Having supported federal, state and private healthcare companies for over 25
years, Wipro recognizes the dynamic nature of the healthcare delivery system,
understanding operational challenges and current federal regulations and
guidelines.
The use and design of technology, process, and
technical/operational staffing has become a critical factor in the growth and
success of healthcare companies. Wipro’s knowledgeable Managed Care
consulting team will structure targeted engagements, helping our clients get
best value and best practices from crucial Managed Care operational areas,
including Managed Care Enrollment, Disenrollment and Maintenance Processing,
Managed Care Sales and Marketing, Eligibility, TRR Processing, Correspondence,
Reconciliation, Reporting, Claims, Encounters, Appeals & Grievances,
Financial Reconciliation, and Staffing.
Consulting includes
current-state processes and procedures; definition and mapping of current-state
processes; workflow and gap analysis; technology gap analysis and
recommendations; staffing and training; P&Ps and gap analysis;
Letters/Fulfillment process improvements; Claims, Encounters and RAPS process
improvements; build or buy decisions; review and validation of defined
capabilities gaps against specified regulatory requirements and benchmarks of
best practices; recommendations for training; and future-state processes to
maintain and increase operational efficiencies, and support regulatory
compliance.
Experienced Managed Care subject matter experts study,
analyze and recommend operational efficiencies tied to targeted client
objectives and deliverables, and leveraged to Wipro’s consulting services
methodology 4-step framework of Discovery, Analysis, Recommendations, and
Implementation, drawing upon proven practices of Lean/Six Sigma and
Kaizen. Throughout a consulting project, Wipro guides clients through all
four phases, proposing focused solutions for the implementation of processes and
technology to support Managed Care programs, supplying access to an
experienced team of Managed Care SMEs as needed, with consultation to produce
results that define and improve program processes along with the support, plans,
documentation, P&P’s, training etc. to successfully implement
recommendations.
Wipro’s consultants work with all functional areas of
the client’s Managed Care business including 3rd party software and services
providers, coordinating client needs to the skillsets of the team, bringing the
right Wipro Medicare Consultant into each task and deliverable.
