Organization Implementation

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Compliance-Focused Operational Processes

Expert Guidance for Building Effective, Compliant Operational Infrastructures

Because of our experience in managed care, we are the ideal consultants to help your organization design operational processes and infrastructures. We take a close look at your operational policies, documenting and reviewing them with regulatory requirements in mind, to ensure compliance with the requirements of concerned federal and state agencies.

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Compliance Strategies consultants have developed and managed numerous functions of government programs.

  • Regulatory compliance
  • Enrollment and marketing
  • Member services
  • Complaints, grievances, and appeals
  • Claims processing
  • Utilization management
  • Case management
  • Quality
Customized Compliance Solutions

Flexible Services for Project Management, Training, and Material Development

FLEXIBLE OPTIONS

As a small consulting team, Compliance Strategies has the flexibility to assist in developing what you need. Some clients are looking for assistance with developing an operational department from planning to hiring staff. Others just need assistance with developing specific workflows.

PROJECT MANAGEMENT

For larger initiatives, consultants are available to develop and manage projects, thereby ensuring the desired outcome is achieved.  The critical path is continuously monitored, with the project manager escalating potential issues to minimize risks.

MATERIAL DEVELOPMENT

Government programs have strict requirements related to material content and approval prior to implementation; whether it’s a mandated member brochure like a Summary of Benefits or Member Handbook or a Service Authorization or Referral Form for providers, we’re here to translate your rules into standardized materials that comply with government requirements, ensuring a speedy approval.

TRAINING AND TRAINING MATERIAL DEVELOPMENT

Compliance Strategies has leveraged its health care experience and its background in adult learning to solve the training challenges facing health plans.  Facilitated workshops are just the beginning. Compliance Strategies has developed computer-based training material, self-study guides, and on-the-job coaching programs.

MEASURING RESULTS

How do you know a process is working?  Consultants can help develop baseline measures and create reports to ensure that performance is accurately reflected and that potential risks are identified and corrected timely.