Navigating the intricate landscape of healthcare poses a myriad of challenges for organizations and at the heart of these complexities lies the daunting task of risk adjustment. The effective management of the risk adjustment process is imperative to ensure health insurance payers have adequate resources to meet the needs of their member population. Risk adjustment requires the management of vendors and the capability to process and supervise the transmission of large amounts of data. Any inefficiencies in this process have immediate financial implications for the organization and its members.
At ProspHire, our team of healthcare professionals offers holistic solutions to bolster every aspect of your risk adjustment program. Whether you require high-level strategic planning, assistance with RFPs, vendor management or program evaluations, we’ll draw upon our extensive knowledge and experience. We excel at pinpointing improvement opportunities that translate into favorable return on investment for your organization.
How ProspHire Can Help
See how ProspHire can help address the key issues facing your organization.
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Risk Adjustment Program Best Practices
Drive organizational transformation through defined goals and a developed playbook for change management and actionable strategies to build a best-in-class Risk Adjustment program.
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Encounter Submission Program Evaluation
Receive guidance and areas of opportunity to achieve optimal capture of diagnosis codes with HCC impact and incremental value accepted and stored by CMS.
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Retrospective Program Evaluation
Maximize the value from chart retrieval and coding efforts through targeted gap identification and appropriate vendor selection for the desired medical record review method.
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Prospective Program Evaluation
Evaluate current activity effectiveness to determine the best suited prospective provider and member engagement programs for annual member diagnosis code recapture.
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Vendor Effectiveness Evaluation
Assess vendor performance against contract service agreements, industry best-in-class standards and standards of delivery quality.
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Program and Project Management
Realize value faster with skilled program and project managers who will relieve leaders of administrative burden and organizing teams to execute the project plan efficiently and effectively.
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Staff Augmentation
Provide talented, experienced subject matter experts to fill temporary staffing gaps to support additional business needs such as RFP execution, vendor management, or vendor implementations.
Client Results
