Operational Process Improvement
For health plans that hold government contracts, operations and compliance are inextricably linked. At the same time, in order to compete in the dynamic reimbursement and care model environment, health plan operations and systems need to be nimble enough to address shifting market demands.
The FTI Consulting managed care team has broad and deep expertise in a wide variety of health plan best practices and system environments. In addition, our knowledge of government programs can help build compliant and efficient operations. Our services assist government contracted health plans in the delicate balance between compliant operations and proficient business processes.
Our service offerings include:
- End-to-end process improvement assessments of all health plans functions including claims, enrollment, risk adjustment and clinical processes and systems
- Benefit configurations testing for medical and pharmacy claims/enrollment
- Workflow, standard operating procedures and desk reference material development for all core health plan functions
- Large-scale system implementation project management including vendor capability and alignment assessments
Senior Managing Director