The Payer landscape is complex and constantly evolving, which means that you need a partner who understands the importance of building solutions that are industry-specific, scalable, and sustainable. We're committed to helping our partners improve the health and financial well-being of members by providing the talent needed to enhance clinical services, quality programs, claims operations, provider relations, and population health management.
An experienced clinical team is vital for enhancing health outcomes and reducing healthcare costs. Our national network of clinicians enables partners to scale teams efficiently during case volume spikes, member growth, and the introduction of new programs. With expertise in Case, Disease, and Utilization Management, as well as Pharmacy Services, Behavioral Health, and Population Health Management, we provide tailored support to meet the needs of your member populations.
Delivering high-quality care is paramount for our Payer partners. Our comprehensive Quality Improvement solutions encompass effective chart retrieval, abstraction, clinical review, reporting, and provider education. We assemble project teams for retrospective HEDIS and Star rating audits, offering a flexible right-to-hire onboarding model to integrate seamlessly with your full-time teams. Additionally, our shared service teams unite Risk Adjustment and Quality Improvement talent, ensuring synergy and efficiency in operations.
A steady pulse on your member population and their respective disease conditions is critical in the mission to customize clinical programs and maintain financial awareness. Our prospective and retrospective Risk Adjustment teams help retrieve, code, audit, analyze, and properly document the disease conditions of members. Whether your team needs help through the RADV audit or investing in building out full-time prospective teams, our network of talent can help fill gaps quickly and establish intelligence for the future.
A strong analytics team is the engine that helps our clients drive key decisions. Understanding member populations and their healthcare is crucial for informed decision-making. We support Population Health, Social Determinants of Health, Predictive Analytics, Financial Modeling, Value-based Care Analytics, and Claim root-cause analysis.
Our pharmacy services play a crucial role in optimizing medication management and enhancing healthcare outcomes. We provide comprehensive support across various aspects of pharmacy operations, including medication adherence programs, formulary management, prior authorization, medication therapy management, specialty pharmacy services, and analytics. Our tailored pharmacy solutions contribute to improved patient satisfaction, medication safety, and overall healthcare quality.
Medasource is intimately familiar with the fast-paced and constantly evolving claims environment. We infuse quality claims talent to increase production, reduce errors, maximize retention, minimize over-payments, and optimize systems through automation, configuration, and development. By implementing best practices and innovative solutions, we help our partners optimize through claims processing, auditing, recovery, FWA, and system development.
Our goal is to reduce friction between our Payer and Provider partners so full focus can be given to their consumers. As the industry pushes towards interoperability, value-based contracting, price transparency, and quality improvement, Medasource assembles custom teams to help with the heavy lift and reduce administrative burden.
Medasource helps our partners provide white-glove service to their members. We infuse member-driven talent to help support teams across enrollment, benefit coverage, price estimation, financial counseling, grievances & appeals, benefit plan design, and much more.
Our Medicaid Implementation Services are designed to support organizations in navigating the complex landscape of Medicaid programs and regulations.
We offer comprehensive assistance throughout the implementation process, from initial planning and strategy development to system integration and operational deployment.
Our team of experts brings extensive experience in Medicaid policy, eligibility determination, enrollment processes, and benefit design.
We collaborate closely with clients to tailor solutions that meet the unique needs and requirements of their Medicaid programs, ensuring compliance with federal and state regulations.
Whether launching new Medicaid initiatives, expanding existing programs, or optimizing operational efficiency, our Medicaid Implementation Services provide the guidance and support needed for successful implementation and ongoing management.
As the Healthcare industry shifts towards value-based care (VBC), our partners leverage Medasource's industry expertise to advise and scale supporting operations. Our network of VBC professionals spans across many key focus areas including, Care & Disease Management, Care Coordination, Value-based contract modeling, Practice Transformation coaching, Data Analytics, Risk Adjustment, and Quality Improvement.
Eric Neltner
Director, Revenue Cycle Management and Payer Verticals