99% Claims Payment Accuracy, 98.5% Procedural Accuracy, Outsourcing Strategy and Implementation

Process Redesign and Change Management to define a flexible, scalable workforce for an East Coast Healthcare Payer.

Overview:

Process Redesign and Change Management to define a flexible, scalable workforce for an East Coast Healthcare Payer.

Business Issue:

This client needed to prepare for a potential increase in the volume of paper claims received as a result of HIPAA while maintaining compliance with service level agreements and simultaneously addressing excessive temporary and overtime costs.

Actions:

Developed a customized approach to outsourcing that accounted for client’s needs, capacity for change, and technology capabilities
Led and managed the rapid “Proof of Execution” pilot, where claims processing began within 2 weeks, providing immediate benefit and freeing up in-house staff to focus on complex cases

Results:

Reduced the need to pay overtime to process claims
Implemented the client’s first-ever international outsourcing effort, creating a flexible, scalable workforce to assist in contingency planning
Monitored the ongoing delivery to ensure SLAs were being met when processing more than 1 million claims annually, with over 99% Claims Payment and 98.5% Procedural Accuracy

What Our Clients Say

"Our team spent a lot of time debating whether or not to hire an outside consultant for this project, but partnering with RubinBrown was one of the best strategic decisions we could have made. The level of service and their commitment to meeting our specific needs blew us away. We know we chose the right ERP system, but that's because we chose the right consultant to help us get there."

CIO

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99% Claims Payment Accuracy, 98.5% Procedural Accuracy, Outsourcing Strategy and Implementation

99% Claims Payment Accuracy, 98.5% Procedural Accuracy, Outsourcing Strategy and Implementation

Overview:

Business Issue:

Actions:

Results:

What Our Clients Say

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Be Your Best for Others at RubinBrown

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