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Our leadership and our consultants are widely recognized for delivering many technological “firsts” in the health care industry.
They have a wide array of expertise from architecting, building and developing mission critical systems like member portals, Claims Systems, Eligibility and Benefits systems, Utilization Management / Pre-authorization systems, Pharmacy integration, etc. Following is a list of our expertise:
Our Health Care Expertise
- HealthCare Domain Expertise
- Enrollment and membership
- Provider Setup
- Provide pricing and contract management
- Benefit, plan and product configuration and management
- Claim and encounter processing
- Claim Pricing
- Capitation
- Premium billing and accounts receivable
- Agent and broker management
- Customer service
- Finance
- Utilization management
- Case and Medical management
- Medicaid and Medicare processing
- Specialty processing such as Dental, Disability and Life etc.
- Underwriting and actuarial
- Pharmacy
- EMR
- Public Sector Programs, including Managed Medicaid
- Behavioral Health Care
- Health Plan & Provider audit support for SAS/70, Sarbanes Oxley, and HIPAA
- Audit and Controls
** Experience is in both Public and Commercial Payor Expertise
Our Health care IT Systems-Specific Expertise
- Claims Adjudication and Payment
- Web Portals (Member, Provider, Employer, Shopper etc)
- Benefits Enrollment, Membership, Eligibility
- Plan Design and Product Configuration
- Utilization Review/Management, Authorizations and Referrals
- Clinical Care Systems
- Provider Credentialing, Provider Networks, Fee Schedules, Provider Reimbursement
- Methodologies
- Systems Integration
- Premium Billing and Reconciliation
- Customer Service/Customer Relationship Management(CRM)
- HIPAA, EDI, Privacy, and Security
- Data Warehousing, Client/Operational Reporting
- Systems Implementation, Systems Migration
- Regulatory Compliance
Our Technology and Information Systems Expertise
- Web Applications: Internet, Intranet, Portals
- Service Oriented Architecture: WS-* Standards, REST
- Messaging and Middleware
- Content Management and Integration
- Database and Storage
- ETL Data Processing (Extract, Transform, Load)
- Data Warehousing and Reporting
- Security and Privacy Standards: HIPAA, PCI
- Systems Integration (including legacy systems): real-time, near real-time, batch,
synchronous/asynchronous
- Infrastructure Design and Support
- Business Continuity and Reliable Systems
- End-To-End Systems and Software Delivery
- Program and Project Management
- Estimation
- Budgeting
- Planning
- Governance
- Systems and Software Development
- Analysis and Requirements
- Architecture and Design
- Software Development
- Quality Assurance
- Unit and Systems Testing
- Information Assurance and Security
- Capacity Planning and Load Testing
- Project Controls and Auditing
- Operations and Support
- Configuration Management
- Release Management
- Production Support
To request our Systems Development services, contact us.
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