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Claims Management Outsourcing

Offshoring claims processing services can help improve claim payment accuracy and maintain a low backlog of work by properly identifying pricing and/or submission inconsistencies to management. Outsource claims management with Connext.

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Outsource Claims Management with Connext

The Claims Adjudicator processes claims according to plan documents while applying company policies and procedures. The Claims Adjudicator verifies data entered from the claim form is accurate and complete to enable the claim to be processed correctly.

They verify that the data entered from the claim form is accurate and complete to enable the claim to be processed correctly by insurance payers.

Offshoring claims processing services can help improve claim payment accuracy and maintain a low backlog of work by properly identifying pricing and/or submission inconsistencies to management.

This involves researching and resolving pre-processing errors and edits to ensure that claims are filed timely. Accurate and timely processing of claim appeals means compliance with the various payor requirements.

Benefits of Outsourcing Claims Management

The Medical Billing process involves researching and resolving pre-processing errors and edits to ensure that claims are filed timely. Accurate and timely processing of claim appeals means compliance with the various payor requirements.

Offshoring claims processing services can help improve claim payment accuracy. The outsourced staff verifies data entered from the claim form is accurate and complete to enable the claim to be processed correctly.

Outsourcing the services of a Healthcare Claims Processor can provide support in the processing and adjudicating insurance claims submitted by healthcare providers.

Outsourced Claims Processors review insurance claims submitted by individuals or businesses, verify the claims information indicated, calculate and process claims payments and determine the coverage and eligibility for claims based on policy terms and conditions. They can work for individuals or specialized industries such as insurance companies, healthcare providers, and customers to ensure timely and accurate claims processing.

They communicate with insurance companies, healthcare providers, and customers to obtain necessary information and resolve claim issues. They also maintain accurate records of claims information and transactions and ensure compliance with regulatory requirements and guidelines.

Aside from claims processors, outsourced Medical Claims Appeals staff can be offloaded claims appeals services such as correcting denied claims, sending corrected claims and managing denials. These Medical Claims Appeals staff are in charge of checking claim statuses online, correcting denied claims, resolving discrepancies and processing refund requests or settlements, and sending corrected claims.

We can hire outsourced Healthcare Claims Processors with a high school diploma or GED, as well as relevant work experience in healthcare claims processing or medical billing, and proficiency of medical terminology, insurance billing codes, and healthcare reimbursement policies. We ensure Outsourced Healthcare staff also have familiarity with electronic medical records (EMRs) and healthcare claims processing software.

Expertise and efficiency

Credentialing requires in-depth knowledge of regulatory requirements, industry standards, and best practices. Outsourcing to specialized credentialing firms provides access to professionals who possess expertise in credentialing processes. These firms are well-versed in the intricacies of verifying licenses, certifications, education, training, work history, and other credentials. They can efficiently navigate through the complexities, ensuring accurate and thorough credentialing outcomes.

Cost savings

Outsourcing credentialing can result in cost savings for organizations. Establishing an in-house credentialing department requires significant investment in personnel, training, technology, and ongoing maintenance. By outsourcing, organizations can avoid these upfront and ongoing costs. Additionally, outsourcing eliminates the need for staff dedicated solely to credentialing, allowing organizations to allocate resources to other critical areas.

Time savings

Credentialing can be a time-consuming process, involving extensive research, verification, and documentation. Outsourcing to credentialing specialists who are well-versed in the process can significantly reduce the time and effort required. They have established workflows, efficient systems, and access to databases, enabling faster turnaround times for credentialing applications.

Compliance and risk management

Credentialing is closely tied to compliance with regulatory standards and industry requirements. Outsourcing to firms with a deep understanding of these standards helps organizations mitigate compliance risks. Credentialing providers stay up-to-date with changing regulations, ensuring that the organization remains in adherence. This reduces the chances of errors or penalties associated with non-compliance.

Focus on core functions

Outsourcing credentialing allows organizations to focus on their core functions, such as patient care, administrative tasks, and strategic initiatives. By delegating the time-consuming and complex credentialing process to external experts, organizations can redirect their internal resources toward activities that directly contribute to their mission and goals.

Scalability and flexibility

Outsourcing credentialing provides organizations with the flexibility to scale their operations based on demand. During periods of increased credentialing volume, such as when onboarding new providers or expanding services, outsourcing partners can quickly ramp up resources to handle the workload. Conversely, during slower periods, organizations can adjust the outsourcing arrangement accordingly.

Quality assurance

Outsourcing credentialing to specialized providers can enhance the quality and accuracy of the credentialing process. These firms have established quality control measures, ensuring thorough verification and documentation. Additionally, they may have access to specialized tools, technology, and databases that improve the accuracy and reliability of the credentialing outcomes.

Claims Management Outsourcing Case Studies

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Outsourcing Claims Management: How it Works

We help healthcare organizations build dedicated claims management support teams in the Philippines. This is the new way to outsource claims management and processing.

1. Assess

Understand your business needs so that we can build a team to supercharge your growth

2. Recruit

Screen, interview, and endorse candidates that meet your specific qualifications

3. Train

Help you train your team for optimal performance

4. Evaluate

Conduct quality audits, evaluations, and feedback loops to ensure your team is performing to standard

5. Execute

Full production of your team with ongoing management support and consulting from Connext

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Dedicated outsourced claims management support: Customized Staffing Solutions

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