Ops 571 Wk1 Dq1

Which process flow structures are prevalent in your organization, or one that you are familiar with? Are the process flow structures appropriate? How effective have the structures been?

As we all have discovered one way or another, whether reading in the text or on the job experience, a critical part of any operation is the process flow. The process flow consists of a series of steps which determine how a product is manufactured or a service provided. The process flow structure determines how facilities will be laid out, the working methods used, the resources needed, the technology used, and/or how efficient the process is.

A process flow structure has four categories, but generally falls into two categories. These two flow structure are either what is known as a job shop or a flow shop. The job shop process flow structure represents a fairly general structure, which is highly flexible and can use general purpose resources. In contrast, a flow shop process flow structure can only use certain specialized resources, with a fixed path for the work. As a result of this, flow shop processes tend to be less flexible than job shop ones.

Being that I work in a physician billing department for a hospital, I would compare our flow process to that of the job shop category. Our structure is a general structure and very flexible since each invoice must be dealt with in its own way. My department more specifically handles insurance denials and in doing so we have our own flow process separate from other departments. We will place a call to the insurance company on the denial and attempt to have the claim reprocesses. If we are unable to have the claim reprocessed we will move to either the appeal process or pending payment process. The pending payment process consists of submitting any and all information or medical notes required to have the claim processed, changing modifiers or diagnosis codes, changing procedure codes, or submitting an updated coordination of benefits....