What we do Client outcomes
Identify:

  • Operation and System Compliance Risks
  • Resource Utilization Constraints
  • Process Gaps and Remediation to enhance Operation and System automation
  • Provider Network Set Up and Configuration concerns
  • Insourcing and Outsourcing opportunities to increase company revenue and process efficiencies
  • Interdepartmental data exchange deficiencies

Implement:

  • Early warning sign strategies to minimize Operation Inventory backlog
  • Robotic Process Automation (RPA)
    • Repetitive Simple to Complex Tasks
  • Validation tools to ensure accurate Provider Configuration, Contract Rates, and Provider Data
 Improved:

  • Eligibility determination
  • Eligibility data accuracy and processing time
  • Claims payment accuracy and processing time
  • Appeals and Grievances processing time
  • Provider Network claim pends and adjustments
  • Provider match rate and payment accuracy
  • Provider Credentialing processes and OIG Check
  • Quality of products delivered to patients and members
  • Member, Provider and Patient satisfaction
  • Regulatory reporting
  • Operations and leadership reporting
  • Seamless interdepartmental data exchange