Healthcare Administration

The path to increased revenues, lower costs and less risk

Healthcare reform is putting added pressure on you to manage costs, improve quality of care, optimize provider performance, and accelerate membership growth.

We help you meet those pressures with a full range of BPO and turnkey healthcare administration solutions, including advanced technologies and strategic consulting services designed to help you optimize member outcomes, focus on revenues, and manage risk to remain compliant.

Customers also enjoy the benefit 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.