Former Hospice Care Nurse and Health Care Educator, and now, Senior Vice President of Decision Support at NCI
NCI’s Charlene Stanley has a passion for helping others. She has worked in the health care field for more than 35 years, and despite the challenges, she still loves it.
“Working in bedside nursing for almost 15 years, I was able to help people face-to-face and it was very satisfying,” she said. “Working at NCI – and supporting health care agencies for several years – we’ve seen how we can serve the government and support their missions to improve the nation’s health care, by bringing expertise and the most effective technologies to their operations. It’s such an exciting time to be in this field.”
As the senior vice president of Operations for NCI’s Decision Support Division, Stanley has experienced the many sides of health care during her career, from emergency room nursing and hospice care to health care education. She uses those skills and experiences each day to lead the Decision Support Division, where NCI has more than 20 years supporting the Centers for Medicare and Medicaid Services (CMS). This includes her team’s work for the CMS Office of Financial Management’s (OFM) task of measuring a reporting annually to Congress on the payment accuracy of Medicare and Medicaid payments made to health care providers and suppliers. This is accomplished in large part through NCI’s CMS Comprehensive Error Rate Testing (CERT) and Payment Error Rate Measurement (PERM) contracts, where the team is expanding the deployment of artificial intelligence (AI) solutions, including the use of robotic process automation and machine learning, to advance the agency’s monitoring, measuring, and reporting of Medicare Fee-for-Service and Medicaid improper payments.
“We are so proud of our work for the CMS Office of Financial Management and its mission,” Stanley said. “Our nurses, doctors, coders, Medicare and Medicaid experts have tremendous experience and knowledge about both very complex programs, and we are always looking for a better way to support very busy providers and suppliers, the overall government health care programs and, of course, our CMS customer. AI is changing how we approach our work and enabling us to use the valuable resources we have, to do the things that only their expertise and knowledge can provide, while automating the simpler tasks, thereby giving them more bandwidth.
“It’s really fun to watch the evolution happen,” Stanley added.
As NCI develops customized AI tools to solve customers’ biggest challenges, Stanley utilizes her team’s knowledge to modernize these functions, such as medical and clinical reviews, including letting the AI tools perform some of the “pre-work” such as policy research, and requesting additional information from providers or suppliers so that the clinicians can use their time to review that data and make the clinical decisions required.
“In addition to pulling data for the reviewers, we are also using our AI solutions to make the actual medical records more efficient for our nurses and doctors to review,” Stanley said. “We receive medical records for about 65,000 claims per year for the two programs and some of those medical records can be very large.”
As an example, Stanley said that a very lengthy and complicated hospital or nursing home stay could involve 10-20,000 pages in just one medical record.
“Now, imagine trying to find one little data point flipping through all those pages,” she said. “We use AI and machine learning to take those static files and turn them into real data that can be searched and categorized by document type. Having AI better organize the record for our review saves significant time, energy, and money, and it’s more accurate as well. It also allows us to, again, work on things that provide even greater value to the customer.
“It’s gratifying for our team to know that our work is providing an important service to the country and making the health care system better and more efficient,” Stanley said.
This is one of the main reasons she enjoys working at NCI.
“What NCI does well, and one of the things I take great pride in – we are very customer focused,” she said. “We see our success in the success of our customer. We really live that. In addition to that, in becoming an AI company, with our modernization of technology, we’ve seen how we can support out customer even better.”
“I really enjoy working with everyone here. I really enjoy how everyone in the company from the CEO down is focused on the customer and what we bring to them and how we can make them successful.”