My background and my passion is health care. It's not only what I do but also what I care about. I love working with clients and my colleagues, making sure that what we're doing benefits everyone involved.

I’ve worked in the health care industry for more than 20 years, about 15 of those at an independent review organization (IRO). I started as an account manager, working with clients on quality assurance, and eventually made my way to become General Manager of the MLS Group of Companies nearly six years ago.

When you tell someone you work in health care, most of the time, they assume you’re involved in direct patient care. Medical review, though, is a different side of the industry, which provides benefits to patients by aiming to reduce insurance costs and preventing fraud.

When I began in the IRO field, I was able to better understand the insurance side of health care. I learned about claims processing, how decisions within the system are made and how these decisions affect patients when treatment is denied or delayed. For example, when a physician recommends sending a patient for some sort of rehabilitation, payers review pertinent documentation to ensure the treatment is necessary. In the peer review process, we verify as a third party that an appropriate and unbiased decision was made based on evidence-based guidelines.

What’s fascinating to me about this industry is seeing how physicians interact with patients, speaking to doctors outside of the IRO world who have had a claim or treatment request reviewed and understanding the importance of clear documentation. It’s important that I emphasize to my team exactly how we’re helping each claimant and client and partnering with the best physicians to ensure the information we’re putting out there is supportive to all parties involved. We’re doing so much more than just pushing paper through an office.

Technological transitions

During my tenure as an IRO employee and leader, one of the biggest changes has been the transition to a paperless environment. Getting rid of paper-based processes offers a lot of advantages, but it’s essential that everyone involved in what we do, from the payers to the physicians, puts security at the forefront.

By going paperless, we’re able to more quickly, easily and securely transfer information between our clients and the physicians with whom we work. With such a seamless workflow, we’re able to offer a faster turnaround on decisions. Years ago, the process took a couple of weeks. These days, we can provide clients with a decision and corresponding report in a matter of hours.

Another shift in our workflow at MLS has been the creation and development of our client and reviewer portals. Any technology we implement is built with our clients in mind, and the portals are no different. The solution has to be easy for our clients to access and utilize while enabling us to exchange data securely. Because we boast a nationwide network of credentialed physician reviewers covering all major specialties and subspecialties, our review portal enables us to easily communicate with these doctors and send them the data they need to perform their role in the process effectively.

As with most industries, along with the benefits of using technology come some challenges. As an IRO, a primary concern is maintaining compliance with strict regulations and guidelines, many of which vary by state. We have to know how we can assist our clients to the best of our abilities based on these regulations. How an IRO operates is very different from that of an insurance company or a physician practice, so it’s crucial that my team and I are aware of all the regulations for each of these parties and how they affect our processes and those of our clients.

Best practices

Many companies promote themselves as the best in their respective industries, but MLS is diverse and truly superlative in the services we offer, the knowledge and training of our team members and our low employee turnover. We’re a complete IRO, serving a variety of entities, including third-party administrators, payers, utilization review organizations, hospitals, state and federal agencies and more.

My colleagues and I take pride in our work and care about our clients. We care about the overall product, the MLS name and who we are and represent. In my role as general manager, I’ve continued the MLS focus on customer service, which is our top priority. It’s the first foundation you have to build within any corporation or office before you turn to the quality of the services you provide. You start with customer service as the base of your operations and build from there.

The future of MLS

My goal for MLS over the next five to 10 years is to have some of the processes and procedures we use become industry best practices. I’d like to see that IROs learn from each other to improve the industry as a whole, resulting in delivery of the best quality of products and services to benefit claimants, patients and physicians.

Health care is complicated and scary to so many people, in large part due to its high costs. I want to ensure through my work that I’m helping improve the industry for whomever I can and guiding individuals in how to get the treatment they might need. That’s my contribution to health care, and I don’t have to work in a hospital or physician practice to achieve it.

For those of you who work in health care, what major changes have you seen over the past decade or so? How do you ensure customer service remains the focus of your organization or company? Contact MLS today to learn more about our services.

Contributing to Health Care Outside the Patient Care Setting, Interview With MLS General Manager, Nicole Long