HEALTHCARE OPERATIONS MANAGEMENT

CLINICAL OPERATIONS

Among offshore vendors, EXL supports the broadest range of healthcare management activities. EXL’s end-to-end clinical operations offerings place a huge focus on patient management, particularly in the areas of member engagement for care management programs . EXL Healthcare has approximately 1,200 clinicians and 900 non-clinicians providing a wide range of care coordination, claim management and administrative services to risk-bearing entities.

EXL’s highly-trained staff provides valuable assistance with patient management through offerings such as administering risk assessments and surveys, precertification and predetermination, UR coordination for authorizations and identification and stratification of potential participants.

Top healthcare and workers compensation carriers are realizing quantifiable and lasting impact from EXL, including up to a 50% reduction in total operating costs, improved quality of care, improved plan efficiency, peer review acceptance of more than 99.8%, and turnaround time that meets URAC-prescribed standards.

CAPABILITIES

CLINICAL SERVICES

  • Pre-Utilization Services
    • Precertification
    • Predetermination
    • Clinical claim review
    • Steerage
  • Post Utilization Services
    • DRG
    • Claims prep and consult
    • Coding review
    • Appeal management
  • Preventive Services
    • Lifestyle coaching
    • Maternity counseling
    • Disease management
  • Utilization Management
    • Prospective, concurrent, and retrospective reviews
    • Appeal and denial management
    • Peer review support
  • Low-Touch Case Management
    • Identification and stratification of potential participants
    • Enrollment and scheduling for assessments
    • Risk assessments and surveys
    • UR coordination for authorizations (inpatient, outpatient, DME, specialty, pharmacy
    • Network steerage
  • Quality and Compliance
    • Special investigation unit
    • End-to-end HEDIS solution
    • Medicare Star Rating (Improve Star Ratings by appropriate intervention)

THOUGHT LEADERSHIP

Managed Long Term Services and Supports (MLTSS)

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OTHER RELEVANT SERVICES

  • Pharmacy
    • Intake
    • Precertification
    • Provider services
    • Network steerage
    • Specialty healthcare management – coaching
    • Sales operations – plan changes
  • Short-term disability
    • Disability intake
    • Short-term disability review
    • Expedited claims review
  • Long-term disability
    • Disability intake
    • Long-term disability review
    • Expedited claims review
  • Workers compensation
    • Utilization review
    • Clinical validation – nurse review
    • Medical team assistant
    • Medical coding review
    • Provider services
  • Long-term care
    • Policy administration
    • Billing

CASE STUDY

A leading US home healthcare provider partnered with EXL to standardize its operations and improve utilization, while enhancing its customer and patient experience.

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LEARN MORE

Get a behind the scenes look at EXL Healthcare’s multi-location clinical operations and 1,200+ nurses that partner with clients every day to improve health outcomes and drive cost reduction.

WATCH NOW

Utilization Management provides an opportunity for carriers to improve care and save costs through reviews and appeals, medical records summarization and data analytics

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READY TO LOOK DEEPER?
CONTACT OUR HEALTHCARE LEADERSHIP TEAM.

 



GET IN TOUCH WITH US

Mail

lookdeeper@exlservice.com

Address

280 Park Avenue, 38th Floor

New York, NY 10017