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Healthcare Payor Consulting Services
Trusted for over 25 years by some of the largest healthcare payors in the nation.
Innovative Healthcare Solutions for Payors
To tackle the many challenges you face as a healthcare payor, you need a partner who understands the nuances of the industry. Over the last 25+ years, we have accumulated extensive experience working on engagements involving both commercial payors and government programs, establishing a reputation as a partner you can trust.
We deliver higher value because we prioritize understanding 1) the nuances of the industry, such as healthcare regulations, claims processing, HIPAA compliance, and evolving care and pay structures and 2) your business plan and goals so we can customize solutions for your specific needs.
“From the initial quote and requirements to the planning, scheduling, and testing, they have been flawless in digging deep into the ‘whys’ as well as the ‘hows’. They came up to speed quickly on any ask moving from one area of the team to the next without skipping a beat. They created detailed queries that we’ve been able to incorporate into our everyday processes and documented everything thoroughly.”
Our Healthcare Payor Expertise
Management & Operations
Leverage our deep expertise in operational strategy, process improvement, project management, and change management to accelerate growth and drive success. We help healthcare payors:
- Enhance operational efficiency: Optimize provider network management and streamline provider onboarding, contracting, and performance evaluation process.
- Improve claims processing efficiency: Reduce manual processes, minimize errors, and improve turnaround times.
- Drive value-based care initiatives: Design and implement effective value-based contracts and programs.
- Improve decision-making: Provide data-driven insights and analytics to support informed decision-making and identify opportunities for improvement.
- Manage complex mergers and acquisitions: Navigate the complexities of integrating healthcare organizations, including provider networks, claims systems, and patient data.
- Ensure regulatory compliance: Ensure compliance with federal and state regulations, such as the Affordable Care Act (ACA) and Centers for Medicare & Medicaid Services (CMS) requirements.
User Acceptance Testing (UAT) Process for EOB Processing
Data Science, AI, & Analytics
Data science and artificial intelligence are powerful tools that can be enabled to help payors improve patient outcomes, drive value-based care initiatives, and data-driven decisions. Our data experts can help payors:
- Gain deeper insights into patient populations: Analyze patient data to identify high-risk patients, understand utilization patterns, and develop targeted interventions.
- Improve provider networks: Use data to evaluate provider performance, identify opportunities for cost savings, and improve care coordination.
- Enhance risk management: Leverage predictive analytics to predict future healthcare costs and identify potential risks.
- Optimize IT infrastructure: Design and implement data architectures and data governance frameworks to ensure data quality and security.
- Leverage AI and machine learning: Apply advanced analytics techniques to identify patterns, trends, and predictive insights.
Utilizing Predictive Analytics to Improve Appeal Success Rates
Technology Services
By partnering with InfoWorks, payors can ensure their technology infrastructure is aligned with their strategic objectives. Our experts can help payors:
- Optimize technology investments: Assess existing technology infrastructure, identify gaps, and develop a roadmap for improvement.
- Ensure regulatory compliance: Address security vulnerabilities and implement robust compliance measures to protect patient data.
- Select and implement the right technology solutions: Evaluate and select technology solutions that align with specific business goals and support value-based care initiatives.
- Integrate complex systems: Streamline operations and improve data flow by integrating disparate systems, such as EHRs, claims processing systems, and analytics platforms.
- Leverage cloud-based solutions: Migrate to the cloud to improve scalability, reduce costs, and enhance data security.
ERP Selection, Change Management, & Data Cleaning
Custom Application & Cloud Development:
Custom application development can provide tailored solutions to address specific challenges and drive operational efficiency. Our experts can help payors:
- Develop innovative solutions: Create custom applications that address unique needs and optimize workflows.
- Streamline operations: Build applications to automate processes, reduce manual tasks, and improve efficiency.
- Enhance data management: Develop data-driven applications to analyze patient data, identify trends, and inform decision-making.
- Integrate with existing systems: Develop applications that seamlessly integrate with existing EHRs, claims processing systems, and other healthcare technologies.
- Leverage cloud-based solutions: Utilize cloud technology to scale applications, improve accessibility, and reduce costs.
