Healthcare at a Critical Crossroads
Healthcare faces increasing complexity. Administrative costs are rising, patient satisfaction is dropping, and providers are experiencing burnout. The potential of digital transformation remains mostly unrealized while patients deal with fragmented systems that focus more on procedures than on individuals.
Payers struggle with manual processes that can't keep up with regulatory changes, driving higher costs. Providers spend more time on documentation than on patient care. Everyone discusses patient-centered care, but operational silos make it nearly impossible to deliver.
Providers struggle with falling compensation and an ever-increasing regulatory burden. Post-pandemic, behaviors have shifted across all stakeholder populations—patients, clinical staff, payers, and government—forcing a fundamental rethink of people, process, and technology strategies. Their entire world is being reinvented even as it continues to spin faster than ever before.
The old strategy of adding more staff to solve healthcare issues isn't effective anymore. What healthcare truly needs is a complete rethinking of how operations function, and that's exactly what UnBPOTM provides.
Siloed Member Experiences
Registration happens in one system, scheduling in another, and billing in a separate system. Patients repeatedly share the same information multiple times while the care teams juggle disconnected platforms that don't communicate.
Prior Authorization
Manual review processes delay necessary care while administrative teams play phone tag with multiple stakeholders. Critical treatment decisions get stuck in paperwork bottlenecks.
Enrollment and Eligibility
Open enrollment periods overwhelm contact centers with outdated systems. Patients struggle to understand benefits, while staff lack real-time access to plan information and coverage details.
Revenue Cycle Inefficiencies
Claims processing involves multiple handoffs between systems and teams. Denied claims require manual intervention, while it takes too long to process and collect.
Member Services Operating Blind
Call center agents lack integrated views of member health history, claims status, and benefit utilization. Simple questions require navigation across multiple systems, transfers, and callbacks.
Data Trapped in Operational Islands
Clinical data lives separately from financial data, which lives separately from operational data. Healthcare organizations can't leverage their information to improve care or reduce costs.
Clinical Documentation Burden
EHR systems designed for billing compliance rather than care delivery force providers to spend more time on documentation than on patients. Administrative tasks consume valuable clinical hours.
Staff Productivity Crisis
Manual processes and fragmented systems reduce healthcare worker productivity. Staff juggle multiple platforms while patients wait, creating burnout and inefficiency across the care continuum.
UnBPOTM Healthcare Revolution
Clinical Operations Expertise
Former healthcare administrators, registered nurses, and compliance specialists design our solutions. We understand HEDIS measures, quality reporting, and care coordination because we've experienced them firsthand.
Unified Care Ecosystems
Patient registration flows seamlessly into eligibility verification, care authorization, service delivery, and billing: one patient journey, multiple touchpoints, zero friction.
AI-powered Intelligence
AI reimagines processes entirely. Service-as-a-Software and technology arbitrage—using solutions like autonomous coding, prior authorization, predictive analytics, and automated QA/QC—enhance scalability, collections, and patient satisfaction. Fit-for-purpose solutions, such as virtual agents recognizing local accents, ensure technology meets specific needs.
Healthcare-Intelligent Automation
AI that understands clinical context, not just administrative tasks. Our technology can differentiate between urgent and routine requests, recognize care gaps, and prioritize interventions based on health outcomes.
Value-Based Partnership Models
We align our success with your healthcare outcomes. Better HEDIS scores, improved patient satisfaction, reduced administrative costs, and faster revenue cycles. Our compensation depends on your success.
Future-Ready Workforce Enablement
Skill-based resourcing will lead to fewer medical coders, denial analysts, and call center agents, as AI automates many routine tasks, leaving room only for true expertise that can configure and control it. Personalized skilling and reskilling with the use of AI to accelerate speed to service and tailor training programs to specific roles and tasks.
Partnership Orchestration
Unified solution with agile partners that offer automation in charity care, prior authorization, and denial management to improve efficiency and meet evolving client needs.
Healthcare Solutions That Actually Work
Intelligent Member Experience
Multi-channel support that gives members instant access to benefits information, claim status, and care coordination through AI-powered assistants backed by healthcare specialists.
Prior Authorization Acceleration for Providers and Payors
Automated workflows that route requests based on clinical criteria, integrate with the provider EHR system, and provide real-time status updates while ensuring appropriate utilization management. It enables providers to electronically file and track authorizations while enabling payors to manage and disposition requests with appropriate utilization management.
Enrollment and Eligibility Excellence
Cloud-based platforms that simplify benefit selection, automate eligibility verification for providers, and guide patients through financial assistance programs with personalized support.
Medical Coding Accuracy
AI-based coding platform to support coders and physicians. Automated suggestions help ensure compliant, accurate, and optimized coding outcomes.
Denial Prevention and Management
Denial management workflows that prevent, mitigate, and resolve claim denials. Identify common denial reasons upfront, streamline billing, and use predictive analytics to flag potential payment bottlenecks. Automated appeals accelerate resolution, ensuring smoother reimbursement.
Patient Financial Engagement
Patient billing platform with self-serve payment portal, flexible payment options, empathetic engagement, and intelligent segmentation to simplify and personalize the billing experience.
Revenue Cycle Optimization
End-to-end RCM that maximizes clean claim rates, accelerates collections, and improves patient financial experience from registration through final payment.
Clinical Operations Support
AI-powered workflows that reduce administrative burden by 30%, allowing healthcare providers to focus on patient care rather than paperwork. Technology solutions integrate with existing EHR systems.
Population Health Operations
Care management support that identifies at-risk members, coordinates interventions, and tracks outcomes while maintaining compliance with quality programs and regulatory requirements.
Technology Integration Services
Cross-functional solutions that work with your existing technology stack. Our partnership orchestration approach unifies care delivery across multiple systems and stakeholders, ensuring seamless coordination.
Health Plan Performance
- 35% reduction in administrative costs
- 40% decrease in tech debt
- >99.5% compliance with urgent appeal processing under 4 hours
- 20% improvement in HRA closure rates
Provider Performance
- Up to 95% increase in patient registrations
- 95%+ coding accuracy
- Up to 98% improved pre-service collections
- 25% reduction in person registration time
- Up to 70% faster authorizations
- 3x improved staff productivity
- 20-30% reduction in uncompensated care
- 30% reduction in administrative costs
Transform Healthcare Operations Today
The healthcare industry is shifting toward value-based care, consumerism, and digital engagement. Organizations that cling to traditional operational models will struggle to compete and deliver quality care. The choice isn't whether to change, it's whether to lead the transformation or get left behind by it.
Traditional healthcare BPO optimizes broken processes. UnBPOTM eliminates the need for broken processes.
Ready to see what healthcare operations look like when they're designed around patients instead of paperwork?
UnBPOTM with us. Better care starts with better operations.