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
|