Texas Children’s Health Plan has long been focused on improving its operations in many ways. At the top of the list is establishing and maintaining good relationships with our providers.
“When providers are happy, members are happy,” said Anna Mateja, vice president at The Health Plan. “It’s an understatement to say that we value providers. They are absolutely essential to the care of our members and families.”
So to that end, meeting the needs of nearly 12,000 physicians and specialists, has become high priority. Among efforts to address this priority was the recent establishment of the Strike Team, a team of four employees solely focused on trouble shooting and customer service.
“Our team ensures that concerns are addressed in a timely way, underlying issues are resolved and overall quality service is delivered to our providers,” said Jennifer Sima, senior decision support analyst who project manages for the group. Strike Team members are Nekia Grays, senior provider relations representative; Christopher Sam, senior claims examiner; Imani Phillips Spears, operations systems analyst II, and DaShawn Wilson, senior provider relations representative. The formation of this special team has required that these employees temporarily step out of their every day roles and take on this special task.
When first commissioned, the group was faced with a backlog of more than 3,043 issues. The combined effort of the Strike Team and multiple departments helped to reduce the targeted backlog to 390 within just a few months. Their work is ongoing and their value to The Health Plan increases each day.
Sima adds that she is incredibly proud of the Strike Team’s progress. She emphasizes that their success has come largely at the hands of collaboration and cooperation with normal operations; including provider relations, claims processing and member services. “The Strike Team is definitely part of our One Amazing Team.”
An overarching theme at The Health Plan is customer obsession. In an effort to become more customer obsessed, there are several projects taking place.
Just a few of these are:
- The implementation of Epic Tapestry, a core claims processing system for managed care organizations that will provide integration across the Texas Children’s system and eliminate the need for multiple databases and duplication of many processes.
- Streamlining the onboarding process for new providers which will make it easier and faster to join the Health Plan network.
- A brand new claims processing dashboard project that provides real-time information on how we are managing claims.
- Customer service training from the Patient Experience department for our Member Services and Provider Services call center employees.
For more information about the Strike Team’s work, please contact Jennifer Sima at jxsima@texaschildrens.org.