Insurance Claims Process Management for a Healthcare IT Company

Managing the insurance claims process end-to-end from data entry to qualification to ensure high reimbursement rates. Rapidly growing, VC-backed Healthcare IT company serving over 1 million patients.

Overview
The Challenge

Exponential Growth Overloads Internal Process Management

A rapidly growing, venture capital-backed healthcare IT business sought to maintain its growth trajectory after raising over $50 million in funding. The client provided flu vaccinations to over 1 million students across U.S. public schools each fall, and their digital health platform helped schools maintain compliance and manage chronic diseases.

As the client experienced the quick, exponential growth common of venture capital-backed companies, they encountered a challenging bottleneck. Each student enrolled in their program had to be verified for insurance coverage. The insurance qualification and claims process, which tended to be time consuming and unwieldy, became increasingly overwhelming for existing staff to manage. Struggling to cope internally, the client initially addressed the problem by bringing on a 10-person team of seasonal employees. While this temporary staff was able to keep up with the paperwork and requirements for 100,000 students per year in the company’s early stages, the volume became increasingly difficult for the client to manage. Finding consistent and reliable seasonal labor developed into a challenge of its own to administer.

The Solution

Establish Processes and Onboard Assivo Staff to Meet Claim Processing Demand

Assivo worked with the client to develop a detailed process for insurance qualification and claims submission. Assivo also created a schedule for each of the 1,000+ schools that the client served in order to build out a workflow. With a complete understanding of the scope of work and how demand ebbed and flowed, Assivo deployed teams to help with insurance claims processing for the client.

Assivo flexed its team sizes up and down to meet the needs of each school and to ensure that all insurance qualification and claims submission activity was completed accurately and on time. With a process in place, the client was able to dedicate its internal resources to more high-growth tasks, catering to their districts, expanding technology, and looking for ways to fuel development with the knowledge that it could manage the resulting workload.

The Result

Reduced Operating Costs Return Funds to Refuel Growth

Assivo’s team saved the client nearly 60% of their in-house operating costs and turned fixed costs into variable costs that reflected volume and need, trimming unnecessary and unproductive overhead. Assivo staff, highly trained to the client’s specific processes and requirements, boosted the accuracy and predictability of the overall insurance qualification and claims process, leading to materially higher collection rates.

The client found a partner in Assivo and quickly realized the benefit of scalable managed talent. The client engagement began with a 25-person Assivo team that serviced 250,000 students per year. Assivo scaled with the client’s own growth to a 100+ person team servicing 1,000,000+ students per year. With a focus on the future, the client was able to expand offerings to school districts and multiply its own portfolio with confidence that Assivo would dynamically respond to their shifting needs.

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