EXL payment capacity services
At EXL Health, we help payers quickly alleviate staffing pressures.
EXL payment capacity services
Payment integrity programs experience fluctuations in the demands on their workforce, as dictated by both internal and external forces. These factors cover a wide gamut, including staffing shortages and employee burnout, lingering backlogs and rapid inventory surges, interorganizational competition for resources, and legislative changes that increase coverage and claims submissions.
When not addressed efficiently, these known and unknown variables cause disruption to all aspects of a payment integrity program – from the provider experience to the financial bottom line.
Even the best-laid plans require adjustments and that includes workforce planning.
EXL capacity services provides flexible and expert support
At EXL Health, we help payers quickly alleviate staffing pressures. As a collaborative partner, EXL works with our clients to assess their cost containment strategy and provide support with a modular delivery model, whether our clients require staff, clinical support, administrative, software/ solutions, or the audits themselves.
Leveraging our on-demand capacity services, we deliver experienced (and scalable) bandwidth, whether you require support for short-term projects or longerterm flexibility, without hiring full-time employees. The EXL expert team provides deep domain knowledge and flexible support to execute your payment integrity needs, quickly and efficiently, in such areas as:
- Coding review
- Claims audit
- Appeal management
- Special investigation unit
- Claims system integration support
EXL’s audit team consists of over 600 accredited clinicians and coders with an average of 10 years of experience. In addition to the auditors, our EXL Payment Services business provides another 600 resources in analytics, data management, subject matter experts, technology support, operations coordinators, client pre-audit and post-audit support and management.
Beyond putting people in place, we deliver support with our industry-recognized best-in-class digital solutions that broaden existing workforce capacities and extend payer operations. With digital intelligence that continuously improves, our solutions apply machine learning within our analytical models and quality programs, ensuring our clients consistently achieve industry leading metrics and results.
Let’s partner your way with our highly flexible delivery model
EXL Health provides highly trained and experienced staff to address a wide variety of financial, administrative, revenue/ payment lifecycle, analytics, technology, data management and clinical needs. We offer a variety of delivery models and will work with you to create an approach that meets you where you are on your transformation journey. Depending on your needs, our workforce enablement solutions offer:
- Full or partial delegation of services
- Capacity/business process outsourcing services
- Global delivery centers that enable mix and match onshore/offshore/work from home model
- Center of excellence for data management, cloud migration, analytics, business intelligence & technology services
Case study: Skilled workforce addresses claims adjustment backlog
Challenge:
- A large national payer presented us with a concern in meeting their recovery goals. Through discussion as a collaborative partner, the skilled team at EXL discovered that their biggest threat was a large backlog of inventory within their payment integrity work that was holding high dollars of recoveries to report, as well as meeting compliance standards, and had been a pain point for years.
Human ingenuity:
- EXL quickly responded and together with the payer created a solution that was active within 30 days. While originally a 6-month project, the project was so successful that the client extended into a 12-month project. Their extensive backlog was up to date by year end.
Outcomes:
- Because of the realized success and immediate shift in inventory, the payer reached out to supplement for another area needing some help, adding another backlog project to continue a length of 8 months. The payer received accountable savings within the year, as well as a fresh start going into the new calendar.