Case Study
Solving Team Challenges at DocSystems Billing, Inc.
Merri Pedersen
Regis University
September 26, 2012
Upon review of the briefing document for DocSystems Billing, Inc., it is clear that problems exist within the organization, both at the surface along with potentially some underlying issues in the teams. In order to present a recommendation to the client, it will be important to identify the problems that exist within the organization, analyze how these problems differ within each area of the organization, and understand why the employees did not like a proposed process change to improve the situation. The recommendation will include a summary of observations, interpretations, and options for next steps.
I will start with looking at the basic problems identified at the organization level as reported by Jim, the senior director in the organization. Jim is concerned about the overall processing times at the call center, including ensuring physicians get payments quickly and patient problems and appeals are services in a timely manner. By asking more detailed questions, it seems the issue is not related to the Billing Specialist team (which was recently outsourced), but is more focused within the MIS (Medical Insurance Specialist) team, which is one of the teams that report thru a manager to Jim. Jim explained that the payment processing starts with the Billing Specialists, and gets escalated to the MIS team when problems arise with a payment. Jim explained that the delays in processing seem to be coming from this team due to heavy workload and juggling questions from the Billing Specialist team. He provided the example of the Platinum Tier physicians, who expected resolution in two to three hours, but are not getting issues resolved for fifteen hours. If the MIS team cannot resolve a payment issue, the payment can then get escalated to the SIC (Senior Insurance Consultants) team, who deal with the very complex payment processing, but this handoff does
Merri Pedersen
Regis University
September 26, 2012
Upon review of the briefing document for DocSystems Billing, Inc., it is clear that problems exist within the organization, both at the surface along with potentially some underlying issues in the teams. In order to present a recommendation to the client, it will be important to identify the problems that exist within the organization, analyze how these problems differ within each area of the organization, and understand why the employees did not like a proposed process change to improve the situation. The recommendation will include a summary of observations, interpretations, and options for next steps.
I will start with looking at the basic problems identified at the organization level as reported by Jim, the senior director in the organization. Jim is concerned about the overall processing times at the call center, including ensuring physicians get payments quickly and patient problems and appeals are services in a timely manner. By asking more detailed questions, it seems the issue is not related to the Billing Specialist team (which was recently outsourced), but is more focused within the MIS (Medical Insurance Specialist) team, which is one of the teams that report thru a manager to Jim. Jim explained that the payment processing starts with the Billing Specialists, and gets escalated to the MIS team when problems arise with a payment. Jim explained that the delays in processing seem to be coming from this team due to heavy workload and juggling questions from the Billing Specialist team. He provided the example of the Platinum Tier physicians, who expected resolution in two to three hours, but are not getting issues resolved for fifteen hours. If the MIS team cannot resolve a payment issue, the payment can then get escalated to the SIC (Senior Insurance Consultants) team, who deal with the very complex payment processing, but this handoff does
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