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Case Study

RCM Outsourcing for Top U.S. Healthcare Provider

Client Profile

Our client is a healthcare provider with hundreds of hospitals and clinics across the country delivering outstanding patient care. While the company already maintained sizable operations in the U.S. and Asia, U.S. labor shortages and offshore challenges had it looking for a nearshore healthcare business process outsourcing (BPO) partner in Latin America who could successfully deliver more complex revenue cycle management (RCM) processes.

Business Challenge

Healthcare providers need new solutions to labor shortages and rising costs

More than 80% of healthcare executives say they are struggling with revenue cycle management labor shortages – and nearly half are operating 10-20% below steady-state levels (2023 Becker’s Hospital Review and PwC Healthcare Revenue Cycle Survey). Our client was no exception.

At the same time, rising healthcare costs leave nearly half of U.S. hospitals grappling with negative margins, states Everest Group’s 2023 RCM Operations PEAK Matrix Assessment – making fast and effective revenue collection more critical than ever to financial stability.

Fraught with frustration and tedious processes, the healthcare industry traditionally struggles with high turnover in its revenue cycle management operations and other back-office related functions. But inflation and workforce shortages exacerbated the problem – making it difficult for our client’s U.S. service center to attract and retain staff while significantly increasing labor costs.

Interest in healthcare BPO has surged in recent years as healthcare executives look for new solutions to their operational challenges. More than 60% of healthcare providers said they planned to outsource RCM processes in 2023 (RevCycleIntelligence report).

Our client had already outsourced some transactional, back-office functions to Asia. But its leadership team was concerned that its existing solution lacked the right skillsets, geographic proximity, and cultural alignment to successfully deliver a more advanced, judgment-intensive tier of key healthcare provider services.

The bottom-of-the-barrel pricing and overnight shifts needed to align with U.S. business hours in offshore locations like India leaves many healthcare organizations struggling to attract higher-level resources who can support complex healthcare processes. The organization was also struggling with traditional offshore challenges, including language, cultural, and time zone barriers.

As service needs expanded beyond standard activities, our client wanted to lower labor costs and enrich its capabilities with a quality nearshore outsourcing partner. By tapping into a top Latin American market with a highly educated population, it could access the critical-thinking skills, outstanding English proficiency, and real-time communication needed to deliver complex, time-sensitive RCM processes without constant support from the client’s internal teams.

Solution & Results

Auxis nearshore RCM outsourcing: a higher tier of talent for a higher tier of processes

After a successful pilot, the client outsourced 12 revenue cycle management processes to Auxis’ Global Delivery Center in Costa Rica – effectively lowering costs and accessing a high-quality, cost-effective talent pipeline without sacrificing performance.

In-scope healthcare BPO services include payment applications, insurance verification and approvals, medical billing services, medical claims management, collections, and more.

The client’s decision to partner with Auxis came down to its extensive shared services experience and well-established platform in Costa Rica, Latin America’s most mature shared services market.

The client felt comfortable that the Auxis team combined the right cultural fit with the top-tier talent, extensive operational knowledge, detailed business understanding, and flexible outsourcing approach to integrate seamlessly with its internal operations and successfully deliver an advanced tier of front- and back-office processes.

Everest Group’s Finance and Accounting (FAO) Peak Matrix® Assessment 2023 recognizes Auxis, a nearshore pioneer with more than 25 years of shared services experience in LATAM, as a Major Contender and the only true nearshore player on its list of top finance and accounting outsourcing companies. Auxis has also been recognized on IAOP’s elite Outsourcing Global 100 list for nine consecutive years.

Key solution steps and results for outsourcing revenue cycle management include:

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