Business Process Optimization

The payer landscape is changing drastically due to a the national focus on healthcare, mounting cost pressure, and the increased financial responsibility of patients. There are steps that your health plans can take to be well-positioned for the frequent changes.

Experienced JCS consultants can help you assess and optimize your organization to be able to thrive in tomorrow's market. We understand both the business problems as well as the technology issues and will bridge the gap with our services.

Our consultants have demonstrated their ability to:

• Assess data discrepancies, identify the sources of those discrepancies (often related to process inefficiencies), resolve existing discrepancies, and enhance solutions to reduce future discrepancies
• Assess processes and optimize them to produce cleaner data, which can result in more satisfied members and providers as well as reduced costs for you, the payer.
• Document and/or refine key processes to address regulatory and procedural changes
• Assess current IT infrastructure, recommend improvements, and assist in implementing the recommendations
• Build member-centric services that focus on wellness

Our consultants have engaged in defining and refining processes across the end to end spectrum of health plans and payers for individuals and groups, including, but not limited to:

• Enrollment
• Eligibility
• Billing/Invoicing
• Payment (binder, one-time, and recurring)
• Reconciliation
• Group and Member Material Distribution
• Claims Processing
• Provider Integration
• Medical Management
• Grievances and Appeals
• Financial Integration and Reporting
• CMS Reporting
• Terminations, Cancellations, and Renewals
• Sales, Broker Onboarding, and Commissions
• Customer Care (provider, member, and group)

Contact us today to find out more about how our consultants can help you achieve your goals.