Develop and implement:
- Regulatory Matrix to establish operational and system requirements in accordance with CMS/State regulations
- Functional area workflows
- Business and system requirements
- Functional area test case scenarios
- CMS/State/Vendor data file exchanges
- Policy and Procedures
- Desktop Level Procedures (DLPs)
- Training Materials for functional areas
- Regulatory and Internal Operational Reporting
- Executive Dashboards
- Audit Universe Development and Testing
- Post Go-Live support
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Proven results:
- Compliant Operations aligned with CMS and State Regulations
- Effective Operational Processes and Controls
- Successful Regulatory Audits
- Reduced Risk of Non-Compliance findings
- Regulatory Reporting Readiness
- Program insight at Executive and Operational levels
- Resources that are prepared, confident and knowledgeable for Go-Live support
- Reduced Risk of Member and Provider Complaints, Appeals and Grievances
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