Insurance Posting Engine
Athenahealth: Director of Design & Product. I led this project as PM and Design leader
Project Goal
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Insurance Claim Posting Quality is degraded. 25 % of Customer cases are owning to this.
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The primary concern of Customer Attrition Risk is bad Posting. # 1 issue in Voice of Customer
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The product was started 20yrs ago and lines of code have been just added. It is an ageing Technology
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The product has shortcoming like Fee-for-service not available. Inadequate support for Alternative Payment Models
Problem Statement
Provider Organizations need to: Capture payment and remittance advice from payers, including patients; match to AR; record transactions accurately, all as quickly as possible
Research Methods
Use Internal discussions, literature, data analysis, and research for:
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Current State: Map, processes, and issues
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Develop Hypotheses and POVs
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Identify and develop “To Be” state/processes
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Support for non-FFS payment models
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Identify potential technical approaches for execution
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List down “Jobs to be done” - about +70
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Preliminary list of POVs to be established
Conduct site visits
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Visit practics in following locations -
Belfast, Boston, Rhode Island, Chattanooga in US. -
Visit BPO centre in Chennai to understand customer issues.
Strategy to get Buy-in
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Socialize and Validate “To Be” state with internal stakeholders and SMEs.
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Meet customers and find their current state and gather feedback
Jobs to be Done (JTBD)
JTBD is a power tool to understand customers needs. Athenahealth strongly beliews in this framework and is applied in every project.
Historically, the primary cause of failed products and services is a misalignment with customer needs. This is not surprising given that 95% of product teams do not agree on what a customer “need” even is. Using this needs framework, product teams can deeply understand the jobs its customers are trying to get done and the metrics they use to measure success.
User Task Analysis
After gathering lot of insights from site visits in Belfast, Boston, Chattanooga Tennessee, we did one more exercise with the SME and leadership team of athenahealth. I was responsible to drive this exercise to conduct an affinity mapping exercise.
Output
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Completed High-level Athena agnostic Posting process flow diagrams
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Preliminary work on AR models for non-FFS payment models - some POVs identified
Service Design Map
A parallel activity was conducted to document the entire journey of the users in the Athena product and to understand how the posting plays roles in this process. What are the various touch points for this user
Building the right posting method
Working along with PMs, SME and Engineering I was able to draft the posting flow
Improved Design
These are some of the hands-on design that show improvement in the overall page layout and posting table
