I have been an employee for more than 2 decades and have had the pleasure of working with some of the most talented people I've known. I have seen many changes over the years but none as numerous and as rapid as in the past 7 years. Unfortunately the management in this company, at all levels, has chosen to bury their heads in the sand and allow one bad decision after another. And management is fully to blame for the current state of our company, which is very bleak. Our core business application has so many defects that we run hundreds of integrity reports daily/weekly to do our everyday work and yet we're still throwing money at the host company to keep telling us what we want to hear but deliver little to no results. Our provider contracts line the pockets of our providers with high reimbursement rates while we continue to lose money every single quarter. We've made payments that are so egregious and when brought to the attention of management we're always told "it's the contract". We need a strong new leader in Contracting to take control of the hemorrhaging. We also need new leadership in our Claims Department and preferably with claims processing experience. Claims employees are treated like children in kindergarten rather than being celebrated and valued for their knowledge and talents. True this department is meeting all dashboard measurements but when the quality of work is at an all time low what have we really gained? Re-work is our constant theme in every department. Contract and Benefit Configuration is constantly incorrect. I'm told that we have an auditing program in place to check this work before it's moved to production, it's just not clear what's being audited. Our overall company auditing program, Internal Audit, is in many ways our enemy. IA should be more willing to work with us, internal customers, rather than berating us. We are not offered any suggestions for resolution or corrective actions and in the long run are creating more problems for all involved. UM/Care Services has always been and continues to be a mystery to me. Why can't we ever fix this department? It's in a constant state of panic and reacting to problems when we should be proactively addressing the problems in the first place. I was optimistic when Richard Burke assumed the position of CEO but in 18 months we haven't really improved our position financially and we are losing talented long-time employees at an alarmingly high rate and it appears we are doing nothing to prevent this. We are in need of drastic change to survive. Otherwise, I'm not certain Fallon Health will still be a viable company in a year from now.
