Leadership Project

1. Employees Training To Prevent
Claims Denials
Rachel J. Tuazon
Team Leader
03/02/2020

2.  According to recent assessments, gross
charges denied by insurance payers has
grown to 15 to 20 percent of all claims
submitted, so it is important to create a
necessary action to prevent this issue.

3.  The goal of the project is to create a well-established process
of managing denied claims by insurance carriers through
reporting, trending and forecasting.
 To create a necessary action plan to prevent claims denials in
order to improve revenue cycle.
 To improve revenue cycle by creating an effective denial
program.
Key benefits of an effective program includes;
o Effective processes for denials tracking and appeal
o Reduced denial cases

4.  Claims denials pose a serious issue in every
organization since it is very costly to appeal, and it is a
huge obstacle to complete the reimbursement in a
timely manner.
 An effective denial management program enables the
organization to better manage revenue cycle. Key
benefits of an effective program include; identification
of principle reasons of claims denials; efficient
processes for denials tracking and appeal; reduced
denial volumes; improved receivables and improved
communication and collaboration with other
departments within the organization.

5.  The scope of the project is to reduce the volume of insurance
claims that are being denied to minimize resubmission in order to
improve revenue. This includes:
o Creating metrics and dashboard reports to responsible process
owners.
o Routing of denied claims to work queues to ensure that issue are
resolved and resubmitted in a timely manner.
o Establish a denial strategies and process to categorize root causes
for improvement.
o Provide education to all clinical staff to minimize recurrence.
o System security access and segregation of duties in processing claim
adjustments, resubmission and write-off.

6. Figure 1:Breakdown of Denials

7.  Improve all areas throughout the Revenue
Cycle
o Patient Admittance
o Ancillary Services
o Case Management
o Enterprise Information System
o Finance
o Health Information Systems
o Compliance

8.  To address denial issue, mandatory training will be
provided to all employees in order to avoid
overwhelming claim’s denial that affects the
hospital revenue cycle.
 3 Trainers will be assigned to lead the training
session
 Training is scheduled on 03/02/2020.
 Training will be held at the Conference Room A.
 The trainers will present the course design and
have the attendees collaborate throughout the
session.

9.  3 trainers to present
 1 laptop
 1 projector
 1 HDMI cable
 Handbook
 Note pads and pens
 Refreshments and snacks for the workshop
 Tables and chairs configured for hands-on
portion of the workshop
 Attendees to bring their laptops.

10.  The presentation is scheduled for
limited time only. To alleviate this
limitation, a handbook is available and
can be utilized as a reference by all
participants. This information will also
be available in the intranet.

11.  The training will take place on
Monday, March 02,2020 from 8am-
5pm.
 PowerPoint and handbook have
completed on February 20, 2020.

12.  Rachel Tuazon and Elizabeth Chase have
completed the PowerPoint presentation.
 Team members reviewed the PowerPoint
presentation and provide feedback for
improvement.
 Robert Blunt completed the handbook.
 Team members reviewed the handbook and
provide feedback for improvement

13. Figure 2: Project Scheduling

14.  Rachel Tuazon
 Elizabeth Chase
 Robert Blunt

15.  Rachel Tuazon lead the project and
provide guidance to the team.
 Each team member were expected to
provide ideas and feedback on how to
improve the project.

16. Identifying problems and implement a possible
solution and Increase employees’ awareness on
possible claims’ denials.
How to measure?
Employees’ performance review and comparing
knowledge and practices before and after the
project.

17. • Define goals and objectives
• Schedule milestones
• Allocate resources
• Designate team member’s responsibility
• Define metric for success
• Build a culture of flexibility and action plan
• Evaluate success

18. As a leader, I practice integrity, empathy and
assertiveness throughout the project. I allow the
team to provide their perspective and ideas and give
importance to team agreement.
In terms of developing highly motivated teamwork, I
focus on rewards structure which I found it appealing
to the team members. Most importantly, I am
considerate and concerned about the needs of my
team members and willing to provide emotional
support when needed.

19. Democratic style of leadership has been applied
in the project. Everyone in the team were treated
equally. We helped each other reach our personal
goals and ensured that everyone is being heard.
Communication between group members is also a
top priority. Team members were positioned to use
their talents optimally to promote productivity and
quality standards. Maintaining morale and workplace
harmony is also crucial.

20. Providing structure is an important task in my
leadership. It provides sense of security, direction and
stability to the team by understanding the project
expectations and goals that needs to be accomplished.
Clarifying norms is also important to me since it is a
component of group functioning. I pay attention to norm
development in my team to help maximize the group
effectiveness.
Building cohesiveness plays an important role
during our project. Everyone is encouraged to express
their personal viewpoints, give and receive feedbacks,
accept opinion different from their own and feel
comfortable doing meaningful task.

21. While working on the project, I focused on
recognizing differences and embracing those
differences. Everyone is treated as an insider
and encouraged to retain their uniqueness.
A culture where difference is valued was built
within my team. Everyone in the team has an
equal opportunity to grow and be successful.

22. In my leadership, I do not react to the
energy of the team, instead I find a way to
transform conflicts into learning and
productive results. It is recognized and
expressed through communication in order
to break conflicts and obstacles and apply it
as a learning experience.

23. The choices that leaders make and how they
respond in each circumstance are informed and
directed by their ethics (Northhouse, 2018).
I practice ethics, values and social justice in my
leadership. I listen and respects my team’s
point of views. I am also concern about
fairness and justice, so I ensures that everyone
is treated fairly and equally while their welfare
is my top priority.

24. Figure 3: Leadership Evaluation

25. Figure 4: Leadership Evaluation 2

26. Team assessment is important to build a strong team
culture. It opens the door to a solid discussion on how to attain
success in a project. On this venture, my first goal was to have
an outstanding team and to make it possible, I always ensure
that the team have open communication. I also need to be
engaged, inclusive, kind and respectful to every member of the
team. Everyone was encouraged to share ideas and we bring
together those ideas to the project which I found plays an
important role for the success of the project. I agree with the
team’s assessment that I need improvement on the ability to
redirect the team to the right path when something in the
project goes wrong.
In the future, I may need to have different options
planned in case we need to modify the project. Lastly, I
understand that I will be more effective if I can revisit our goals
regularly in order to make changes in a timely manner
whenever it’s necessary.

27. Figure 5:Basic Lessons Learned Process (White & Cohan,2015)

28. I have learned that communication plays
an important role in conflict and its resolution.
The most helpful approach to conflict is
collaboration which requires a person to
acknowledge, deal and resolve the conflict by
fully focusing to others concern without
sacrificing their own. Managing conflicts
effectively is a key to a stronger relationship
among others and a creative way to resolve the
problem.

29. Encouraging and motivating the team is very
essential to the success of our project. This includes
open communication, establishing constructive
climate and practicing equal opportunity and
empathy. Regular team huddle also helps a lot
because this is the time, when we share our ideas,
suggestions, concerns, and actions that may need to
be improved or eliminated.
In the future, I will review my previous
leadership experiences and feedbacks from the team
to determine my efficiency and apply this leadership
style to the new project.