EMPLOYEE
Senior Regional Sales Manager Employee Since:
October 24, 2011
Education:
Double Major: BBA Business Management BBA Marketing
Strengths:
• Experience / Industry Knowledge • Passion for Increasing Savings • Desire to Serve
Best Part of Working at UCS:
Infectious nature of staff. Whether the issue is savings, service or whatever, the desire every UCS employee delivers in doing their job to the best of their ability and more importantly to fix anything that does go wrong quickly and correctly the first time is inspiring. UCS just makes you want to do better and deliver more.
Hobbies:
• Golf • Brewing Beer • CLEVELAND INDIANS. Gotta love ‘em!
SPOTLIGHT Do you have any pets?
I have a 10.5 year old Golden Retriever named Floyd. He’s a great big ball of love/fun. Great breed!
What would someone find you doing on a weekend? Unfortunately, mostly yardwork & my honey-do list.
What is your greatest accomplishment?
The next time I get to help someone increase their savings.
Favorite Movies / TV Shows? MOVIES: • The Pink Panther movies (ONLY Peter Sellers) • Independence Day • Paper Lions
TV: • Gold Rush • Deadliest Catch Not sure why but I don’t like missing either one!
What major goal(s) do you hope to accomplish someday?
I’ve always wanted to catch a fish that is longer than I am tall (6 ft.) or weighs more than I do. (I’ll let you fill in that blank.)
Favorite board game?
RISK. We played games that lasted days, and some that weren’t finished for over a week!
Weirdest thing to ever happen to you:
Back in the days of Anthrax scares, I ended up being quarantined at a prospect’s office after a sales call. It seems a load of magazines was delivered that included excessive corn starch in the packaging. The hazmat people came, police, and fire rescue and shut down the building. No one in, no one out. I missed my flight, stayed an extra night and went home to wait for results of the tests they ran before they let me leave.
What is your biggest regret? Never being able to hit a curveball.
Favorite Quote of Life Motto:
This changes from time to time. I’ve been thinking of a line Shakespeare wrote in Henry V. “Once more unto the breach, dear friends, once more...” It seems to fit the life and circumstances of a career in sales. It also speaks to tenacity and determination to complete the task regardless of difficulty.
My family includes:
Just my lovely wife as immediate. I also have two brothers and a sister, and of course mom and dad. Dad has been gone for awhile but my mom just turned 100 seven months ago!
NEW EMPLOYEE NEWS Kurt Smith
Director of IT Security
Henderson, NV
Please welcome Kurt Smith to United Claim Solutions! He has 30+ years experience in the IT field. He spent the first 20 years in IT systems and network administration (both technical and management), and spent the last 10 years in IT Security in the medical field at HealthDataInsights (HDI) as CISO. He later became VP of IT Systems and Security. During his employment, he lead IT security initiatives for commercial insurance company clients and government contracts with Center for Medicare and Medicaid Services (CMS). Kurt helped sell HDI in first round discussions hosted by Morgan Stanley leading a $400 million acquisition of HDI by HMS Holdings. Kurt started in the field of IT before there we notable college degrees in the field. He holds certifications in Microsoft’s MCSE, MCDBA, ICS2 CISSP, GIAC GSEC. Although he was raised in Sioux City, Iowa, he moved to California in 1985, and then to Las Vegas in 1996. Physical fitness is an integral part of his life. His hobbies include computer gaming (in moderation), photography and trail hiking.
Important What is Occurring?
Additional payments are not being paid to the provider in a timely manner.
Why is it Important?
This is very important (especially with Air Ambulance claims) because at any time, the provider can cancel the settlement agreement (especially when we have conveyed in writing that the additional payment will be made in a certain time frame). We want to make sure your savings are locked in!
What You Need to Do:
You will receive a revised invoice, letting you know that an additional payment needs to be made (time frames are included, which have been specified by the provider). Please make sure you are paying the additional payments to the provider (any invoices or settlements) in a timely manner.
... Provider & UCS establish settlement agreement.
...
UCS sends revised invoice letting client know an additional payment needs to be made.
... Client pays the revised invoice in a timely manner, and is overjoyed with the savings!
Provider is happy & will likely discount claims for us in the future.
DIABETES: There are risk factors that may indicate an individual is at an increased risk for developing diabetes mellitus (DM). There is increasing incidence of diabetes in the USA. Per the CDC, www.cdc/gov, there were 22 million non-institutionalized people with the diagnosis of diabetes as of 2014. Diabetes Mellitus comes in 3 forms:
1 2
• Juvenile (type 1): Diabetes Mellitus (DM type 1): Can develop at random and suddenly; Autoimmune process destroys the insulin producing cells of the pancreas (beta cells). Body’s ability to produce any insulin is destroyed. Usually starts in childhood, but can develop in adulthood. • Adult–onset (type 2) Diabetes Mellitus (DM type 2): Can take years to develop; People with type 2 diabetes either do not produce enough insulin or cells have impaired metabolism and do not react to insulin (insulin resistance). Type 2 diabetes may develop so gradually, the affected individual may not realize the signs and symptoms are related. Genetic predisposition can’t be changed. However, lifestyle choices can affect the development of DM type 2. - Lack of exercise affects how well the body uses insulin. Muscle contraction and insulin both increase muscle glucose transport. Regular exercise improves blood sugar control because exercise induced skeletal muscle glucose uptake remains intact even if insulin metabolism is impaired. - Unhealthy meal planning/choices increases the risk of type 2 diabetes. Being overweight increases the likelihood of insulin resistance. - Smoking lowers the effectiveness of insulin. People who smoke require larger insulin dosages to control diabetes.
3
- Stress increases blood sugar. Stress increases cortisol levels. Cortisol impacts insulin metabolism. • Gestational Diabetes Mellitus (GDM): Affects 1 in 25 pregnant woman worldwide; Hormones from the placenta affect the woman’s insulin receptors. The condition develops about the 24th week of pregnancy. Obesity, a family history of gestational diabetes and a positive urine test for sugar are signs a woman is high risk for developing gestational diabetes. Gestational diabetes affects both mother and developing child. - Because insuling is made by the baby’s pancreas, the baby may have hypoglycemia at birth. - GDM disappears after resolution of the pregnancy; both baby and mother are at increased risk of developing DM type 2 later in life.
TYPE 1: The body does not produce insulin
TYPE 2: The body produces insulin but is not used efficiently
GESTATIONAL: High blood sugar levels in pregnancy
Types, Triggers & Tests The body’s cells run on glucose (sugar). Glucose is a large molecule and needs help to get into the cell. Insulin, produced by cells in the pancreas, helps cells absorb the glucose. In diabetes, insufficient insulin creates a condition where the sugar doesn’t get into the cells properly. The cells are “starved” even though there is plenty of “food” around. The starving cells are responsible for the signs of diabetes. • Fatigue from lack of fuel (glucose). • Extreme thirst and blurred vision results when the body pulls fluid away from the tissues (muscles, eyes, etc.) & into the bloodstream when blood glucose is elevated. Because the body tissues are dehydrated, the person feels thirsty and drinks more. • Frequent urination is from drinking more fluid in attempts to satisfy the extreme thirst. • Extreme hunger is present since the cells are starving for fuel. • Weight loss occurs because the body turns to muscle mass and fat for nutrients since it can’t get the glucose. • Infections and slow wound healing are evident. Bacteria and fungus love a glucose rich environment. White blood cells, in charge of wound healing, are negatively impacted by a high blood sugar.
Ketoacidosis is a concern when blood sugar is not controlled. Because the body can’t use sugar, it uses fat. When fat is used for a food source, acidic ketones are formed. Ketoacidosis can be fatal since the body’s chemistry is affected. • If the body’s cells are sufficiently starved, cells will die. • During the dying process, potassium is released from cells. • If kidney function is diminished, less potassium is excreted from the body and potassium accumulates. • The resulting hyperkalemia can be a life threatening. Triggers for ketoacidosis include trauma (emotional or physical), alcohol or drug abuse (particularly cocaine) some medications (ex: steroids), illness, and missed insulin dosage/inadequate insulin. When diabetes is suspected, the physician will obtain lab tests. A1C, random glucose test, and glucose tolerance tests identify impaired glucose metabolism. An A1C value will indicate what the average blood sugar has been over the last 2 3 months. The random glucose test will identify what the current blood sugar level is. Electrolytes, urinalysis, chest xray, and EKG may also be performed. Diabetes can lead to multiple major medical problems. Fortunately, complications of diabetes take a while to develop. The less controlled the blood sugar, the higher the risk of complications. When diabetes is not controlled, excess glucose damages capillaries. (Remember, glucose is a large molecule). Heart attack and stroke risk, kidney damage, retinopathy, slow gastric motility, cataracts, glaucoma, nerve damage (neuropathy) and poor blood flow to the feet leading to amputation, and hearing impairment are possible. Alzheimer’s disease risk is also greater – though it is unknown why. Once diabetes is diagnosed, blood sugar needs to be controlled. Controlling blood sugar requires commitment. When finger sticks are witnessed, know that the person performing the action has made a commitment to manage their heath.
UCS Solution Showcase: EDI Claim Routing • Quick connections including proprietary formats • Connections to multiple PPOs for repricing • Can accept paper claims from providers & transmit via EDI
Clearinghouse & Scan / OCR • Receive claims via Clearinghouse • Scan or OCR Claims & Retransmit EDI • 2 - 3 day turnaround
Data Warehousing • Searchable online data storage • Archive & store claims / attachments regardless of format or source • Eliminates the need for paper • Provides customizable access • Data entered via EDI, OCR or Manually
Why UCS for Claims Flow Management? • Virtually eliminate mailroom functions • Decrease operational costs & increase profitability • Eliminates the need for paper • Provides customizable access • Data entered via EDI, OCR or Manually
Claims Flow Management CLAIMS FLOW PROCESS
START Claim Generated
STEP 1
Clearinghouse / PPO Network sends electronically
STEP 2
Claims flagged for review and negotiations
STEP 3
Claims sent to Primary PPO or repriced
STEP 4
Claim Returned
STEP 5
Claim edits applied
STEP 6
Claims outside Primary PPO repriced as OON/ESP
STEP 7
All processed claims and invoices ready for adjudication
STEP 8 FINISH
Employee Birthdays: May 1: Shawn Dwyer, Sr. Systems Analyst & QA Tester May 18: Lisa Schnepp, Claims Editing Analyst May 19: Zack Mastov, Application Development Manager May 20: Ali Rose, Sr. Accounting Analyst & HR Coordinator May 20: Marci Watson, Manager of Provider Relations
Anniversaries: May 2: Jeanette Duarte, Accounting Clerk 1 Year Anniversary May 5: Essense Garcia, Claims Processor 2 Year Anniversary
April Contest Winner:
SPRING CLEANING CLIENT CONTEST Dawn Reynolds - $50 Gift Card
MAY CLIENT CONTEST: This month, numerous horses & their jockeys are facing off around the county to secure the top spot! For a chance to win a $25 VISA Gift Card, please answer the following:
Which 3 races are known as the “Triple Crown� races?
Email your submissions to: Amanda Hertig Marketing Specialist ahertig@unitedclaim.com