BSAD 320 Problem Statement Development Draft

Problem Statement Development: Draft Working in the medical billing industry can be daunting at times. My last position as a follow up representative, proved to be the most challenging job that I have ever had. I have an extensive background in the medical insurance industry. I was aware of the way that claims were to be handled and submitted to insurance companies. The company that I had worked for had just won a contract for taking over the medical billing for twelve physicians in Portland, Oregon. Right off the bat, there were a variety of issues concerning how to bill the medical claims correctly. Claims have to be submitted on time, with the correct codes and information on them, before they can be processed by the insurance company.
There were so many denied claims coming back to be fixed, which in turn created many problems for the employees. When the workload outweighed the employees assigned to bill the claims, is when it started to become a major concern. It not only added additional work for the employees, but time away from their other duties. There was poor communication between the management team, employees and the physicians that we were billing for. As a follow up representative, I was in charge of denied claims for this group of physicians. Since the physicians’ offices were not located in Indiana, the rules for billing were quite a bit different then what I was used to. I had noticed that many errors were being made, due to the lack of training for the employees on this new billing system. Most of these issues were developing at the start of the shift and progressed throughout the work day.
The end result for these issues was that, claims were filed incorrectly, thus increasing the workload of the denied claims. When the person responsible for entering the medical information was unaware of their mistakes, this increased the amount of denied claims that I was left to deal with. This continued to be the biggest problem