Case Study

Defining Operational Changes

Case Study

Wekiva Consulting Group (WCG) provided a Technology and Operations Executive for a major California healthcare payer organization. The organization provides affordable quality care to its members through innovative programs and services designed specifically for the managed care environment.  The Client had implemented many programs to review utilization, quality assurance compliance, medical risk management and patient issues and concerns.

Design

The Client had experienced extensive growth over the past several years and required a person with broad experience in Information Technology, Healthcare, Operations and Management of a geographically dispersed workforce to define and streamline processes. Our primary goals were to review, document and provide recommendations for improving the offshore services for claims entry, claims processing, adjudication, care management and new automation opportunities.

Conquer!

WCG successfully delivered on our goals by 1) direct reviews (in-person and remote) of all phases of the current services which were provided locally and through two separate offshore companies, 2) document the current workflow of manual and automated processes, 3) created a plan to improve the workflows and increase automation (onshore and offshore), and 4) design of a management dashboard to visualize and manage Key Performance.

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