Case Study $7$: Solving Team Challenges at DocSystems Billing, Inc.

Read the DocSystems Billing case, including the briefing document and four scenes, and consider the following questions:

What problems exist in this organization? How do these problems differ based on the employees$$ roles? Why do employees object to Jim$$s proposed solution?

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 practices, as well as specialists such as cardiologists and physical therapists, contract with DocSystems to process the billing paperwork through the maze of health care insurance 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 usually 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.

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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 colleagues who remain at DocSystems that the outsourcing company treats its employees poorly.

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 insurance 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 specialists, 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 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.

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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, DocSystems

Dave: Organization Development Consultant, DocSystems

Rosie Jones: Medical Insurance Specialist, D