Operational inefficiencies can wreak havoc throughout an organization and have the potential to create significant compliance issues. Whether it be outdated processes or systems, cross-functional breakdown, resource constraints, identifying the true root cause is critical to mapping a future state solution. At GHG, our team of experienced subject matter experts can work with your plan discover complex pain points and effectively implement a path to resolve them while minimizing the disruption to your members and business.

Operational Assessment

Achieving operational excellence begins with the identification of organizational strengths and weaknesses. GHG’s team of veteran experts will assess each and every operational area of your organization. Together, we can assist in AEP preparation, transmit timely and accurate membership information, recommend staff levels and utilization, and maintain or improve all enrollment processes.

Process Improvement

Once operational improvement opportunities have been identified, GHG’s operations team will become fully immersed in your organization to pinpoint the specific business areas and processes that are prime for optimization. We will work closely with you to develop a detailed process improvement roadmap that will ensure your workflows are best-in-class.

Root Cause Analysis

GHG has decades of experience stress-testing operational business units to identify potential problems and uncover the root cause behind them. Our comprehensive root cause analysis service focuses on every segment of your organization’s value chain, as our experts help implement CAPs post-audit and proactively address operational problems before evolving into compliance risks.

Compliance/Audit Remediation

Through an internal auditing process, the need for improvements may have been identified and corrective actions may have been implemented. GHG can determine whether the appropriate measures have been put in place to monitor and audit these items going forward to ensure sustainable correction. Our remediation services can also help you anticipate any potential deficiencies that CMS may identify during audit.

Reconciliation & Revenue Management

When it comes to financial reconciliation and overall membership data management, plans must protect against leakage. GHG can help you stay ahead of the CMS reconciliation process by accessing your member premium revenue, accounts receivable, and CMS revenue reconciliation. We help create transparency into your premium reconciliation functions and achieve accurate reimbursements from CMS.

Implementation

A successful implementation requires detailed knowledge of CMS requirements, guidance, and operational processes. The intricacies of these attributes can be difficult to navigate if you are just starting out or need to focus on existing business. GHG will work with you throughout the implementation process and serve as your primary knowledge base as you launch your start up or expansion.

Interim Management

GHG’s seasoned veterans can enrich your team by providing the leadership and knowledge your organization needs to keep moving forward. If it’s a matter of bandwidth, we can supplement your department(s) with professionals who have years of experience in providing strategic, operational, financial, and clinical services to the industry across a full spectrum of business needs.