Amid a large restructuring process and in a state of flux, this client—a Medicaid managed care organization—was in need of an interim medical director to provide leadership and oversight to its struggling credentialing and case management department.
A large health plan had a severe backlog in reviewing records and determining pay denial of claims. Jacobson provided a team of work-at-home medical review nurses who worked through the backlog in less time than expected, completing the project two months early.
This nonprofit health plan was in the process of developing its underwriting department. At the time, its clerical staff and nurses were handling underwriting activities and had grown its inventory to 11,000 applications. Our consultants were able to quickly eliminate the backlog, setting the bar for the client as they recruited permanent staff.
A health plan was struggling to pass the Center for Medicare and Medicaid Services’ audits. Jacobson’s expert was able to handle Medicare Part C and Part D grievances, complaints and appeals.
After a poor CMS audit, this health plan was in need of a consultant who could correct the problems and respond to CMS for a validation audit. Jacobson’s consultant utilized a background in Medicare compliance and CMS audit experience to quickly put together a corrective action plan.
This Blue Cross Blue Shield plan was not meeting CMS requirements and turned to Jacobson for a consultant who could improve policies and procedures and train the existing staff.
A large managed care organization turned to Jacobson for support during a major reorganization and consolidation effort. Jacobson helped them develop a work plan, design an efficient process for configuring plans, and assemble and train a team of plan-building consultants to manually configure and test the system.
A Blue Cross Blue Shield plan contacted Jacobson with a critical backlog of overpayment claims. Jacobson quickly arranged a team of claims professionals. Our team quickly addressed the backlog, correcting a huge amount of claims.
This leading health plan was experiencing enrollment discrepancies between its in-house database and CMS system. Jacobson quickly delivered a dedicated team that tackled the discrepancies, decreasing them from 22 percent to less than 3 percent.
A major Blue Cross Blue Shield plan’s inventory for unallocated cash was at an extremely unsatisfactory level. Jacobson sent a team of contractors to help with the backlog; within a year, the inventory had dropped significantly.
As healthcare reform deadlines were approaching, a health plan desperately needed additional trainers. Jacobson worked quickly to identify a trainer with extensive healthcare reform knowledge and Facets technology expertise.
In response to a significant backlog in written correspondence, this Medicare administrative contractor contacted Jacobson. After one week of condensed training, Jacobson’s staff of experienced customer service representatives handled more than 21,000 calls over the course of four months.