Cotiviti - Integrated Revenue Cycle Management (IRCM)
Project: Integrated Revenue Cycle Management (IRCM)
The IRCM exploratory research project is chartered to explore and validate methods to reduce administrative burden and payer-provider abrasion in the Revenue Cycle Management (RCM) and Payment Accuracy areas of healthcare. Two potential IRCM services will be explored in this project. Service 1 is an AI model that provides an audit-risk warning integrated into the EHR pre-submission workflow. Service 2 is an AI-generated list of patients who are pre-authorized for high-cost procedures and pharmaceutical interventions to bypass bureaucratic, prior-authorization workflows.
Business and healthcare participants in this project will research current RCM and Payment Accuracy policies, processes, and economic models to identify target areas for Proof of Concept (POC) development. Technical participants will research and develop experimental machine learning models and EHR system integration architecture. Business and technical participants will research and develop prototype user interfaces and user experience workflows. Participants will have access to real-world clinical and financial data as well as Cotiviti’s payment accuracy policies. The project outcome objectives include delivery of a findings report and presentation and a technical demo of any prototype software capabilities.
Company Description: Cotiviti is a leading healthcare informatics company that optimizes the economics of health care with integrated clinical and financial solutions. Cotiviti serves as a trusted intermediary to align and facilitate payer, provider, and purchaser cooperation toward a common interest in the health and wellness of patients. With business units in payment accuracy, risk adjustment, performance analytics, quality improvement, and consumer engagement, Cotiviti insights uncover hidden opportunities for healthcare organizations to collaborate and cooperate in ways that drive toward The Quadruple Aim of Health Care.
NOTE: Preference is given to students in the UOnline MS in Nursing Informatics program. Contact your department directly if you would like this experience to count towards capstone requirements.