Quality Audit Platform

AuditShark Quality Audit Platform

Quality Assurance Audit Platform for Payers

Get the Most out of your Audit Teams!

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THE PROBLEM

QA Audit teams at health plans are under pressure to reduce administrative costs and find efficiencies while improving the overall quality of their core operations. These teams often rely on aging technology, disconnected systems, and manual processes. They are blind to insights, unable to prioritize audits on emerging issues, buried in administrative tasks and are stuck in a reactive position. Audit Teams are already maxed out but are being asked to do more each year without increasing the size of the team.

GO DEEPER

Multiple Siloed Systems:Audit teams must audit multiple aspects of the business, but these operations take place in disconnected systems like adjudication platforms, enrollment systems etc. Audit Teams must manually audit across many systems of record, slowing them down and increasing administrative costs

Unable to Scale: Manually comparing screens from multiple systems, logging and capturing findings, and escalating issues are all sources of highly manual workflows that decrease cycle times and increase administrative burdens and costs. Teams are at capacity but cannot scale in the current state.

Audit teams want to audit larger samples and focus audits in the areas that suspected defects are occurring from but because of rigid technology, they cannot adjust sample parameters or focus audits on emerging patterns.

Audit teams generate enormous datasets in their audit findings but are unable to detect emerging patterns and trends that lead to inefficiencies. Instead of proactively prioritizing audits, they remain reactive, often “fighting fires” and can shift to a proactive audit operation.

While the audit teams find issues, the fix is performed by other teams. Often these issues are hard to track, and issues are ‘lobbed over the fence’ to be fixed, never to be tracked again. Audit Teams want to know for certain that issues were resolved after they’ve been found, but lack the insights, infrastructure and platform to easily manage the process.

Audit teams want insights into their audit performance. They want to detect patterns and trends, easily report performance, measure user efficiency, and easy analyze the business for insights. But reporting is highly manual and so payers have limited insights into the defects in the operation.

OUR SOLUTION

Get the MOST out of your Audit Team and transform your Audit Operations with AuditShark!

AuditShark is the first platform built to supercharge health plan audit teams. AuditShark provides a single, comprehensive platform for audit teams to perform all their audit work, capture findings, and communicate between teams. With a modern platform, audit teams can get the most out of their teams by leveraging streamlined automation, data analytics, and artificial intelligence.

solution

With our Quality and Compliance Audit Platform, health plans can experience:

comprehensive
One Comprehensive Audit Platform
scalability
Scalability and System Flexibility
maximum
Maximum Efficiency & Productivity

rehumanized
Rehumanized Work and Access to Insights

OUR PLATFORM

AuditShark is a cloud-based payment integrity audit platform designed to help health plans manage their own internal audit functions so that they can maximize efficiency, accuracy, and margins.

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Key features & Benefits

  • Audit all claims and data with AI-driven error prediction scoring
  • Empower audit teams to prioritize audits on the fly with dynamic user control of sample parameters
  • Audit faster with single screen Smart Audit Workflows and Automation
  • Boost capacity with faster audit cycle times
  • Cure root causes with enterprise communication, issue tracking, and proactive surveillance of ‘fixed’ issues
  • Easily measure auditor efficiency and share best practices across the team
  • Detect emerging patterns and insights a powerful reporting suite

BENEFITS

  • Maximum Productivity
  • Maximum Accuracy
  • Reduced Costs
  • Improved Control & Quality
  • Right-Sized Workload Balancing
  • Complete Data Access & Analytics

Rehumanize the Audit Experience and play to your strengths with Augmented Intelligence (AI)

While portions of the audit process can, and should, be automated – the core components of the audit function are deeply human and the audit performances relies on humans to perform their best work. But audit processes are often like assembly lines, grinding the human auditors down in administrative workflows, leading to burnout and sub optimal performance. AI won’t replace auditors, but it can augment them.

We believe Auditors and the technology they use should both be free to play to their strengths. When auditors are unburdened by heavy administrative tasks, they perform their best work. And likewise, when technology is designed and leveraged to its strengths, it becomes a force multiplier and a catalyst for the team.

Augmented intelligence

Get the MOST out of BOTH systems and teams by ensuring they play to their strengths
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Computers & Software

Connecting Systems

Routing Information

Assembling Information

Aggregating Data

Detecting Patterns

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Human Auditors

Judgement

Reasoning

Curiosity and Empathy

Understanding Context

Decision Making

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What could a comprehensive approach to claims
auditing mean for your business?

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