People of the U: Rosalind WilliamsPublished on Wednesday, October 7, 2020By: Ruth Cummins, email@example.comWhen an insurance company denies the claim of a UMMC patient, Rosalind Williams and her coworkers in Revenue Cycle try to discover why.Williams scrutinizes many details of a patient’s time at the Medical Center. Where were they treated, and how? Were they hospitalized, and why, and for how long? Why did they receive the medications they were given? Why was their treatment medically necessary?“I handle appeals for claims that were denied for medical necessity,” said Williams, a registered nurse and clinical appeals coordinator. “We analyze the denials and provide a sound appeal that will possibly overturn the denial by the insurance company. That in turn will create revenue for the hospitals.”Although Williams doesn’t deal directly with patients, she acts as their liaison. She develops a letter to send to the insurance company for each appeal, gathering the clinical information needed to explain why the patient received the treatment they did.“We look at the intensity of the stay and the severity of the illness,” Williams said, with an eye toward whether criteria set up by the insurance company is being met. Among facts she might gather: “How sick was the patient when they arrived? Did they have a fever? Was their mental status altered? Did we give the patient fluids? What did we do in order to stabilize them in the Emergency Department before they were admitted?”She evaluates whether the patient needed to be admitted versus whether they could have been appropriately treated in the ED. “Once a patient is admitted, we look at daily clinicals to see what was done for him,” Williams said.Williams said that one of the best things about her job is the opportunity it gives her to use her combined experiences gained after working 23 years at UMMC.“I’ve done a lot of different things,” said Williams, a Clinton resident and mom to two teenaged sons. “I’ve worked in Infection control, as a chemotherapy nurse, as a case manager in pediatric and adult care, as a floor nurse, and in utilization review. This helps me to make decisions on my own. I know how things really work.”“Rosalind is a wealth of knowledge,” said Grant Stapleton, manager of business operations in Patient Financial Services. “She is responsible for creating and submitting appeals and reconsideration requests to denials we receive from both government and non-Government payors. We receive specific types of denials that require a clinical analysis, and Rosalind is a go-to teammate that we can count on to help build a stronger clinical response to support our cases and appeals with the payors.”Her job can be very rewarding, Williams said. “Whether it’s $1,000 or $300,000, when we can show that we did what we were supposed to do, both the Medical Center and the patient benefit. The patient doesn’t have to have that bill.”Every institution is rich with personal stories. We want to know ours.Do you know a student, staff, volunteer or faculty member at the University of Mississippi Medical Center whose story would make an interesting feature or deserves to be recognized?Know someone who you think more people should know about because of his or her commitment to his or her job and/or the people he or she works with or for? Who has a fascinating hobby? Who participates in a remarkable group? Who has accomplished something amazing?We want to learn more about each individual who makes up our extraordinary UMMC Family, and we want to share what makes each person unique and special in the People of the U section of our dynamic new UMMC Intranet.To nominate someone to be considered for a People of the U feature, just complete and submit this short form. If that person is picked for a feature, a member of the Communications and Marketing staff will contact him or her to learn more about his or her personal story.Soon, the rest of the Medical Center will know why your nominee is an outstanding reminder of what makes this place so special – the People of the U.