Patient Access Managed Call Center Solution

The Vendor is required to provide comprehensive patient access and managed call center solution supporting center including the technology platform, supplemental staffing, operational leadership, workflow automation, reporting capabilities, and related support services necessary to support centralized patient access operations.
- Clinical access and navigation operations
• Appointment scheduling, rescheduling, pre-registration, and referral coordination workflows
• Real-time insurance verification and demographic accuracy validation
• HIPAA-compliant patient communication services
• Billing inquiry support and patient communication assistance
• Coordination with providers and clinical departments regarding urgent operational matters
• Continuity-of-care and patient navigation initiatives
• Preventive care and patient outreach campaigns, including annual checkups, flu shots, mammograms, dental services, and related custom workflows
• Outbound patient outreach workflows supporting appointment rescheduling, continuity of-care initiatives, preventive care campaigns, care gap closure initiatives, and related patient engagement efforts
• Multi-channel patient communications including phone, SMS/text, email, and web-based workflows
• Language access and multilingual communication support capabilities
- Reporting, analytics and operational oversight
• Real-time dashboards displaying speed-to-answer, abandonment rates, first-call resolution, scheduling activity, and patient access trends
• Workforce productivity, staffing, and operational performance analytics
• Quality assurance and patient satisfaction reporting
• Operational alerts, escalation visibility, and reporting export capabilities
• AI-enabled analytics, transcription, sentiment analysis, and workflow insights, where available
- Operational leadership, quality assurance and workforce management
• A designated team lead responsible for operational management, supervision, escalation coordination, and primary liaison responsibilities with corporation leadership
• Workforce oversight and operational coordination for vendor-provided staffing resources
• Quality assurance (“QA”) methodologies supporting operational consistency, patient satisfaction, and performance management
• Training, onboarding, workflow support, and operational stabilization services
- Technology, integration and security
• Integration with EMR, scheduling, telephony, and patient access systems
• Hl7, FHIR, API-based, and other secure interoperability capabilities
• Workflow automation, patient engagement, and operational escalation management capabilities
• Role-based access controls, audit logging, and cybersecurity protections
• HIPAA compliance and applicable regulatory and security requirements
- Implementation, support and innovation
• Implementation planning, workflow configuration, onboarding, and go-live support
• End-user training and operational support services
• Service level agreements (“SLAs”) and escalation support procedures
• Business continuity and disaster recovery capabilities
• Optional AI-enabled automation, virtual agents and chatbots, predictive staffing, and patient self-service capabilities.