Our client provides diagnostic testing for a variety of institutions including pharmacies, medical offices, and educational facilities. Throughout the pandemic, our client was focused on providing quick and accurate testing for COVID-19.
Data needed for testing reimbursement or payment was not always collected from the institutions. This left our client with hundreds and thousands of unreimbursed bills. Many of these bills were attributed to missing data.
Our client’s process for collecting missing data was managed by their back office. Their staff spent hours sifting through multiple sources to research and obtain the needed information. Occasionally, outreach to physicians’ offices, laboratories, pharmacies, or other organizations was necessary.
Faced with an immense backlog of missing information, our client needed additional resources to obtain the data and correctly bill the charges. That’s where the Radius Global Solutions team came in.
The Radius Global Solutions team improved efficiency for our client by updating their procedures in 3 key areas:
Our team attended two, 4-hour training sessions hosted remotely by our client. As we started working through real-life scenarios, we uncovered additional steps, actions, and missing information. After updating several components of the training curriculum and created:
A process for loading cases to the Contact Manager database on LiveVox was created. With this new process, cases are given to an agent to review. Once the agent has worked the case, they can categorize the case as “Cleared.” This means they have cleared the error and the case is complete.
Alternatively, the agent can indicate that follow-up is required with an outside party to gather additional information. Outreach could be to an individual or an organization, such as an insurance company. Outreach types are “Email,” “Fax,” or “Call.” Agents can also mark a case for “Manager Review” if needed.
Cases tagged for follow-up outreach are downloaded at the end of the day and addressed in Overland Park. This process was implemented to accommodate insurance carriers that ask our team to address multiple cases at once. Manually handling this type of outreach is the best way to meet these clients’ needs.
A Quality Assurance (QA) program to independently monitor, evaluate, and provide coaching to agents was developed for our client. QA agents also worked on missing data accounts before they started evaluating the agents. This allowed them to have a better understanding of the steps that the agents take while clearing errors daily.
Two accounts were reviewed for each agent weekly. A variety of accounts were reviewed to ensure that different errors and outcomes were measured.
QA evaluations were scored according to how well the agent performed the necessary tasks. An immediate coaching notification was sent to the Operations team once an account was reviewed with a QA score of 80% or less.