Case Study $5$: Solving Team

Challenges at DocSystems Billing, Inc.

Read the DocSystems Billing case, including the briefing document and four

scenes, and consider the following questions:

$1.$ What problems exist in this organization? How do these problems differ

based on the employees' roles? Why do employees object to Jim's pro

posed solution?

$2.$ Make a recommendation to the client about what could be done next

based on the data included. Summarize your observations for Jim, offer

possible interpretations, and suggest an approach for next steps.

Briefing Document: DocSystems Billing, Inc.

About the Company

DocSystems Billing, Inc., processes insurance billing paperwork for a network of

small health care clinics throughout the United States. Privately owned physician prac

tices, as well as specialists such as cardiologists and physical therapists, contract with

DocSystems to process the billing paperwork through the maze of health care insur

ance companies and networks. DocSystems charges either a flat fee for each bill it

processes or a percentage of the total, depending on the contract with the provider,

About the Call Center

$$ Forty full$-$time employees work at the onsite call center: $30$ Medical Insurance

Specialists $($who handle cases of moderate complexity$)$ and $10$ Senior Insurance

Consultants $($who handle very complex cases$).$ The senior consultants have usu

ally worked up through the ranks, often first working on basic billing, then as

medical insurance specialists. Most of them have a long tenure with DocSystems,

ranging from $17$ to $23$ years.

$$ An additional $100$ employees $($called Billing Specialists$)$ work at an outsourced

call center, DocSystems contracts out the initial processing of claims and basic

computer input. The contract employees used to work at DocSystems until the

outsourcing.

$$ The call center was outsourced a year ago to another organization. Almost all of

the former DocSystems employees were offered jobs with the new company, but

the pay and benefits were not comparable. Word has spread to the former col

leagues who remain at DocSystems that the outsourcing company treats its

employees poorly.

$288$ ORGANIZATION DEVELOPMENT

Call Center Reorganization

The remaining group of $40$ employees was reorganized into two new teams about

$3$ months ago. Initially, there had been two managers$-$Alex managed the senior insur

ance consultants, and Dana managed the medical insurance specialists. Both reported

to Jim, the senior director. In the new structure, Alex and Dana both manage $20$

employees, with each managing half of the specialists and half of the consultants.

That meant that some of each group remained with their former manager, while

some moved to a new manager. Senior management hoped that the integrated teams

would start to share knowledge between more senior and more junior practitioners.

Roles and Work Process

Billing Specialist

The billing specialists do the initial computer input and handle the majority of the

cases. Normally this occurs without any need for DocSystems intervention or assistance,

but occasionally there are difficult issues that arise. For example, a cardiologist may

have conducted a certain procedure that fits more than one category in the DocSystems

database, and the billing specialist may be unsure how to categorize it accurately. A

phone tree system has been set up between the outsourced organization and

DocSystems so that the billing specialist can call any of the medical insurance special

ists, who are required to be on call at least $4$ to $5$ hours during a typical $8-$hour shift.

The partners can also formally escalate cases by handing them off through the system

for a medical insurance specialist to work.

Medical Insurance Specialists $($MIS$)$

A similar process works for the medical insurance specialists. They are assigned

insurance cases on a round$-$robin basis. They typically handle two types of cases:

$(1)$ any case that has been "kicked back" by the insurance companies for more information

Case Study $5$: DocSystems Billing, Inc. $289$

and $(2)$ any case where the patient has filed a complaint, grievance, or appeal, Like the

billing specialists, they work on the case to get it accurately processed and filed, and if

they run into problems, they can call on their senior counterparts, the senior insurance

consultants, to ask a question. They also have the opportunity to formally escalate

cases to have one of the senior insurance consultants handle the case if it seems too

complicated.

Senior Insurance Consultants $($SIC$)$

The senior insurance consultants handle anything and everything, but they usually

work on only the most complex cases. They also answer questions from the medical

insurance specialists. They usually get their work from formally escalated cases that the

medical insurance specialists cannot handle on their own.

The DocSystems Case in Four Scenes

Central Characters

Jim: Senior Director, Customer Service