Modernizing the user
experience and reducing
wasted hours
Wednesday, July 21, 2021
Challenge
Before partnering with Macedon Technologies, an analytics company specializing in healthcare datasets processed millions of claims yearly for payment accuracy. While machine learning models analyzed the bulk of the data for miscalculations without requiring additional inspection, the remaining records required manual intervention to check for billing discrepancies. Auditors were manually assigned claims to review, with senior auditors and audit support staff serving as escalation points.
Auditors were left to manage their workloads, relying on an outdated and clunky custom-built system. Searching and assigning claims was an inefficient process that duplicated work and created confusion about task assignments among the team.
To increase efficiency, the company required a solution that could intelligently assign claims to various audit staff and eliminate manual task tracking. The solution would serve as a centralized repo for claims data while also reporting on telemetry data. Finally, the end-user experience would improve efficiency in analyzing claims and ease training for new users.
"“It has and continues to be a great and valuable partnership for our company. Working with the [Macedon] dev team is almost as if we are working
with an extension of our own organization. Excited to see the future things we build out together.”
—Senior Specialist
Solution
Macedon rose to the challenge and developed a proofof-concept showcasing Appian’s strengths. Under a tight schedule, the team rapidly built the prototype following Agile methodology, which optimized the team’s time and helped keep a laser focus on business value and prioritization. The development team maximized the power of low-code and delivered a solution that exceeded the client’s expectations.
Appian was the ideal replacement for the client’s existing system. Appian’s workflow orchestration capabilities allowed for seamless task assignment and escalation. Integration support, paired with a powerful low-code platform, provided the necessary hooks into machine learning models and internal databases.
Macedon team members utilized Appian’s seamless integration capabilities to provide a solution that centralized data across various databases. With the power of Appian SAIL interfaces, the team ensured the system had an intuitive UI for the audit staff to complete their work and share knowledge effectively. Finally, the team developed an intelligent task routing process that delegated tasks to auditors based on their workload.
Result
The Appian solution has received immense praise from the client. They feel so confident with the platform that they are requesting additional processes and enhancements to be automated. Auditors are no longer wasting time finding the next claim to analyze – the system automatically assigns their work. The user experience is seamless and efficient, so auditors can take action on a claim and immediately move on to their next assigned task. Auditors have all the claims data they require to make a decision in a single place, reducing time wasted tracking down information on other systems.
Managers can now view reports that measure KPIs such as employee workload and projected overpayment recovery. The application empowers management to reassign tasks for individual users and entire teams to account for resource changes.
From outdated and manual to modern and innovative
Ready to Talk?
Curious how Macedon can help simplify your work and processes? Let's get started
