Audit and Reconciliation

Insurance & Health Plans
Daily operations require claims processing to be the top priority of insurance companies operations. Retrospective analysis and reconciliation often fall by the wayside to have a continuous claims processing flow. The lack of analysis and audit reconciliation can lead to ongoing incorrect claims payment and costly reprocessing overhead cost.

Sunlit Cove Healthcare Consultants provide the following services:

Provider underpayment submissions

Bulk submission of account underpayment claims by providers is very common in this current healthcare budget environment.  Review of underpayment determinations and contract terms can detract your current employees from their daily activities. It is also important to determine the total monetary implications when there is claim of underpayments. Having an independent outside review will help protect the insurance companies bottom line. It is also important to thoroughly review the contract terms for future rate negotiation.

Payment turnaround  time review

Reviewing payment turnaround time for your major providers can pay financial to dividends to your bottom line.  It is important to differentiate between a clean claim payment vs. a subsequent submission that requires your staff to process the claim multiple times.  Root cause identification and collaboration with provider will reduce claim reprocessing and reduce the employee overhead cost.

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Navigating the dynamic and complex revenue cycle arena is a challenge for many health plans, health care vendors, and providers.

We simplify it.

Ensuring Our Clients Rapidly Achieve Their Financial and Operational Goals

Our focus is to help your business grow and run smoothly. We understand the challenges faced with the claims processing and recovery environment. Sunlit Cove Healthcare Consultants provide professional subjects matter experts in the healthcare industry to enhance your business. Our consulting services are available to assist with your day-to-day operations and provide expertise in growth and change management.

Sunlit Cove Healthcare Consultants

Sunlit Cove Healthcare

Our focus is to help your business grow and run smoothly. We understand the challenges faced with the claims processing and recovery environment. Sunlit Cove Healthcare consultants provide professional subjects matter experts in the healthcare industry to enhance your business.

Leadership | CEO

Lori Intravichit is the CEO of Sunlit Cove Healthcare Consultants. She has more than 25 years of healthcare experience. Lori has extensive experience in healthcare administration in senior management roles within both provider and payer organizations.

Sunlit Cove Healthcare Team

Experts

Our team of experts at Sunlit Cove Healthcare Consulting have a diverse skillset which allow us to focus on the unique challenges facing the healthcare industry today. Our combined years of expertise in healthcare administration enables us to effectively analyze constraints, problem areas and challenges.