April 2013 Employee of the Month

Work together.

A simple but effective concept, and it's the customer service mantra of our April Employee of the Month, Industrial Rehab Nurse/Compliance Officer Lori Fowler.

"I approach customer service as I do life — we are all on this earth together, and we need to stick together," said Lori, a 14-year BWC veteran. "I recognize that we should all — MCOs included — have the same goal: Take care of the customers, injured workers and employers. We can only do that if we work together to do things right and improve things wherever we can."

Lori's can-do, helpful work ethic is one of the reasons her supervisor, Industrial Rehab Supervisor Jeffrey Buffer, nominated her for BWC's monthly honor. "Lori is a genuinely helpful person who wants to share her knowledge with those around her and does so in a selfless manner," said Jeffrey. "Her work is always conducted with the unique approach as to how Ohio's injured workers and employers will be impacted in terms of appropriate, quality medical care and the relationship between that care to Ohio employers' legal and financial responsibilities. Lori has shown a willingness to assist our staff without hesitation, even when working outside of and above her area of specialty or classification. Her personal work ethics and integrity are strongly reflected in her work products and reported outcomes in terms of accuracy and timeliness."

She's a busy woman here; her day to day tasks vary based on her assignment at the time. Lori primarily performs compliance reviews to determine MCO compliance with contract requirements, but she also reviews internal BWC processes such as disability evaluators' panel, drug utilization reviews, provider compliance, and medical coding and reimbursement. This could include reviewing issues related to case management, processing of treatment requests, BWC and MCO processing of medical invoices, provider coding of medical invoices, appropriateness of treatment, retrospective treatment and much more. Thanks to her vast array of expertise, Lori's also regularly assigned to work groups, where she provides a compliance perspective on new projects.

True to her customer service mantra, her favorite part of working at BWC is her interaction with so many different people. Lori is routinely consulted on staffing issues with internal colleagues in the Operational Policy, Analytics & Compliance and Field Operations divisions; compliance and performance monitoring; provider relations; medical billing and adjustments; HPP systems support; HPP reporting; hospital reimbursement review; fraud; and medical policy.

Externally, she interfaces with MCOs through onsite compliance reviews as well as fielding questions from MCO staff on case management, treatment authorizations and medical billing. Lori has recently also provided crucial information on enrollment and credentialing issues with providers.

It might be all in a day's work for her, but Jeffrey continues to gain respect for Lori's dedication. "She is a self-starter who consistently is thinking ahead as to departmental and agency needs in terms of work processes and products," said Jeffrey. "Lori has willingly assisted our internal staff in this department and in other BWC departments without hesitation in terms of identifying policy and procedural resources related to our work and that of the agency. External customers have benefitted from her input during compliance reviews and onsite audits when integrating with the MCO and provider community."

Her job isn't easy, but Lori loves it. She encourages honesty and open communication in her day to day business. There are times when we can't give someone what they want as we have to balance everyone's needs and interests," she said. "I also like to encourage questions, as I feel that the only dumb question is the one not asked."