Services

Executive Strategy and Management

Rebellis Group offers practical solutions and expert guidance to support all areas of the MA and Part D organization. We help plans develop the cross-functional staff, systems and synergies needed to build a culture where staff can thrive, and each person can feel pride in contributing to a winning organization.

• Interim Staffing

• Training

• Industry Intelligence

• Staff and structural appraisal

• Expert candidate vetting

• Executive Project Leadership

• Analytics and Intelligence

• Silo elimination

Operations

Our consultants have decades of experience in helping organizations create the most efficient and compliant operations. We’ll evaluate end-to-end operations to identify compliance and operational risks and then provide comprehensive tools and actionable plans to remediate and monitor ongoing operations, from the Notice of Intent through Application and full health plan implementation.

• Interim Staffing

• Call Center, Enrollment, Premium Billing and Reconciliation

• Claims Processing including COB, Recovery, and MSP

• Finance and Accounting

• IT Infrastructure, Vendor Integrations, and CMS and State Reporting

• ODAG and CDAG Case Processing

• Provider/Vendor Contracting, Network Adequacy, and Management

Technology Support

We assist with all aspects of technology selection, implementation, and optimization, ensuring solutions that meet the specific needs of your organization while fulfilling the explicit requirements of MA and Part D plans.

• Technology Selection

• Implementation Support

• Existing System Optimization

Pharmacy

The Rebellis Pharmacy team is renowned for its many years of experience and deep subject matter understanding needed to support the full array of pharmacy-related projects in Medicare Advantage, Medicaid, ACA, and commercial organizations.

• PBM Selection or Re-Contracting

• PBM Oversight

• PBM Audit

• MTM

• Part D Operations Re-Engineering

• Benefits Administration Testing

• Rejected Claims Review

• Formulary Administration Operations

Compliance

We offer expertise in all aspects of operational compliance, from advisory services to internal and external audits, remediation, and delegation oversight. Our mock-audits will serve as a verification process to ensure that your compliance and operational procedures are in order, will strengthen the systems that are in place, and will unearth opportunities for improvement that often lead to more effective management and the minimization of errors in the future.

• Application Support

• Delegated Oversight

• Mock CMS Program or Financial Audits

• Audit Remediation

• Independent Validation Audits

• CMS Audit Support

• Compliance Advisory Services

Sales & Marketing

MA plans count on Rebellis Group to provide insight, expertise and proven solutions to the full array of sales and marketing challenges posed by today’s competitive environment. Our strategies can help your organization stand apart from the competition while furnishing the analytical tools and metrics needed to achieve great results.

• FMO/Sales Call Center Selection

• Sales Oversight

• Channel Strategy

• New Market Analysis

• Benefit Design

• Marketing Material Review

Risk Adjustment and Coding

Proper risk adjustment processes, correct encounter coding, and data collection/submission are critical to the success, growth and profitability of any MA plan. Ongoing proficiency in this area also helps foster a positive relationship of trust and confidence with CMS and other business partners. The Rebellis team has years of experience working with MA plan to assure accuracy and competency in this undertaking.

• Risk Adjustment Submissions/Reconciliation

• Provider Education Strategies

• Auditing

• Strategy

Star Ratings

Our experts bring together many years of experience to provide not only insight into a successful Star Ratings strategy, but the tactical actions that can improve outcomes for both the patient/provider experience and overall measures. We can help develop and/or implement a best-in-class Star Ratings program to support your plan's structure, goals, objectives and provider/partner relationships for enhanced member and provider engagement and satisfaction. That translates into additional dollars into your organization to better serve your members year ‘round.

• Stars Strategy Analysis

• Work Plan Implementation

• Star Ratings Data/Dashboard Development

Clinical Operations and Quality Improvement

Clinical operations, strategy and processes are some of our strengths here at Rebellis. The consulting team at Rebellis Group is uniquely prepared to support all phases of clinical operations as they relate to the full spectrum of quality improvement, utilization management and medical management programs within a Medicare Advantage plan. Whether development from the ground up or revision resulting from a strategy change, we can assist in your every need.

• Case Management Program

• SNP Models of Care

• Chronic Care Improvement Program (CCIP)

• NCQA/URAC Accreditation Assistance

• Quality Improvement Program/Workplan and/or Committees

• Organization Determination and Appeals Clinical Decision Making

• UM Policies and Procedures