A healthcare diagnostics leader was advancing into high end genetic testing, starting with cancer screenings that required prior authorization from insurance companies. With no experience managing the prior authorization process, the client sought HGS for our specialized clinical expertise and prior authorization services.
HGS began the engagement with a consultative approach to prior authorization, drawing on clinical knowledge and workforce management innovation. We built 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, HGS made process changes to reallocate lower-tier work to agents, so RNs could assume work related to 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.
In just three years, HGS helped grow this partner’s genetic testing business line from inception to over $100 million per year in revenue. By moving the lower-tiered support work to agents, we helped achieve client savings of 19%.