Critical Communication

Running head: CRITICAL COMMUNICATION EVENTS

Critical Communication Events

Organizational Communication- BADM 6123

Master in Business Administration Group 110

Southern Nazarene University

Dr. Pam Broyles

Lee Brown

August 22, 2011

I currently work at Mercy Physicians of Oklahoma (MPO) central billing office. At MPO central billing we file insurance claims for patient’s that have visited a MPO physician. The position I currently hold is Patient Account Representative. There are two different aspects to being a patient account representative. These include accounts receivable follow-up and denials. I have worked on both teams during my five years at MPO. The last three years I have been on the denials team. The denials team follows up on claims the insurance has already processed, but has been either denied or processed incorrectly by the insurance company. It is my job to call the insurance company and to find out what needs to be done to get the claim corrected and paid by the insurance company.

Working at MPO for five years there have been many successful or memorable incidents. One event that stands out to me was discovering our own insurance, Mercy Health Plans (MHP), had been processing claims incorrectly. I noticed the problem and that there were a lot of patient’s claims that had been processing incorrectly. I contacted MHP to find out what was wrong. MHP told me that they did not receive the required pricing sheet from First Health Network. All MHP claims first go to First Health Network to be priced and forwarded to MHP for payment. I discovered First Health was receiving the claims electronically and they did price the claims correctly, but the information was not transferring correctly between First Health and MHP. I contacted our provider representative with MHP and with her help we were able to get the correct pricing sheets forwarded to MHP and the claims were reprocessed and paid correctly.

In this case the fact that I...