Functional/Process Specialization

Claims management- Claims Intake, Claim Adjudication, Medical reviews, and audits.

Provider Data Management- Provider Roster Management, Credentialing- NPI, Sanctions, Address & Education audits

Payment Integrity- Post Payment Audits, Clinical Reviews, Utilization Management, Prior Authorization, High $ Claims Audits

Care Management- Care Coordination, Risk Assessment, Case Management, HEDIS,

Patient Access – Patient Onboarding, Clinical Operations, Discharge processing

RCM - Medical Coding, AR, Billing, Prior Authorization, Eligibility Benefits

Customer Services – Payer and Provider Contact Center Operations

Applications

Payer: Facets, Nasco, Amisys, Crea Advance, Availity Portal & APIs

Provider: M3M, EMRs (EPIC, Cerner, Allscripts etc..), FHIR Sandbox