Healthcare management companies face a formidable mandate: Build high-performing health management programs that improve quality of care and patient outcomes, keep costs under control and increase consumer and provider engagement.
Accenture Intelligent Healthcare Operations helps clients deliver on all counts by combining a cloud-based analytics platform with exceptional talent. We help payers, providers and government agencies drive breakthrough growth, increase customer engagement, improve health outcomes and reduce cost.
Claim edits, configuration testing
Claim suspends/pends adjudication
Adjustments, rework and correspondence
Health risk assessments
Health outreach (e.g. post-discharge calls)
Prior authorization intake and clinical review
Concurrent clinical review
Post-service clinical claim review and appeals support
Benefits management and communication fulfillment
Case installation and member enrolment
Contract development and benefits configuration
Premium billing, accounts receivable and reconciliation
Claim and provider service support
Member and provider outreach
Medical records retrieval and review
Results Health BPS has delivered:
Applied analytics IMPROVED CASH FLOW BY $13 MILLION
Helped a client to save nearly $140 million in total medical costs by using Accenture Advanced Health Analytics Platform
Automation helped to strategically process claims, limiting late and inaccurate payments and avoid more than $15 million in penalties
Reduced costs by $30 million per year, a 33% reduction, by scaling 1,000+ non-clinical and licensed nurses in the Philippines, India and US
"Sometimes businesses suffer from an operational illness. As diagnosticians, we see what’s wrong and know how to fix it. When we are in charge of millions of transactions or access points; we’re really at the heart of operations, so every second counts."
Health Business Process Services Lead - Accenture Operations