Health Care, Business Processing & Recovery Solution

PeopleForce provides "On Demand Transaction Services" so health care payers and providers can deliver both better customer service and operate as low-cost service providers:

• Cost savings of up to 40%
• Process transactions faster at a lower cost-per-transactions;
• Scalability
• Rapid scaling up or down to match business requirements and pay for transactions only when they are completed;
• Speed, Transparency & Control
• Total transparency, remaining in control, and dictating speed and changes to output requirements.

PeopleForce is a global provider of managed HIPAA-compliant Health care Business Processing and Recovery Services for payers and providers.   

The PeopleForce Solution achieves "hard dollar" cost savings for payers and providers by transitioning them to lower-cost operating environments, increasing productivity of personnel, and improving first-time resolution rate of health care claims.  It also mitigates operational risks as well as fraud and abuse by increasing control and transparency. 

Overview

Health care expenses are expected to represent 20% of GDP in the US by 2016, almost twice the spending levels in many European countries.  Excessive administrative costs as well as waste and fraud are contributing significantly to this crisis.  As a result, health care payers and providers must alter their strategies and practices in order to contain costs and retain consumers.

At PeopleForce, we utilize a patented methodology to transition payers and providers to modular work flows; then, execute the work by combining work flow parallel processing with technology and a distributed workforce.  We perform the work on a <fixed cost per transaction basis-enabling both flexibility and scale.  Our Solution helps both payers and providers to address the challenges of cost containment while creating a more customer-centric approach in the following ways: 

• Implementing variable cost-models in lieu of a fixed-cost infrastructure;

• Transitioning to lower-cost operating environments while providing a better level of customer service;

• Allowing health care providers to focus on their "core" services;

• Leveraging new technology infrastructure platforms without making additional capital investments;

• Adhering to "Prompt Pay" regulations and avoiding penalties by leveraging our "On Demand Transaction Services"-increased productivity and improved customer response times;

• Increasing productivity by transitioning to new technology platforms (in compliance with HIPAA regulations);

• Operating with greater speed and more transparency in order to create value and execute transactions more cost effectively;

• Sustaining business growth by improving revenue generation-and, eliminating revenue leakage-with more vigilant work flow and process management;

At PeopleForce, we offer comprehensive HIPAA-compliant policy and procedure training, regular HIPAA compliance audits, trained personnel on HIPAA policy implementation, and HIPAA implementation experience.  Our distributed workforce model allows us to employ, recruit and train people with these highly specialized accreditations, backgrounds, and skills.  We always have more people available than required at any given time.

The range of services includes billing, collections, appeals, claim processing, and related claim processing services.  These services offer broad, comprehensive managed ‘back-office' and call center support for Revenue Cycle Management:

• Scheduling-data gathering and payee claim investigation and verification;
• Registration-eligibility, reference and authorization, and patient account opening;
• Charge, Capture, & Coding-data entry, Charge Master Review, ICD-9-CM coding, and CPI coding;
• Billing-imaging and data digitization, pre-billing resolution, claims filing, and electronic claims generation;
• Follow-up-accounts receivable, denial management and root cause analysis, cash posting, EOB processing, and patient balance collections;  

In addition, PeopleForce offers ‘back-office' and call center support services for Benefits Administration:

• Enrollment-imaging and data digitization, indexing, data entry, underwriting, and policy generation;
• Policy Maintenance-member changes, premium administration, policy renewal, and policy coverage changes;
• Claims Administration-data entry, investigation and verification of claim, pre-adjudication, adjudication, and statement processing;
• Customer Service-claim, product, premium and provider inquiry, and pre-authorization;
• Collections-over-payment recoveries;

The PeopleForce Solution permits the top-tier payers and providers to combine our domain knowledge and technology tools with an "On Demand Transaction Services" Model, in which our clients pay a fixed fee for transactions only when they are processed and completed.  

In addition, our Solution permits smaller health care payers and providers to leverage a cost-per-transaction operating infrastructure that otherwise would be too costly to develop and maintain.   

Why the PeopleForce Business Processing Solution?

PeopleForce has invested in the domain expertise, as well as the cutting-edge automation and imaging technology, to increase productivity for payers and providers.  By transitioning to an "On Demand Transaction Services" Model, PeopleForce enables a successful transformation to a more scalable, customer-centric ‘back-office'.

The PeopleForce Platform, called WorkCenter, functions as a transformational hub for work flow re-design, implementation and execution with full reporting capability.  Because it is based on open standards technology and delivered as a hosted managed service,

 The PeopleForce Solution delivers the following measurable results for health care payers and providers:

• Significant cost savings-25% to 40% cost savings on infrastructure and personnel through automation and digitization of the ‘back-office' fulfillment processes;
• Speed and Transparency-increasing agility and flexibility, shortening cycle times, and improving speed-to-market;
• Increased Revenue Generation- accelerating receivables and overpayment recoveries by up to 45% through service innovation, limiting fraud and abuse, improving response times, and enhancing levels of service;
• Improved fraud and abuse detection-enhancing revenue generation up to 6% by mitigating claims fraud and abuse

PeopleForce enables better service line management and increased productivity.  By leveraging our patented methodology for process management transformation, we allow payers and providers to transition to lower-cost operating environments and enable the generation of unrealized revenue through: 

• Business simplification;
• Better service at a lower cost;
• Tighter integration of the work flow tasks with customers, employees, partners, and vendors;
• And-most important-create value by optimizing working capital.  

PeopleForce's Healthcare Insurance Business Processing Solution originates from the U.S.-based headquarters in Bethlehem, Pennsylvania.  For more information, you can contact us directly at (610)419-0892 or (866)569-1043.