The Payer landscape is complex and constantly evolving, which means you need a partner who understands the importance of building solutions that are industry-specific, scalable, and sustainable. We're committed to helping our partners improve the health and financial well-being of members by providing the talent needed to enhance clinical services, quality programs, claims operations, provider relations, and population health management.

Clinical Services

An experienced clinical team is crucial to improving health outcomes and reducing healthcare costs for member populations. Our partners leverage our national network of clinicians to scale teams during case volume spikes, member growth, entrance into new markets, introduction of new products, and development of clinical programs. Our expertise in building out custom teams of clinical professionals specialized in Case, Disease, and Utilization Management, Pharmacy Services, Behavioral Health, and Pop Health Management allows for steady support for your members.

Quality Improvement

The quality of care members receive is extremely important to our Payer partners. Effective chart retrieval, abstraction, clinical review, reporting, provider education, and data analytics best practices are the cornerstone of a highly functioning QI department. Medasource assembles project teams through retrospective HEDIS and Star rating audits. We also have a flexible right-to-hire onboarding model where our network of clinical, non-clinical, and QI analysts can join our clients' full-time teams as prospective activities become prioritized. In addition, we build out shared service teams where Risk Adjustment and Quality Improvement talent work harmoniously under one roof.

Risk Adjustment

A steady pulse on your member population and their respective disease conditions is critical in the mission to customize clinical programs and maintain financial awareness. Our prospective and retrospective Risk Adjustment teams help retrieve, code, audit, analyze, and properly document the disease conditions of members. Whether your team needs help through the RADV audit or investing in building out full-time prospective teams, our network of talent can help fill gaps quickly and establish intelligence for the future.

Claims Services

The fast-paced and constantly evolving claims division is an environment we're intimately familiar with. We infuse quality claims talent to increase production, reduce errors, maximize retention, minimize over-payments, and optimize systems through RPA, configuration, and development. From claims associates to payment integrity and system configuration analysts, Medasource will help your leaders assemble a financially strong and compliant claims division.

Population Health Analytics

A strong analytics team is the engine that helps our clients drive key decisions. Understanding your member population and the healthcare they receive is extremely valuable. Population Health, Social Determinants of Health, Predictive Analytics, Financial Modeling, Value-based Care Analytics, and Claim root-cause analysis are all areas we help support. Our experience customizing teams of analysts and data scientists allows health plan leaders to feel confident in their mission to improve health outcomes and reduce financial burden.

Network/Provider Services

Our goal is to reduce friction between our Payer and Provider partners so full focus can be given to their consumers. As the industry pushes towards interoperability, value-based contracting, price transparency, and quality improvement, Medasource assembles custom teams to help with the heavy lift and reduce administrative burden.

Member Services

Medasource helps our partners provide white-glove service to their members. We infuse member-driven talent to help support teams across enrollment, benefit coverage, price estimation, financial counseling, grievances & appeals, benefit plan design, and much more.

We're Here to Help Improve Your System.

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