Pratical Expertise. Measurable Impact.
If your business is focused on a specific core issue or department, Advantage Operations can focus on those challenges to help create efficiencies or prioritize workflows. Below are the key business sectors that Advantage Operations focuses on, revealing where impacts on the stabilization of your operational workflow create challenges or bottlenecks that lead to loss.
Operational Guidance
Claims Processing Configuration
Provide detailed information on key data configuration points that are required for cohesive, accurate, and compliant claims processing. Items included in this process, as examples, are provider contracts, fee schedules, vendor coding, EOB and Remittance generation, etc. All facets required for high AA (auto adjudication) rates are discussed, along with guidance on efficiently handling claims that require manual adjudication while maintaining compliance and required processing times.
CRM Review
Assessment of any CRM system that is used for internal processes or communication affecting the operational output of your business. Walk through your CRM system, what its capabilities are, and how they are being utilized. It is often found that CRM systems are vastly underused, which prevents operational efficiency and causes bottlenecks in processes or information.
Internal Audit Programs
If you do not have an internal audit protocol in place, Advantage Operations can assist with implementing it. Examining the business processes and where gaps or errors can occur helps in identifying what your audit process should be (claims, rev cycle billing, enrollment files, etc.). If there are processes in place, an assessment is conducted, and any advised additions are discussed as necessary regarding cadence, data utilization, report output, and external audit readiness. (CMS, SOX, etc.)
Operational Workflow Creation and Connectivity
Examination of your business workflows, procedures, technology platform, and how it interconnects with the information processed through it. This is especially imperative for healthcare payors, as multiple values require seamless programming and connectivity within the operational model to ensure accurate claim adjudication. Advantage Operations walks through the day-in-the-life of the business output to understand the operational process, identifying disconnects in both manual and technological components to be remedied for utmost efficiency.
Policy and Procedural Assessments
Review of any P&P documentation, collaborating to update, polish and refine, or simply assess the timeliness in line with current business processes. If there are no such documents in place, Advantage Operations works with your team to understand the business functions that require the omitted documentation and assists in the construction and implementation of the required documentation.