Tywanna Swain_Week 3 Outline.docx

1 Final Paper Prep Outline Tywanna Swain The University of Arizona Global Campus MHA 601: Principles of Health Care Administration Dr. Yvonne Lozano October 31, 2023

2 Final Paper Prep Outline A. Introduction  Thesis: Healthcare delivery is a complicated sector that is constantly evolving with many reoccurring changes such as operational processes, organizational changes, competitive innovation, increasing cost, and medical reform. To effectively manage these changes and others, there must be efficient organizational operations in place. B. Gainwell Technologies a. Gainwell Technologies is a strategic partner and technology provider to those who operate in America’s health and human services industries. Gainwell has locations across all 50 states however, this site is located in Tallahassee, Florida. b. The mission of the company is to empower clients through innovative technologies and solutions to deliver great health and human services outcomes for beneficiaries nationwide (Gainwell Technologies, 2023). c. The company services more than 5 million recipients in the state of Florida and approximately 207,000 Medicaid participating providers are enrolled. d. Gainwell Technologies offers a wide range of global services, including core Medicaid solutions, to its consumer base. With over 50 years of experience, Gainwell has established itself as the leading Medicaid services provider. As a contractual-based organization, Gainwell serves the Agency of Health Care Administration (AHCA), which is its main stakeholder. In addition to the contract, Gainwell is bound by several service-level agreements that must be fulfilled on a monthly basis. Failure to meet these agreements may result in liquidated damages

3 for the company. To ensure that all contractual requirements are met, our Quality Assurance team follows a comprehensive review process. This process involves specific measurement, reporting, evaluation, and follow-up steps. By utilizing this process, Gainwell is able to identify and analyze problems, determine appropriate corrective actions, and implement process improvements. This approach involves the entire organization, which ensures that all departments are actively involved in maintaining the quality of services provided. Overall, Gainwell Technologies is committed to delivering high-quality Medicaid services and continuously improving its processes to meet the needs of its consumer base and fulfill its contractual obligations. The global services offered by Gainwell Technologies include: i. Claims – which is the process that involves health care providers receiving payment for services they rendered to a patient. ii. EDI Clearinghouse Services – which facilitates the transmission of electronic claims between payer and provider. This process also supports batch transactions and direct data transactions. iii. Provider Solutions – this is the credentialing of providers in the state that is interested in participating in the Florida Medicaid program. iv. Managed Care – services offered to managed care organizations such as enrollment and payment processing.

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4 C. Departmental Problem on Operational Efficiency a. One departmental problem that has an impact on operational efficiency is the occurrences of return to provider (RTP) letters that have invalid or incomplete application deficiencies identified in the letter. This results in a delay of provider approval, additional work for the staff, as well as provider escalations from the client. D. Two Solutions to Identified Problem a. Staff could possibly be returning applications with invalid deficiencies due to lack of training and lack of knowledge regarding processes and procedures. One solution to this problem is to ensure that the processes are documented so that staff can use them as a guide when processing applications. Creating standard operating procedures will help avoid any confusion staff may have as well as make sure that everyone is on the same page regarding what they are supposed to do. Knowledge management ensures a more efficient business. “ Knowledge management is an organized and systematic method for managing the knowledge within an organization and using this knowledge in various activities in order to achieve the organization’s goals” (Haddadpoor et al, 2015). b. Another solution to improve invalid RTP letters is to implement a comprehensive training program. “Training is a necessity in the workplace. Without it, employees don’t have a firm grasp on their responsibilities or duties” (Cross, 2018). Training is an important way for the organization to reestablish the performance of staff which leads to organizational success and growth. This solution is similar to the

5 transformational leader theory. According to (Walston & Johnson, 2022, pg. 314), transformational leaders engage in activities that not only change performance but also change the very essence of the organization. E. Conclusion a. Healthcare is constantly changing. Operational efficiency is key to minimizing waste, decreasing errors, as well as driving down cost. Without operational efficiency, it’s impossible to manage the daily changes in the health care industry.

6 References Cross, Ogohi & Daniel, Cross. (2018). Effects of Training on Organizational Performance. Asian Journal of Business and Management. 6. 2321-2802. http://dx.doi.org/10.24203/ajbm.v6i5.5489 . Gainwell Technologies. (2023, September 26). Gainwell Technologies. https://www.gainwelltechnologies.com/ Haddadpoor, A., Taheri, B., Nasri, M., Heydari, K., & Bahrami, G. (2015). Process Documentation: A Model for Knowledge Management in Organizations. Materia socio-medica , 27 (5), 347–350. https://doi.org/10.5455/msm.2015.27.347-350 Walston, S. L., & Johnson, K. L. (2022). Organizational behavior and theory in healthcare: Leadership perspectives and management applications (2nd ed.). Health Administration Pres

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