Automated revenue reconciliation in healthcare: Finally, accuracy at scale
Business challenge
For nearly a decade, a Midwest-based regional health plan had no established process for revenue reconciliation, relying on outdated workflows, fragmented systems, and manual processes that consumed time and left too much room for error.
"It was like trying to hit a moving target,” said the plan’s enrollment manager. “Membership is constantly changing, but you have to compare it to a snapshot in time. It was incredibly challenging to keep everything aligned."
The turning point: automation and centralization
After years of piecemeal solutions, the health plan implemented Reveleer's Member Management Solution to centralize enrollment, premium billing, and revenue reconciliation.
The health plan quickly eliminated siloes that had previously hindered their progress, automating transaction reply reports, improving collaboration, and giving them confidence in their CMS compliance.
The plan’s enrollment manager noted: "Before Reveleer, we had zero automation—it was all manual work. Now everything is centralized in one place, and we don’t have to jump around or deal with file transfers or possible errors in data pulls."
A new era of accuracy and efficiency in member management
Adopting Reveleer’s Member Management Solution has transformed the entire revenue reconciliation process for the health plan. Centralizing member management activities has led to a significant drop in payment and membership discrepancies and greatly enhanced efficiency by automating manual processes to free up staff time.
Next steps: scaling member management operations
The regional health plan has added new layers of accuracy and efficiency to their member management operations and successfully recovered additional revenue to improve their financial performance. The plan will continue to leverage Reveleer’s member management software across multiple lines of business, scaling their operations to unlock new gains in accuracy, efficiency, and revenue recovery. As the plan’s member enrollment manager noted, “With Reveleer, there’s so much automation setup that when revenue reconciliation hits, we’re ready. We don’t have to wait for anything. We can go right to it and see everything we need in one place and in real time."
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