Happenings
Shared Services’ Second Quarter Honorees Raise the Standard for Claims and Appeals
Coach of the Quarter
April Jackson
Clear communication guides April Jackson’s work as a Utilization Management Manager for the Jurisdiction J and Jurisdiction M A. Through regular updates, team meetings and individual guidance, she clarifies expectations, addresses common errors and helps employees reach their goals. April also encourages staff to recommend process improvements and makes time to recognize their accomplishments. Her hands-on support strengthened the team’s quality assurance reviews, reporting and communication with providers and helped them earn a 100 percent quality score for 2025.
Team of the Quarter
Jurisdiction J Part A Appeals
Team members: Kathleen Barbato, Traci Beauchamp, TaBryant, Whitney Garris, Susan Harrelson, Sabrina Holland, Sandra Hopkins, April Jackson, Shaquana Linder, Sidney Roberson, Karen Schmitt and Toccora Wilson
The Jurisdiction J Part A Appeals Team works closely across a fully remote environment to meet the timeliness and quality standards established by Palmetto GBA and the Centers for Medicare & Medicaid Services. Team members use shared resources and direct appeals questions to a central inbox to keep guidance and responses consistent. The team attends ongoing training and also continues to improve its work through updated templates, enhanced instructions and expanded cross-training. Their collaboration led to perfect scores for redetermination timeliness and the most recent quality review, with every appeals analyst exceeding annual quality requirements.
Process Improvement of the Quarter
Part B Claims Processing
Team members: LoveaLee Blevins, Tricia Cordell, Angela Culver, Dorrita Gleim, Lori Holsinger, Crissy Jackson and Dana Schmidt
The Part B Claims Processing Team identified an opportunity to increase efficiency while delivering important information to providers more quickly. Before the process improvement, two procedure codes submitted without required documentation indicators were suspended and routed through two separate manual reviews. By enhancing the system logic, the team automated the identification and rejection of these claims, immediately notifying providers that additional documentation is needed. The improvement eliminated duplicate reviews and accelerated provider notification giving them the opportunity to respond sooner. It also enabled processors to focus more attention on claims requiring individual review.
