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Quality Assurance Manager Angela Jackson Recognized for Improving Auditing

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Cardinal Innovations Healthcare Quality Assurance Manager Angela “Angie" Jackson said her passion for working in the behavioral healthcare field began with a summer internship when she fought to help children and adolescents get appropriate treatment for mental illness from the state of North Carolina.

She worked in the Willie M. Office, which filed a class action lawsuit against the state. “The lawsuit, known as Willie M., mandated appropriate treatment for a class of emotionally disturbed children and adolescents," Jackson said.

Jackson worked on a research project that brought her closer to those affected. “In my role, I was able to spend time with Willie M. members, hear their stories and interview them about what they wanted and needed in their lives. Their stories touched my heart and confirmed that human services was definitely the field that I wanted to explore."

Support teams that work behind the scenes can be invaluable to helping members receive the best possible care and that's one reason Jackson was nominated for a Cardinal Leads Award last spring by Service Center Senior Director Cynthia Reese.

Cardinal Leads Award nominees are featured in Leadership in Action articles throughout the year for their commitment to Cardinal Innovations' core values, which include courage, integrity, accountability, compassion and demonstrating a pioneering attitude. Jackson was nominated for her leadership and compassion. Reese said Jackson was instrumental in developing a claims audit team and restructuring an audit process for monitoring coordination of benefits with Comprehensive Community Clinics (CCC).

“Angie built this team from nothing. She hired qualified staff who are content experts in claims and developed standard operating procedures and workflows for conducting internal and focused audits,"

Reese said in regards to her involvement in the coordination of benefits reviews with CCCs. “She empowered her team to rewrite and update the process. As a group, they educated the providers as well as internal business partners. Updating this process has had a direct impact on the reduction of over payments and claims and will improve scores during external state audits."

Jackson, who has been with Cardinal Innovations since April 2014 and works in the Service Center, said the claims audit team and additional audit processes such as coordination of benefits reviews with CCCs are assisting with fulfilling Cardinal Innovations contract requirements with the state.

“These auditing processes are ensuring that we are being good stewards of the funding that has been provided to us to serve members," Jackson said. “When we are able to identify process improvements within our billing system and or business processes that allow us to maximize our funding streams we are able to serve more members and assist them with long term health and wellness."

When the claims audit team was created in 2015, the internal claims audit compliance rate was 90 percent. As of the end of 2017, the claims audit compliance rate is at 99.2 percent for processing accuracy (the percentage of claims processed without an error) and 99.9 percent for financial accuracy (the percentage of total dollars that were paid correctly). Jackson credits the hard work of the claims audit team and collaboration with internal business partners including Claims, Utilization Management, Finance, Network Management and Information Technology for the improvements.

For the past three years, the coordination of benefits audits have focused on the billing practices of CCC providers and we have seen an increase in compliance each year. In January 2019 these reviews will be expanded to all providers in our network that have coordination of benefits requirements in their contracts. Training and outreach material is currently being developed to educate providers on their responsibilities.

“I am very proud of the work that the Service Center audit teams do on a daily basis to promote internal accountability and help the organization remain in compliance with state requirements," Jackson said. “I believe that the work that we do aids in assisting our members to receive the best care possible."

That first internship led Jackson to her current role, she said. After graduating college, Jackson worked in the Juvenile Court system for several years.

“I was deeply saddened to see children and adolescents go through a revolving door of correctional institutions because they were not connected with the appropriate treatment services," she said. “After three and a half years of working in the Juvenile Court system, I became a mental health case manager which started my career in behavioral health."

Over the last 20 years, she has worked in various positions in behavioral health that include case management, case management supervision, and management positions in provider relations, provider accountability, program integrity and quality assurance.

“I enjoying helping others and advocating for their well-being whether through direct service or indirectly from a regulatory compliance and auditing standpoint," Jackson said.

Jackson said her family also has personal experience with a mental health problem.

“Shortly after coming to work at Cardinal Innovations, I had a family member diagnosed with a mental health disability. Although I had worked in behavioral health and knew the appropriate channels to help get them connected with the resources they needed, it didn't lessen our struggle and heartache as a family," she said. “I have been able to see what our members go through as they attempt to access services and find quality providers during a time when they are at their wits end."

Jackson said navigating paper work, waiting lists and telling your story to multiple service providers can be exhausting.

“I have been fortunate to know how to access services because I have worked in behavioral health; however, I think about our members who may not be as fortunate to have this knowledge and need the services that are provided by Cardinal Innovations to help them advocate and access appropriate services," she said. “This personal experience has strengthened my passion even more to do my part to help those with IDD, MH and SUD."

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