Authored by: Zach Tabor
Speed and accuracy are critical to appeals and grievances (A&G) departments. With looming deadlines and busy staff, maintaining efficient and compliant workloads is an essential, but labor-intensive, manual task – which is why many turn to robotic process automation (RPA) to help.
RPA allows A&G departments to leverage bots to get manual tasks off employees’ plates, freeing them to work on higher-level tasks. “RPA essentially mimics human interactions,” says Zach Tabor, director of software engineering at i3 Verticals. “The robots perform many of the tasks a human would do within a web portal, and the bots can do the work quickly and accurately.”
A&G departments that haven’t yet leveraged automation often have many questions, starting with: What are the benefits, and exactly how does RPA make workflows more efficient?
The benefits of healthcare payer automation and RPA
RPA solves many of the challenges A&G departments struggle with, including crushing deadlines, overloaded employees and the need to mitigate potential errors and compliance risks. It can help with:
- Data extraction and validation. Program bots to pull relevant data for incoming appeals more quickly and validate it for accuracy and completeness.
- Document processing. Use bots to read and extract information from electronic documents to speed processes.
- Data entry and creating cases. Get rid of the cumbersome task of manually entering data. Once the bot extracts and validates the data, continue to use RPA to input the information into relevant systems, creating a digital case identifier.
- Routing and prioritizing. Use bots to intelligently route cases to the appropriate individual based on the preset criteria.
- Compliance support. Bots help ensure you’re meeting compliance regulations for claims handling and processing with consistent, faster workflows.
While you’re not going to use RPA to make decisions – humans do that – you will find RPA helps support how quickly those decisions can be made, which keeps claims moving toward a faster resolution.
Use cases: Robotics process automation in healthcare and A&G
According to Jon Swisher, director of sales engineering at i3 Verticals, many A&G departments wonder if entering data in web portals is the only thing RPA can be used for – and the answer is “Absolutely not.”
Robots, for example, can be triggered to conduct tasks based on incoming emails.
“Receiving an email often triggers an employee to complete a task – the need to check on something,” says Swisher. “With RPA, we can tell a bot to watch for emails that use certain expressions or keywords. It’s then trained to open the email, evaluate it, and conduct the preprogrammed task.”
It can help with many initial tasks, such as gathering data, creating a case, and more. But it can also help update cases, check status, and trigger the next steps in the A&G workflow process.
Automation healthcare and RPA: Selecting the right tools
RPA helps support your team with faster workflows and a competitive advantage. But when considering adoption, where should you start?
Start by uncovering the processes that slow you down. For many, this will be setting up claims and compiling relevant data. Also, when considering healthcare RPA partners, consider factors like how easily a solution can scale, ease of employee use and integration capabilities.
“You’ll want a solution that integrates easily with your existing systems and programs,” says Tabor. “This integration is critical for ensuring smooth processes and a solid user experience.”
And while adopting RPA has clear internal payoffs with faster processing capabilities and streamlined workflows, it also has external payoffs. Slow processing time frustrates members, so when you can positively impact that pain point, you will naturally improve customer satisfaction and support business success.
Want to learn more about how RPA can improve your A&G processes? Let’s talk!