Back office automation for a leading Healthcare Solution

A leading healthcare solutions provider partnered with Tieto Tech Consulting to automate complex provider enrollment workflows. By consolidating multi-channel requests and streamlining manual processes, the solution:

• Reduced resolution time
• Improved team capacity
• Enhanced overall service efficiency.

The client is a leading healthcare product company, specializing in Care Management, Pre-authorization, Population health, and ACO. Their portfolio consists of multiple products sold as modules or packaged solutions. As a key partner with the nation’s leading health plan and risk-bearing provider, it assists the provider to optimize personalized delivery of predictive and prescriptive decision support for clinicians, physicians, consumers, and caregivers.

The company offers services to manage the registration & enrollment of health plans for health providers or their clients. Registration and enrollment workflow supported by the customer’s team varied for each end-user client. The support team managed enrollment requests with large data volumes received through multiple channels, including Fax, Jira tickets, phone calls, and claim information files. The current workflow managed by end providers and customers, was predominantly a manual-driven process and was impacting services such as SLA’s, accumulated requests, and end client satisfaction ratings.

Tieto Tech Consulting focused on the business imperatives and understood the actual provider enrollment and registration process. Our team analyzed the business requirements and gained clarity on the SLA’s agreed between the provider and end users. Based on the workflow analysis and business needs, we designed a solution blueprint that automated pieces of the provider enrollment and registration workflows. Our subject matter experts presented the blueprint to the stakeholders for verification and acceptance of the solution.

We implemented the following features:

• Utility tool to automate provider data load into the target system
• Aggregation logic to easily bundle related provider tickets originating from various channels into a single request
• Automatically initiate specific provider enrollment workflow based on consolidated requests
• Created a master template to accommodate all provider detail requests to support 80% of client's Line of Business.

• Reduced service ticket resolution time by 20%
• Lessened the redundancy of operational staff by 10%
• Improved the resolution capacity of the support team by 10%
• Forecasted improvement of customer satisfaction level by 5 points