the number of manual medical reviews by a registered nurse. Given the success of CARD, this initiative was named Process Improvement of the Year.
Key Achievements:
Workload Reduction: Substantially reduced the workload for medical reviewers, allowing them to focus on claims from other states.
Cost Savings: Provided significant cost savings by eliminating the need for new staff.
Quality Control: Allowed flexible quality control by adjusting manual review volumes.
Coach of the Year
Lori Holsinger
Lori Holsinger, a Claims Operations manager, has been named Coach of the Year. With over 20 years at Palmetto GBA, Lori is celebrated for her exceptional dedication and support of her team. She stays current on processing changes through training sessions and steps in to train new associates when needed. Lori is known for her attentiveness to team members' personal and professional needs, respectful and knowledgeable approach, and commitment to improving work processes. She addresses issues with grace, listens to all perspectives, and provides constructive criticism to enhance efficiency. Her positive attitude, continuous support, and willingness to exceed expectations make Lori a valued leader and trusted friend to her team. Lori's dedication and leadership have made a significant impact on her team's success.
Key Achievements:
Performance Metrics: Mentored her team to meet 100 percent of 152 external metrics.
Team Support: Conducted one-on-one and team meetings to identify and bridge performance gaps.
Efficiency: Her team achieved timeliness rates higher than 98 percent.
Process Improvement: Contributed to ten process improvement projects.
Team of the Year
Debt Management System Collaboration Team
Team members: Vishnu Boochireddy, Melissa Cash, Ray Dailey, Carol Harper, Heather Hastings, Reetu Joshi, Derek Roberts, Thomas Sorrells, Danian Taylor
The Debt Management Systems (DMS) team of associates from two divisions—Systems and Support and Finance and Accounting—has been named Team of the Year. The team participated in a Centers for Medicare & Medicaid Services pilot program to create Application Programming Interfaces (APIs) that connect internal Palmetto GBA systems to the Healthcare Integrated General Ledger Accounting System (HIGLAS). The team developed APIs that enabled the incompatible systems to communicate and share data. Collaborating with outside agencies, the team created and tested the APIs within a three-month window to meet their deadline. These enhancements increased accuracy and efficiency for the Finance and Accounting Department, allowing them to retire old software and servers, thus reducing costs. The DMS team is valued for its high-quality solutions, effective communication, and strong collaboration.
Key Achievements:
Process Improvement: Developed APIs to enable communication between incompatible computer programs within a three-month window to meet the deadline.
Operational Efficiency: Reviewed and improved other areas of operation, increasing accuracy and efficiency for the Finance and Accounting Department. Saved an estimated 3,019 work. Eliminated the need for specific software licenses and servers, provided real-time data access for providers and internal tracking platforms, and supported faster collections while minimizing lost paper checks.
Cost Reduction: Retired old software and servers, reducing costs.
