North Dakota’s best-kept secret

Despite its low public profile, Noridian Healthcare Solutions has 1,500 employees and national reach

EDITOR’S NOTE:

Paul Wilson is president and CEO of Noridian Healthcare Solutions of Fargo, N.D. And in this Q&A, he tells Prairie Business about the company and its coast-to-coast operations.

Wilson is a former CEO of Los Alamos Medical Center in Los Alamos, N.M. He also held CEO positions at Innovis Health (now known as Essentia Health), at DMS Health Technologies and at Lake Region Healthcare of Fergus Falls, Minn.

Wilson holds a master’s degree in hospital administration from the University of Minnesota-Twin Cities and a bachelor’s degree from the College of St. Scholastica in Duluth.

Q.

PAUL WILSON, NORIDIAN HEALTHCARE SOLUTIONS PRESIDENT AND CEO

MY SENSE IS THAT MOST NORTH DAKOTANS KNOW ABOUT BLUE CROSS BLUE SHIELD OF NORTH DAKOTA, YOUR PARENT COMPANY, BUT FEW KNOW ABOUT NORIDIAN HEALTHCARE SOLUTIONS. IS THAT ACCURATE?

You’re right on both counts. First, we are a wholly-owned subsidiary of Blue Cross Blue Shield of North Dakota, and we have been for about 30 years. BCBSND is the state’s largest health-insurance provider, so of course it is very well known.

Second, most people have no idea what we at Noridian do. And that’s true even though we’re the fourth or fifth largest employer in Fargo.

Even many of our new employees are uncertain, because the work is foreign to most people. So whenever I speak at our employee orientations – which I do every two weeks – I talk a lot about what the company is.

Q. WHAT DO YOU SAY?

A. A.

We are a federal- and state-government contractor, and what we contract to do is administer the health care side of government services, such as state Medicaid programs and the federal Center for Medicare and Medicaid Services.

That’s what we do. That is our focus: state and federal health care administrative services.

So, our work ranges from helping the state of Iowa administer its Medicaid program to providing national medical review for CMS.

Among our other duties, we also administer all of the back-office functions for about 25 million beneficiaries who are enrolled in the Medicare program, from North Dakota all the way to Guam and almost everywhere in between.

And that’s a pretty sizable obligation. That’s a lot of responsibility to deliver services to what I consider a very vulnerable population. You know, my parents are on Medicare; my dad is in a nursing home, and he is dependent on Medicare for all of his health care needs. So are most people are when they get over age 65. So you can see, that’s a pretty sizable obligation that we have, and we take it very seriously.

Q.

HOW MANY PEOPLE WORK FOR NORIDIAN, AND WHERE DO THEY WORK?

We are pretty far-reaching. North Dakota is our home base, and we have four offices here. We have our main office in Fargo, an office in Grand Forks, an office in Jamestown and a call center in Leeds, N.D.

By the way, that Leeds office is a very special place. It’s a small office; it has only about 30 people. But they’re a tremendously talented group.

We also have an office in Eagan, Minn., one in Camarillo, Calif., and finally, we have a small office in Seattle.

Q.

HOW ABOUT YOUR TELEWORKERS? WHAT KIND OF WORK ARE THEY DOING?

Those are our physical locations.

We have more than 1,500 employees, including about 800 in North Dakota. And of the 1,500 total, about 650 people are actually teleworkers – remote workers who work from home.

Q.

A.

Most of them are nurses working medical review, which means they’re helping to make sure that Medicare payments are being made only for services that meet Medicare requirements. They’re able to do that remotely from their homes.

YOU ALSO HAVE A FEW ROBOTS, I UNDERSTAND?

Yes indeed; we have robots in place. In our case, they’re nothing more than PCs, but it’s still interesting to watch them work. Their screens will open and close, and the blanks on their online forms will get filled in.

It’s RPA, or Robotic Process Automation, and it automates the routine keystrokes that our employees used to have to do.

For example, on behalf of our providers and beneficiaries, we “credential” providers – somewhere in the area of 400,000 providers across the U.S. We look up physicans’ licensing; we make sure they’re in good standing in their profession and so on.

We have a desktop that’s called a robot that actually goes out and does all of the research for us on every person we credential. It does the routine processing so we can use our people for other things that are much more critical – things that take judgment and decision-making.

Q. AS YOUR WEBSITE NOTES, “NORIDIAN HAS BEEN A TRUSTED MEDICARE ADMINISTRATIVE CONTRACTOR SINCE CMS OPENED ITS DOORS IN 1966.” THAT’S MORE THAN 50 YEARS. WHAT’S YOUR SECRET? HOW DO YOU KEEP ON MEDICARE’S GOOD SIDE?

One answer is, we currently have the highest customer service rating of any of the contractors within CMS. We are really proud of that.

There are several reasons why we’ve achieved those high ratings. The simple fact of our being a North Dakota-based company is one. This whole “North Dakota nice” thing that you always hear about? That plays very, very well across the United States.

We handle calls and issues and problems, and that means “North Dakota nice” is one of the advantages that we have.

Second, we put a lot of time and effort into training, because we know we are only as good as the last call.

Q. WHAT DO YOU MEAN?

A. A. A.

This is really important to me, and it’s really important that every employee understands: we provide services for Medicare beneficiaries, meaning people who are 65 years and older and are dependent on us to access medical care.

That means we should do everything possible to make sure they’ve got the access they need, they can see the physicians they need to see, and – interestingly enough, because we’re a government contractor – that we take as much bureaucracy out of the system as we possibly can.

For example, our call center training is about eight weeks. From the day that a new person shows up, it’s many weeks before we let that person grab a phone and start handling calls.

The reason is that health care is complicated, as you know. The terminology is complicated, the billing is complicated, the cases can be complicated.

So when we hire call-center staff, we do so with the expectation that there will be significant training.

And that’s vital, because as I tell every one of our new hires at orientation, they have much more of an impact on customer service in this company than I do.

At the end of the day, what allows us to continue to be in this business is our customer service – our ability to make sure that physicians get paid and beneficiaries get access to care.

NORIDIAN HAS PROVIDED HEALTH CARE ADMINISTRATION AND SUPPORT SERVICES IN ALL 50 U.S. STATES, THE COMPANY REPORTS. THIS SCREENSHOT SHOWS NORIDIAN'S CURRENTLY ACTIVE GOVERNMENT CONTRACTS INVOLVING MEDICARE, MEDICAID, DURABLE MEDICAL EQUIPMENT (DME) AND AS SUPPLEMENTAL MEDICAL REVIEW CONTRACTOR (SMRC). IMAGE: NORIDIANSOLUTIONS.COM

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Q.

WHAT’S YOUR OWN STORY?

I came up through the provider world, so I’m a former hospital CEO. I ran a small insurance product, but I was in health care administration for more than 30 years before I came to Noridian.

And because I spent all my career on the provider side, I have the perspective from the provider as well as from the insurer; I can bring both of those to the table. So when things happen with providers, I can understand their situation. I’ve been there and can feel their frustration.

For example, we process $67 billion a year in claims. So, when something happens that involves, say, a few thousand dollars, it might not seem like a lot. But it is an enormity to a provider. If you’re at a small practice in rural Wyoming, that’s a very important sum to the physician and the practice and the staff. So we have to be sensitive to that, and we are.

WHAT WAS YOUR VIEW OF NORIDIAN WHEN YOU WERE ON THE PROVIDER SIDE?

In a number of locations I was at, Noridian was our third-party administrator for claims, cost reports and those kinds of things; and we had a terrific relationship with the company.

Noridian did really good work, so I’ve always had a favorable impression. And when I got the opportunity to come here, I didn’t second guess it. I knew this is really what I wanted to do.

I’ve been here now almost three years, and I’ve found that we strive every day to live up to our tag: “Solutions that put people first.”