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Improving a healthcare client’s medical audits with a high-quality and scalable workforce of credentialed coders

Jul 6, 2023

The Client

A leading healthcare risk adjustment firm that providers and payors trust to validate critical medical records for reimbursement.

The Challenge

When the Centers for Medicare & Medicaid Services (CMS) resumed initial validation audits after their pause during the pandemic, risk adjustment firms had to verify records for 2019 and 2020 simultaneously. The client needed a workforce of high-quality, credentialed coders who could scale with demand while maintaining data accuracy. They chose w3r Consulting for our expertise in the healthcare sector and our ability to provide high volumes of top technical talent.

The Solution

The w3r Consulting team conducted a thorough but time-conscious assessment to match credentialed medical coders in our talent pool with the client’s current and future needs. We conducted a pre-test process to select exceptional candidates, eventually placing 64 contingent coders within the client’s organization.

Our team ran a functional staffing program with team leads and a dedicated program manager to oversee and mentor the team of coders as they validated sample sets of medical records. We helped coders adjust to each account’s unique risk tolerance and maximized our client’s best practices by identifying strategies to increase productivity, quality, and motivation.

Through w3r’s leadership, the client in turn could remain focused on running their business rather than managing their team or resolving quality issues, keeping other projects moving forward smoothly.

The Results

At the end of the 2021 IVA season, 70% of coders made it through the assignment process and 12.5% were retained for additional coding and audit work after the initial commitment. We used our experience as lessons to boost coder engagement for the 2022 season and create a 30-hours-per-coder SLA that improved overall quality and reliability.

When the time came, the client engaged w3r Consulting for the 2022 IVA audit season. As one of two partners, we improved client timelines and quality once again, triggering fewer financial penalties than the 2021 season and boosting overall performance.

Contact Us

We helped our clients overcome their challenges and achieve lasting results. Let us do the same for you. For more information, email us at info@w3r.com

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