Intake expertise takes a new line of business from inception to $100 million in 3 years

Overview

A healthcare diagnostics leader was adding high-end genetic testing to its laboratory testing menu. With no experience in managing the prior authorization process with healthcare payers, the client sought support in establishing the new process in a short timeframe. Sagility, with extensive experience in all aspects of healthcare business processing outsourcing, helped the client establish new workflows, procedures, and standards while strategically assigning the work among offshore agents and RNs for cost savings.

Client background

The client is a global life sciences and diagnostics leader operating one of the largest clinical laboratory networks in the world. The company processes millions of lab tests — from genomic sequencing to COVID-19 tests to paternity tests — weekly. Every day, 275 Sagility agents, RNs, and coding specialists in the Philippines and India work on behalf of the client to process accounts receivable and denial resolutions, do ICD-10 translations, and administer prior authorizations.

Business challenge

The genetic testing market is growing rapidly (anticipated to grow by 10% each year to $21.26B by 2027) and increasingly competitive. Because of the risk, unknowns, and specialized equipment and talent required for this type of testing, entering the market is extremely costly. Finding cost savings in supporting processes is essential to offset initial investment costs.

The client was launching its genetic testing business with a focus on cancer screenings that required prior authorization from insurers. However, the client had no experience managing this type of prior authorization process. Ensuring accurate, efficient prior authorization processes paves the way for building revenues and a reliable customer base quickly. It also ensures that patients and their physicians get diagnostic and treatment information quickly.

The solution

Sagility began the engagement with a consultative approach to prior authorization, drawing on clinical knowledge and workforce management innovation. We assembled a team of RNs, based in the Philippines, to initiate the preauthorization support work, well supported by employee training and engagement. With a focus on operational streamlining and cost containment, Sagility over time made process changes to reallocate lower-tier work to agents, so RNs could focus on work requiring clinical knowledge.

Next, we built to scale, adding staff at the right levels to help our client build this service line from the ground up. As the ultimate testament of success—this service line has grown increasingly more successful with additions to the type and number of tests requiring this high-level medical and financial screening.

Global locations

USA • India • Philippines • Jamaica • Colombia

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