Strategic Business Alignment
- Develop a robust strategy tailored to align with your unique business goals.
- Execute strategies that enhance operational efficiency and foster sustainable growth.
Cost Optimization
- Reduce cost per member through strategic cost management initiatives.
- Lower administrative costs without compromising on service quality.
Claims Management Excellence
- Improve auto-adjudication with advanced claims management solutions.
- Integrate claims systems for efficiency and accuracy.
Provider Data Enhancement
- Improve provider data accuracy and reliability.
- Streamline credentialing processes to ensure compliance and quality.
- Improve Provider Enrollment
System Maximization
- Maximize core and ancillary systems for enhanced operational performance.
- Optimize operations through the integration of cutting-edge technologies.
Credentialing Process Improvement
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Credentialing backlog of initial applications or recredentialing applications
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Develops plans to reduce inventory to align with the health plans policies.
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Review staffing ratios and KPI’s for departments to meet expectations
- NCQA readiness.
Business Expansion and Consolidation
- Expand and consolidate new lines of business with a focus on sustainability.
- Optimize operations to ensure a seamless integration of expanded services.
Program Development & Training
- Develop and implement programs for sustainable growth.
- Provide comprehensive training for effective program execution.
Network Development and Operations
- Optimize provider services, contracting, and credentialing.
- Turn around health plans through strategic interventions.
Standard Operating Procedures
- Develop and implement standardized operating procedures for streamlined processes.
- Evaluate staffing models to meet the unique needs of clients and service line agreements.
Quality Assessment
- Review the quality of primary, secondary, and tertiary care services.
- Assess total PMPM cost, utilization rates, and cost per elected episodes for continuous improvement.
Mergers and Acquisitions Management
- Navigate the complexities of mergers and acquisitions with confidence.
- Streamline the process to ensure a seamless transition and maximize value.
Our Portfolio
Let’s Make Things Happen
More than 30 years’ experience. Extensive background in Managed Care, Preferred Provider Organizations, Third Party Administration, Claims Operations, Credentialing, Contracting, Provider Enrollment, Medicaid Programs, Medicare Advantage and Health Care
Spending products and processes, Utilization Management, Configurations of core systems.
Partner with key stakeholders to effectively plan and execute strategic enterprise-level business initiatives from conceptual state through implementation of process.
Your partner in strategic health care solutions for Health Plan Clients and Managed Care Organizations.