MODERN OPERATIONS FOR HEALTHCARE
Embrace AI-enabled healthcare operations
Modern AI-integrated healthcare operations
The playbook for growth is being rewritten. We believe the future belongs to the modern enterprise that embraces AI-integrated business operations—a business that can anticipate and act instantly to boldly seize opportunities amid rapid change.
Innovative partnerships are essential for payers, providers and pharmacy benefits managers to succeed in the competitive healthcare field. We help clients rethink how they create value, innovate and grow by combining business and process expertise in the medical field with intelligent digital platforms to optimize business operations.
Business outcomes and strong ROI
MetroHealth and Cognizant partnership in healthcare
MetroHealth’s investments in Cognizant Revenue Cycle Management are driving positive results increasing productivity by 8% in the last year and average daily collections by 25%. The services are built around a proprietary Unified Single Platform (USP), a performance improvement engine and a cloud-based technology platform that continuously deploys automation and innovation to improve quality and financial outcomes. The solution also includes an ARM tool to prevent claim denials on the front end by identifying the root causes of initial claim rejections, avoidable and non-avoidable. The tool can categorize the denials down to the department level, so we can identify trends and use that information to educate and train our staff. Since implementation, denials have decreased by 30%, which translates into $13M in additional revenue.
MetroHealth and Cognizant have a long-standing strong partnership and we continue to work together to reduce denials/accounts receivable and increase cash collections.
Healthcare BPS and automation services
- Payers
- Digital revenue cycle management solutions
- Pharmacy benefit managers
- Horizontal offerings
Enrollment and member services
Our member enrollment, premium billing, reconciliation, and onboarding services put members at the center, ensuring a seamless experience across their multiple touch points. Our solutions in benefits configuration simplify complex structures and improve efficiency.
Provider data management (PDM)
Industry leading capabilities, from provider credentialing to contract loading and provider data management, our solutions ensure data accuracy. With Cognizant, payers can create comprehensive PDM strategies that focus on four components: single source of truth, data governance, bidirectional integration, and end-to-end platform. We help you structure your processes knowing that PDM is a journey, rather than a one-time initiative.
Claims administration
With deep understanding of claims processing—from front-end operations, claims adjudication and appeals to supporting Special Investigation Units (SIU). Our integrated solutions ensure accurate and timely payments, reducing interest payouts and penalties.
Clinical support services
Cognizant’s care management services can help payers gain access to certified and experienced talent pools globally. Our delivery teams offer expertise in utilization management, case management, and population health management—helping clients deliver improved clinical outcomes.
Customer experience management
Cognizant’s contact center services provide payers with digital transformation solutions that improve member and provider experience. Our services support members and providers with omni-channel contact services designed to improve customer satisfaction (CSAT) and NPS scores.
Full cycle RCM
Cognizant’s RCM gives an intuitive edge to the healthcare industry. From scheduling and registration to payment posting, we handle end-to-end revenue cycle management services for hospitals and physician practices. With proprietary RCM workflow technology, we help you maximize efficiency and improves cash flow with digitized management.
Front-end RCM
Our complete suite of patient access and engagement includes registration, scheduling, remote patient monitoring, discharge planning, health risk assessments, and wellness and lifestyle coaching. Improving these areas enables providers to embrace a digital-first, intuitive operating model—leading to fast, easy and safe experiences for their patients.
Middle office RCM
Cognizant provides customized coding and charge master services for any size or type of organization, from physician practices to hospitals. We leverage the latest RCM technologies to expedite and automate processes that help reduce errors and increase claim submission rates. Our fully outsourced mid-cycle RCM services will help you scale fast.
Back office RCM
Our account receivables service combines skilled professionals and proprietary technology to resolve accounts through all revenue streams. Established workflows, multi-channel outreach and financial assistance programs maximize revenue and recovery.
Complex claims
Cognizant can help healthcare organizations overcome growing reimbursement complexities and optimize revenue. With expertise and innovative technology, we identify the proper workers’ compensation and third-party liability carriers to ensure claims are paid in accordance with state regulations.
Clinical administration services
Our clinical administrative services focus on improving patient experience and quality of care. You’ll gain a competitive edge with our robust set of services—utilization management, bill review, record retrieval, gaps identification and physician training. Our resources include 350+ USRNs (registered nurses) and 700+ certified specialists.
Claims services
We offer a flexible pharmacy claims processing platform along with efficient distribution management services for employers and third-party administrators—enabling them to improve processes while controlling prescription costs.
Benefits configuration
Cognizant’s workflow extracts and consolidates information across all departments of the pharmacy benefit managers (PBM), providing plan sponsors with a 360° patient view that enhances critical health and financial decision-making resulting in best outcomes. We provide Day 1 assurance of correct adjudication outcomes, along with complete and accurate eligibility, prior authorization, accumulator and claim history data.
Frontend mailroom services
Cognizant enables modern operations by leveraging a data platform for order intake, a centralized workflow for prescription filling, a call center to support mail-order pharmacy services, and access to physicians’ offices to obtain prescription refills or to verify information.
Mail order processing
Our services include intuitive digital tools to analyze medication requests and calculate the urgency of the treatment—reducing errors and improving efficiency. To speed up order fulfillment, our workflow platform accounts for tracking, verification, approvals, follow-ups and on-time delivery.
Intelligent automation services
Get your business future-ready with industry-aligned IT and process automation solutions.
Cognizant Neuro® Business Processes
Simplify and accelerate automation adoption, integrate and orchestrate resources and see returns faster.
Business ops to accelerate scale
Grow digitally native scale-ups and new revenue streams at the speed of ideas.
Employee experience enterprise services
Find out how you can deliver persona-based employee experiences at scale.
Featured work
Insights
Explore additional business process services
Take the first step
Serving customers by looking forward as well as back is a big promise, but the power of today’s new digital capabilities is vast and growing.
Let’s talk about how digital can work for your business.