Project Highlights

  • Improved the Gaffey Claims Management application used by hospitals and health care facilities
  • Implemented a dashboard solution that streamlined management of health insurance claims processing and payments
  • Delivered core product enhancements resulting in an increase of claims throughput
  • My role was as a Product Design Manager
A picture of a laptop with the Gaffey Claims Management application displayed

Challenge

At the conclusion of providing medical services for patients, Hospitals and health care facilities needed to ensure that claims submitted to insurance companies for payment were processed quickly and accurately.

Hospitals and health care facilities leveraged the EDI standard for claims submission and payment. Reconciling diagnosis and procedure codes for submitted claims was complex and prone to error.

Additionally, managing claims submitted to multiple insurance companies often became cumbersome and overwhelming leading to delays in payment.

Solution

Project scope consisted of application refresh along with net new screens and main dashboard. The team and I delivered a comprehensive overhaul of claims processing capabilities for the company's flagship medical billing and claims management application.

As a Product Design Manager I was responsible for leading a team comprised of a Business Analyst, Front-end Architect, and Back-end Developers. This team was responsible for gathering requirements and creating product design artifacts along with final development, testing and launch.

Application integrated the EDI standard built upon an Oracle database with the application layer sitting on a Windows Client.

Screen capture of the Gaffey Claims Management application dashboard
The Gaffey Claims Management application dashboard.

Screen capture of the Gaffey Claims Management application claims management console
Claims management console and claims editor screens.

Collage of screen captures of the Gaffey Claims Management application
Splash‑screen and several Gaffey Claims Management application screens.

Page samples from the Gaffey Claims Management application user guide
Page samples from the Gaffey Claims Management application user guide.

Close up detail of several custom designed icons used in the Gaffey Claims Management application
Detail study of custom designed icons used in the Gaffey Claims Management application.

Print samples of Gaffey Claims Management application marketing data sheets
Gaffey Claims Management marketing data sheets and direct mailer.

Collage of custom designed icons used in the Gaffey Claims Management application
Custom designed icons used in the Gaffey Claims Management application.

Impact

The Gaffey Claims Management application was extremely well received

Gaffey's flagship medical billing and claims management application had no meaningful usability updates in 14 years.

While the launch was via a tiered rollout, it was eventually updated for all Gaffey clients. The feedback was overwhelmingly positive as both Hospitals and health care facilities indicated that the solution surpassed their expectations and addressed pain points.

The major application improvement was the comprehensive all-in-one dashboard view of claims — with submission status depicted. Processing time was shortened and accuracy improved as a result of easier claims tracking.

Overall claims processing throughput-efficiency improved upwards to 30%
Improved the ICA (Initial Claims Acceptance) rate to 97%
Product enhancements resulted in a reduction in the sales cycle from approximately 12-18 months down to 6-12 months
Hospitals and health care facilities could view and track claims activity at the individual insurance company location level
Easy report generation
EOB attached and tracked to each claim
Each claim submission included 270, 271 healthcare eligibility details
Integrated 837 - Health Care Claim and 835 - Health Care Claim Payment/Advice

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