PAYMENT INTEGRITY PROGRAM IMPLEMENTATION
Experience seamless & optimized payment integrity with expert guidance
From Start-Up to Scale-Up: Supporting Your Payment Integrity Journey
We are dedicated to building, optimizing, and accelerating payment integrity solutions. Whether you need help standing up a Payment Integrity Office (PIO) from scratch, pushing your program to the next level, or are looking for skilled contractors to augment your staff, our team of industry experts can meet you where you are.
How We Work With Health Plans:
1. ADVISORY SERVICES
We collaborate seamlessly with your current resources and vendor partners to assist in strategic decision-making and project advancement. Our methodology involves championing your plan, remaining vendor-neutral, and ensuring cost-effectiveness to accelerate your end-to-end payment integrity program.
Planning
Execution
Results
Planning
- Strategic Planning Support: Tailored plans for Payment Integrity Office (PIO) setup, growth, or expansion.
- Procurement Excellence: Guidance in procuring resources for seamless payment integrity initiatives.
- Comprehensive Payment Integrity Development: Oversee all aspects, from issue identification to resolution.
Execution
- Project Support: Assistance in implementing payment integrity initiatives.
- Streamlined Operational Management: Efficiently manage operations, minimize errors, and enhance efficiency.
- Data Mastery and Analytics: Expertise in managing health plan data and deriving insights for decision-making.
Results
- Demonstrate Value: Measure impact on medical expenses, providing clear financial understanding.
- Financial Alignment: Collaborate to align efforts with financial goals for comprehensive assessment.
- Provider Relations Enhancement: Improve relationships through accurate payment processes, fostering trust.
2. STAFF AUGMENTATION
We’re here to assist you in building your payment integrity organization by facilitating the recruitment of skilled individuals to occupy pivotal positions necessary to successfully implement, expand, and operationalize your Payment Integrity Office (PIO).
- Payment Integrity Subject Matter Expert (SME)
- Program Manager
- Business Analyst
- Quality
- Documentation
- Training
- Vendor Management
- Payment Integrity Business Leader
- Overpayments Manager
- Recoveries Manager
- Sr. Healthcare Analyst
- Healthcare Analyst
- Auditor
- Claims Adjusters
- Eligibility & Third-Party Liability
- Data Scientist
- Product Data Scientist
- Data Engineer
- Analytics Consultant
- Solutions Lead
- IT Project Manager
- Enterprise Architect
- Sr. Data Architect
- Data Integration Engineer
- SIU Investigator
- Sr. SIU Investigator
- SIU Manager
- SIU Director
3. DATA & ANALYTICS SOLUTIONS
Data and analytics are the foundation of any successful Payment Integrity program. We provide expertise in managing health plan data, implementing robust data architecture, and utilizing analytics and business intelligence tools for comprehensive insights.
Data & Analytics Strategy
Platform Enablement
Advanced Analytics Acceleration
Data Product Delivery
BI Modernization & Visualization
Adoption with Data Marketplace
PI Articles:
Chad Roswick, VP Healthcare Consulting
As the Payment Integrity Practice Leader, Chad’s expertise helps implementation teams:
- Conceptualize & operationalize execution (A-Z)
- Guide the process during unexpected complexities
- Reach timed milestones despite shifting priorities
- Smoothly navigate cross-functional initiatives
All while ensuring an accurate implementation improves your customers systems, processes, and creates lasting bottom-line results. With 20+ years experience in financial analysis and Healthcare PI solutions, plan administrators, and care providers, Chad’s 360-degree perspective of the industry’s inherent challenges has given him a unique ability to quickly identify issues, develop remediation plans, and improve outcomes.