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Healthcare Outsourcing: Sample Roles for your Offshore Healthcare Staff

The global healthcare BPO market is projected to reach USD 468.5 billion by 2026 from USD 296.4 billion in 2021, at a CAGR of 9.6% during the forecast period. (MarketsandMarkets)

Roughly 25% of all U.S. hospital spending consists of administrative costs.(Commonwealthfund)

It costs nearly $250 billion to process 30 billion healthcare transactions each year – 15 billion of which are faxes. (HIMSS)

Outsourcing Healthcare services is a cost-effective solution that can help companies with their intra-day operations. Healthcare outsourcing is the practice of healthcare organizations outsourcing services, particularly non-core business functions, to third-party providers. Healthcare outsourcing allows for a dedicated and highly specialized offshore healthcare support team to streamline operations and lower costs.

Benefits of Healthcare Outsourcing

The Healthcare Outsourcing market continues to be a lucrative market as it allows for overhead reduction, efficiency, and decreased costs. Selecting the right healthcare outsourcing partner allows for an end-to-end patient experience. Here are some benefits you can get with the right outsourcing provider:

  • Access to Top Talent
  • Improved Processes
  • Customization and Scalability
  • Full-Scale Revenue Cycle Management
  • High Literacy rate and Excellent verbal and written communication skills
  • Data-Driven Approach
  • Data Security

Read more on an in-depth discussion on the benefits of Healthcare Outsourcing on our previously published article.

If you are planning to partner with a Healthcare Outsourcing provider, look for a provider with talent pool equipped with the following basic competencies:

  • High Attention to detail
  • Excellent written and verbal interpersonal skills; including the ability to interact with people at all levels of the organization including the executive leadership
  • Excellent time management, customer service and organizational and decision-making skills.
  • Able to handle all communications with the company from a remote position
  • Experience with computer software and word-processing software and spreadsheets (e.g. Microsoft Office, SharePoint or Google Drive, or any cloud-based storage functions, desktop sharing, cloud services, and VoIP)
  • Up to date knowledge of technologies in the health information sector and their applications
  • Knowledge in producing reports such as pivot tables and basic charts and graphs.
  • Ability to work independently, while collaborating with team members
  • Must have a working understanding of patient-hospital-medical providers relationship such as confidentiality clauses, medicine dispensing and the like

Sample roles that healthcare organizations can outsource are: medical billing and collections, pre-authorization, inbound and outbound calling, calls & action, timely & correct payment posting, to eligibility verification are some of the tasks clients can delegate to healthcare outsourcing providers.

Connext Global Solutions offers excellent Healthcare Outsourcing Solutions. Here is a list of common roles with their accompanying tasks that you can delegate to a Healthcare outsourcing and staffing solutions provider like Connext Global Solutions:

Healthcare Account Manager

The offshore Healthcare account manager acts as the dedicated point of contact of the client and is responsible in overseeing and managing the daily operations of the offshore team. The dedicated account manager provides performance reviews, real-time quality monitoring and feedback sessions. Equipped with management and organizational skills, it is required that the manager has an understanding of US rules, regulations and practices affecting medical billing and insurance verification, has a comprehensive knowledge and understanding of rules, regulations and practices affecting medical billing and insurance verification, revenue cycle, collections and payment posting, medical billing and coding, Medicare and Medicaid, and third-party payers.

Credentialing Specialist

Healthcare Outsourcing roles can also extend to administrative functions such as the credentialing application process. Credentialing Specialists conduct primary source verification and ensure proper and timely handling of credentialing applications of participating providers and are monitored on an ongoing basis. This includes, but is not limited to, providing application assistance, data entry, file audits, requesting information, sanctions, progress and monitoring reports, and maintenance of electronic files.

Medical Billing Specialist

Accurate data entry is provided by Medical Billing specialists The dedicated outreach specialists reach out to respective insurance companies via inbound and outbound calling for collecting payments and insurance verification. They process confidential medical documents and accounts creation, participate in all quality assessment activities and assist to collect and analyze all information and recommend required improvements to all processes and provide follow-up calls for Claims Audit, Claims Follow-up appointments if required 

Claims Adjudicator

The Claims Adjudicator processes claims according to plan documents while applying Company policies and procedures, verifies data entered from the claim form is accurate and complete to enable the claim to be processed correctly and improves claim payment accuracy by identifying pricing and/or submission inconsistencies to management.

Healthcare Support Specialist

Your outsourced Healthcare Support Specialist coordinates and communicates with healthcare providers and patients. They maintain departmental records, reports, and files, communicate delivery setups, make follow-up telephone calls to maintain accurate records, including submittal/return dates and approval periods, and ensure that medical record account entries are up to date.

Connext Global Solutions provides Excellent Staffing and Outsourcing Solutions

Connext Global Solutions is a dedicated team of business process outsourcing experts and innovators, with experience in supporting world-class companies in Title and Escrow, Healthcare, Produce Distribution, Retail and Fashion, Design Consulting, and Finance.

Aside from providing Healthcare Outsourcing solutions or other industry-specific outsourcing solutions, Connext also provides customized and highly flexible offshore staffing solutions designed to supplement onshore client staff with highly qualified, but lower cost offshore team members personally selected by the client. Healthcare outsourcing providers need to provide fully customized and scalable staffing and process solutions to healthcare organizations.

Depending on the staff and need of the organization, on top of the above stated functions such as Credentialing Specialists, Medical Claims Processors and Medical Billing Specialists, clients can build a team of:

  • Virtual Nurses
  • Certified Public Accountants
  • Customer Experience Professionals
  • Administrative Assistants
  • Web Developers
  • Data Analysts
  • IT Help Desk or Service Desk Support
  • And More

Organizations can also build custom cross functional offshore teams which they can scale up or down as they see fit.

Connext redefines healthcare outsourcing by providing fully customized outsourcing solutions for healthcare organizations looking to innovate and grow. Connext Global Solutions provides Healthcare Outsourcing designed with the patient in mind. Outsource Healthcare services to Connext today.