Creative Ways to Solve Staffing Shortages
Client: Health Plan
Challenge: In 2021, CMP engaged with a Facets client for a 12-month inventory reduction plan.
CMP Solution: To better serve our client, CMP sought the assistance of a third-party staffing company. At the end of the project, CMP analyzed the performance of the temp staff compared to the CMP examiners. We found that our performance optimization efforts enabled CMP’s examiner team to handle the same amount of claims as the temp staff but with five fewer examiners. Results of this effort generated lower training costs for the project and reduced overall hours for the examiner team. This benefited our client greatly as we were able to identify other key differences between CMP and a traditional staffing agency. For example, CMP’s fees accrue for production and throughput, where a staffing company bills for hours on the account, whether generating value-add output or not. For every 1 hour worked by a CMP employee, a staffing company temp would work 1.5 hours to yield the same output. CMP’s services includes retention efforts, re-training, quality assurance, mentoring, management, consulting, efficiency, accountability, and leadership. A staffing agency only provides temporary staff for hourly rates. As a result of these findings and CMP’s action, we were able to successfully support our client with a more effective 12-month inventory reduction plan than traditional solutions would have provided.
Smart System Conversion
Client: Health Plan
Challenge: The client was undergoing a claim system conversion and desired a BPO partner to manage claim runout and provide additional production capacity on their new application.
CMP Solution: As the client cross-trained its staff and managed the migration to their new application, CM staff trained on the client’s proprietary, legacy system and helped to reduce the backlog and manage inventories. As business transitioned to the new application, CMP deployed a team to manage overflow inventories on the new application. As throughput rates and automation increased on the new platform, the client scaled back to the CMP Safety Net and continues to utilize CMP to support their claims overflow needs today. CMP’s support was a cornerstone of the client’s IDC-10 contingency plan and continues to be part of their overall staffing and operational planning. When the client encountered a significant weather event, completely shutting down operation, CMP’s staff was able to continue processing claims for the client, allowing them to meet their contractual requirements and avoid penalties.
Staff Augmentation and Training
Client: TPAs
Challenge: A Third Party Administrator (TPA) serving the Taft Hartley market encountered challenges hiring in several local markets and desired support for planned and unplanned disruptions in their workloads. The TPA’s client required staffing at a unique location.
CMP Solution: CMP employed a team of experienced claim processors in a unique location to meet the needs of the TPA and their Taft Harley client. The TPA provides day-to-day employee oversight and direction, while CMP offers technical support and human resources services. CMP also provides ongoing expertise and development to the client in claim processing, quality, and productivity. The CMP Safety Net offers continuous support for planned claim inventories and unplanned disruptions. The CMP team has an assigned claim inventory and is responsible for maintaining timing standards and quality performance. The CMP team is cross-trained to handle additional skill sets as inventories increase and decrease on their primary assignment. The result is that the CMP team provides an efficient solution for the assigned workload but an economical and flexible solution for other workloads that may require attention and additional support.
2-Step Approach to Eliminating Claims Backlog
Client: Health Plan
Challenge: The client is an administrator of short-term major medical policies and faces an excess inventory of medical records and a claims processing backlog due to substantial sales growth.
CMP Solution: CMP provided a two-tiered approach to addressing the client’s immediate need for support. First, CMP deployed a part-time team to begin training. The part-time team consisted of staff working on other assignments with the necessary skill set and capacity for this assignment. The part-time strategy and CMP’s “train the trainer” model allowed the Client and CMP to react immediately and impact excess inventories. Though only working part-time, the initial team successfully trained and met the client’s productivity ad quality standards within seven (7) weeks of their start date.
All-in-One Auditing Team
Client: Health Plan
Challenge: This national payer was planning the operational consolidation and claim system conversion of a multi-system/multi-location environment. They desired a single auditing team for new employees, third-party outsourced employees, ongoing random, large claims, and specific cause auditing.
CMP Solution: Utilizing CMP’s “train the trainer” model empowers CMP to develop Subject Mater Experts on each of the legacy and replacement systems. CMP ramped up audit teams for each skill set and completed reviews of new hires and outsourced employees on each of the disparate platforms. CMP also participates in the client’s audit committees, establishing best practices and process improvement opportunities. As each platform has a unique conversion schedule and staffing model, there have been substantial increases and decreases in audit workload for each skill set. CMP’s flexible staffing model and extensive cross-training allowed its auditors to be migrated between the platforms as planned quickly or unexpected changes in workloads were encountered. The client valued our flexibility and responsiveness and therefore retained CMP for ongoing auditing services and as the contingency plan should there be a disruption with the client’s organized employees.
Custom Software Solutions
Client: Health Plan
Challenge: A Medicaid payer had a backlog of Claim Adjustments resulting from retroactive fee schedule and benefit changes.
CMP Solution: CMP sent a team of Subject Matter Experts (SMEs) to the client’s location to develop an operational strategy for managing claim adjustments. CMP quickly deployed a group of 20 internal and external claim processors to handle this assignment. CMPs SMEs provided training in auditing and process improvement recommendations to remediate the backlog of adjustments. Since the client did not have established workflows for claim adjustments, CMP developed an Inventory Distribution System (IDS) to distribute and manage the work. The IDS application was developed by CMP’s software design team and included several functions for managing work distribution, bundling line item adjustments on common claims, inventory management, and security. CMP successfully resolved all assigned adjustments within the client’s timeframes and quality standards. The client valued CMP’s responsiveness and flexibility in managing claim adjustments with minimal intervention and involvement from the client. CMP’s innovation in developing the IDS tool proved invaluable in assisting the client with adjustment backlog remediation and provided the proper controls to demonstrate timely and accurate completion.