Healthcare Administration

Business Process Outsourcing, Claim Administration, Revenue Management, Member Services, and more for healthcare payers

Increasing consumerism and government reform mean that challenges to manage costs, improve quality of care, optimize provider performance, and accelerate membership growth never subside.

We help you meet those challenges with a full-service Business Process Outsourcing healthcare program and turnkey healthcare administration solutions, including Business Processing as a Service (BPaaS), advanced technologies and strategic consulting services designed to help you optimize member outcomes, focus on revenues, and manage risk to remain compliant whether you are a government or a commercial plan.

Customers also enjoy the benefits of being able to:

  • Add modules incrementally to help manage costs and minimize operational disruption.
  • Optimize the benefits of adopted modules while maintaining and planning strategic IT investments.
  • Automate diverse administrative functions to help increase efficiency and enhance customer satisfaction.

Revenue Management

Integrated with Johns Hopkins ACG® System, our proprietary analytics solutions help you identify risk-score discrepancies and substantiate undocumented diagnoses and conditions for comprehensive retrospective reviews.

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Core Claims Administration

Our solutions meet the administrative requirements of virtually any line of business and help lessen the risks, costs and disruptions of core system modernization.

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Provider Network Administration

Reduce the time and cost associated with provider maintenance with flexible, advanced tools that manage provider financial arrangements and reimbursement, quality and grievance, and specialty referrals.

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Member Services

Leverage our people, processes, and technology to develop effective, consumer-focused programs that help you adapt as the market evolves.

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Health Plan Compliance and Program Integrity

Our comprehensive governance, risk management, and compliance programs deliver mechanisms to monitor and manage the complex and evolving regulations from federal and state agencies.

Event Center Services for HealtHCARE

Minimize operational disruption during critical or unexpected healthcare events through our multi-platform, operational support model that integrates flexible, scalable mail center and call center services, and more.

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Interoperability Solution for Health Plans

Employ technology used by large-scale plans at a market-entry pricing level as a BPaaS service for government program compliance. Our FHIR-based solution is tailored for small-midsized plans to avoid unnecessary output expense in development and deployment. Plans send us the data on the front end, and we manage trusted exchange and disbursement as required.

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Strategic Consulting

Uncover actionable insights into your organization to update strategy holistically or for specific challenges. The Executive Consulting Group draws on over 75 years of collective experience, in particular with government-sponsored health plans. Our seasoned consultants collaborate with executives to align organizational infrastructure, staff, and processes for your health plan.

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