Healthcare Consulting

Healthcare Consulting

Provide consultative services to simplify claim payments and recovery process
  • Development and enhancement to software tools
  • Automation of claim offset processes with technology
  • Process improvement and cost management strategies
  • System and process integration
Provide consultative services to assess gaps
  • Clinical/Medical Record Audit Programs – DRG, HBA, Medical Necessity, Implants, ER coding
  • Clinical Mobile Audit Solutions – Physician, Hospital and Outpatient
  • Data Mining Programs and Organization
  • Pharmacy Audit Programs and Organization
Identify cost saving opportunities
  • Assess current payment integrity and other cost saving initiatives to identify Cost of Care Savings target
  • Identify top priority audits for the payer
  • Modeling of prospective cost savings by initiatives
Contract Compliance & Pricing
  • Using analytic tools to assess Provider Network Contracts
  • Regulatory Compliance assessment
  • Affordability Act Changes and Impact
  • Quality Audits Improvement Processes
  • Self-Funded Groups (reductions of penalties)
  • Cost Reduction to complete audits