• Monthly/Quarterly MCO financial settlement review Funding/Claims analysis.
  • HCC funding review and reconciliation.
  • Medicare Risk Adjustment (MRA) analysis to optimize funding based on patient population, severity diagnosis and acuity level
  • IBNR analysis to ensure consistency and uniformity in MCO chosen methodology.
  • Assigned membership accretion and deletion review to scrutinize for unreconciled or omitted member funding