Claims Auditing: Key Strategies in Healthcare Benefit Plan Cost Containment
As Mark Cuban recently stated, "CEO's don't know where their health benefit dollars are going". This lends perspective into the need for business leaders to focus more attention on the benefit plans they are offering their employees to better control costs, protect plan assets, and enhance employee satisfaction.
Join William Norris and Chuck Nefkens of Moss Adams as they dive into how medical claims auditing of benefit plans can serve as a key strategy in preserving valuable healthcare benefit dollars and managing financial risk. They'll discuss key cost containment considerations for organizational leaders and HR professionals including the following:
- Identifying opportunities to reduce costs on medical and pharmacy benefit plans
- Understanding the potential risks when working with Third Party Administrators (TPA’s)
- Key provisions to be aware of in reviewing your company's healthcare benefit administration
- Leveraging data analytics to support cost containment strategies
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Will has been providing healthcare advisory services since 1991 and focuses on the Payer and Managed Care sectors. He has extensive experience working within the operational infrastructure of payer organizations in areas such as claims administration, provider contracting, utilization and referrals management, membership/eligibility, and claims auditing and recovery. Will’s clientele includesmulti-state and regional Health Plans, Managed Care Organizations, Self-Insured Employers, Third-Party Administrators, and Management/Administrative Services Organizations.
Will has consulted with large and small payers alike, delivering extensive support in the areas cost containment, operations re-design and process improvement implementation. He has provided his claims auditing expertise to hundreds of self-insured employers assisting them with assessment of their Third-Party Administrators - providing reliable performance measurement and evaluation, cost containment strategies, overpayment recovery opportunities and actionable corrective action strategies.
Lastly, Will has been retained in litigation support matters related to Payer/provider payment disputes – tapping into his extensive experience working in the Payer operations space.
Chuck has worked with health plans, integrated delivery systems, medical groups, independent physician associations (IPAs), management services organizations (MSOs), delegated risk entities, self-insured employers, and health systems since 1995.
Chuck’s areas of expertise include healthcare claims audits, revenue recovery, data analytics, payor operations, risk adjustment, managed care, custom database application development, and more. He has created software that is used by payors across the country for auditing claims. Additionally, he has provided litigation support services in numerous disputes involving claims payments, shared risk settlements, risk adjustment, and other matters.
