How RPA helps healthcare payers do more with less

Peter Raimist , Principal Healthcare Consultant at Amitech Solutions, is a veteran of the healthcare industry with over 20 years’ experience working in payer organizations, such as Optum of UnitedHealth Group and Anthem Blue Cross Blue Shield. In those 20 years, Pete has witnessed a shift from manual processing of administrative tasks, like assigning patient cases to RNs, processing provider inquiries around claims status, and adjusting claims as needed, to harness Robotic Process Automation (RPA), saving payers thousands of hours annually on administrative tasks.

Read on for our Q&A with Pete to understand how RPA helps payers tackle escalating administrative costs and improve member and employee experience.

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What is RPA?

RPA combines software and intelligent automation to free up humans from tedious, manual work. RPA is capable of cognition, coordination, orchestration, speech recognition, listening, and interpretation. I’ll give you an example of RPA in practice at a payer organization:

Before RPA, in order for a claims specialist to adjust a claim, she needed to send an inquiry to the pricing team first to ask for the rates. The pricing specialist would have to read the inquiry, research the rates to apply, and then manually respond to the inquiry so the claims specialist could resolve the claim. After RPA, bots are able to read the inquiries, do the research, and return the pricing information to the claims specialist, eliminating a tremendous amount of manual work and quality issues, and shortening the cycle time.

RPA is reshaping payer operations by automating repetitive tasks, streamlining data management, and enhancing compliance and risk management processes. It's essentially empowering payers to do more with less, driving efficiency, accuracy, and cost savings across the board.

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What specific business problems can RPA solve for payer organizations?

Most operational department leaders will tell you they don’t have enough staff to address their current workloads, let alone take on more, and by leveraging automation, they’re able to incorporate ‘digital workers’ or bots into their workflow to add capacity to their teams at a fraction of the cost. The key benefit of RPA is the reduction of labor hours spent on high-volume, repetitive tasks. By automating routine tasks, valuable resources—like time and money— can be redirected towards strategic initiatives and innovation. RPA also improves data accuracy, enhances compliance, and mitigates risks. There are a multitude of use cases for which RPA is an appropriate solution across every value stream, and the benefits to your customer experience are game changing.

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How does RPA address the challenge of managing vast amounts of unstructured data in payer operations?

Unstructured data is a pervasive issue in healthcare, and RPA excels in tackling this challenge. By leveraging machine learning models and bots to read and parse out critical information, RPA can extract, organize, and analyze unstructured data from various sources, such as emails, documents, and notes. This tech-driven solution not only improves data accuracy but also enables faster decision-making and enhanced operational efficiency.

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How does RPA deliver value to end consumers?

RPA creates tangible improvements to the member experience, while also translating into significant cost savings, enhanced operational efficiency, and accelerated innovation for the payer organizations. Members experience faster response times, improved service quality, and a better overall experience. Ultimately, RPA drives value across the entire payer ecosystem.

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What does the future hold for intelligent automation, and how will it impact organizations that do not adopt RPA?

The future of intelligent automation is incredibly promising given the rate of advancements in AI driven automation and Natural Language Processing (NLP). These technologies are poised to revolutionize the way organizations operate. Organizations that embrace RPA today are laying the groundwork for future success and differentiating themselves in an increasingly competitive payer market. Conversely, organizations that fail to adopt RPA risk falling behind, facing higher operational costs, increased errors, and diminished competitiveness. In fact, I’m seeing some large employer groups now requiring that the payer automate a certain number of processes to retain the business.

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What is the biggest barrier to healthcare payer organizations adopting RPA solutions?

Quantifying the value of adopting RPA is often hard for payers who have not done it before or are struggling to gain traction. At Amitech Solutions, we specialize in helping these organizations navigate the complexities of quantifying an RPA program value. From strategy development and road mapping to solution design and deployment, we provide end-to-end expertise and support to ensure our clients maximize the benefits of RPA. Our team of experts leverage proprietary methodology and tools as well as leading technologies to deliver tailored solutions that drive tangible ROI. At Amitech, we get it. Cost pressures are huge. Resources are stretched thin and competition for business is getting more and more challenging. However, getting started with RPA is easier than you might think, and we’re here to guide you every step of the way.

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Visit us to get in touch with Pete or learn more about RPA.

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