Product Designer at Opencare
User Research, User experience design, user interface design, Interaction design,

Optimizing Insurance Verification

Context

Insurance Verification

Opencare provides insurance verification (IV) services that get dental practices the information they need to confidently schedule and treat patients. Before a patient arrives, a team of Opencare specialists will check their insurance coverage so both the patient and dentist know what insurance will cover vs. what will be out of pocket.

Why is this valuable for dental practices?

• It saves time

• It allows the office to effectively treatment plan

• Doing IV wrong is costly

My Role
I worked closely with a cross functional team of product managers and engineers to design Opencare’s internal Revenue Cycle Management (RCM) portal that would automate manual processes and optimize a team of specialists' workflow so they could efficiently provide patient insurance verifications to dental practices across the United States.

I conducted research and discovery sessions to understand the team’s workflow and identify pain points and areas for optimization. Based on my learnings I designed, prototyped and tested iterations of the RCM portal before launching our MVP, which has since evolved based on user feedback and changing customer needs.

The Challenge

To gain a deeper understanding of the team's workflow I utilized various research methodologies before identifying the main challenges our RCM portal would aim to solve.

User Personas

Started by sending out surveys to the insurance verification team to collect the data which was used build personas.

Qualitative User Interviews

I conducted several interviews with our insurance specialists and supervisors to determine their frustrations and needs.

Key Insights

• There was a lack of process for completing insurance verifications 

• Every specialist has a slightly different way of doing things 

• Work was kept in a matrix of Google Sheets. This made it hard to keep track of work and track progress 

• It was taking one supervisor an hour every day, per practice, to manually audit the appointment schedule and create cases in Google Sheets

• The insurance verifications being shared with practices was inconsistent 

• Manual processes will not be scalable
  
  

Challenge 1: Lack of process causes rework and quality issues

Challenge 2: Manual processes are very time consuming and not scalable

Project Goals

• Capture patient insurance information in a consistent way without using Google Sheets

• Decrease average time it takes for an specialist to complete an insurance verification 

• Automate manual processes to improve team efficiency 

• Offer service to more profitably

The Design

Conceptualization

After determining the standard insurance verification workflow, I conducted multiple usability tests for the low/mid fidelity designs with our insurance specialists to understand if the RCM portal would meet their needs. It was important that the information architecture and content hierarchy felt right and aligned with our standard insurance verification process.

For each insurance verification to be completed a new case was created in the RCM portal and each case would then be updated with different statuses as it progressed to reflect the work being done. Depending on the case, different methods (e.g. checking the insurance providers web portal or calling in) could be used to retrieve patient's insurance information and the portal would reflect this.

Once an insurance verification was completed RCM portal would generate a PDF of the patient's insurance information which the specialist would download and share with the dental practice.

Launch MVP

At launch we were focused on creating a standard insurance verification process in the RCM portal and knew that automations would have to be fast followers.

Key Insights

• Standardizing the insurance verification process helped the team work more efficiently and decrease errors 

• Many insurance providers would send electronic faxes containing an explanation of the patient's insurance information - had to be requested 

• Specialists we spending too much time manually retrieving faxes and then uploading to RCM portal 

• Supervisors could better understand their teams productivity 

• Manually creating cases in the portal was still taking too much of the supervisors time
  
  

Launch V2

After launching the MVP and collecting feedback for a month I iterated on the RCM portal using the key insights I had collected.

Features

• Automatically generate cases using custom integrations with practice management softwares

• Attach fax backs in portal using third party tool

• Autofill fields in case based on previous IVs with shared group number

Key Insights

• Manually downloading insurance verification PDF and sharing with practice was taking too much of the specialist's time.

• Lack of standard inputs for fields was causing inconsistencies in information being shared with customers. 

• Group like information in the way a specialist would see it in a insurance providers portal
  

Launch V3

Over the next few months I would have regular feedback and shadowing sessions with our insurance verification team as well as our customers to learn what could be improved with the service and internal tools. I also spearheaded the creation of Opencare’s design system, the Crown Library, during this time which was used in the latest iteration.

Features

• Allow specialist to automatically upload insurance information to practice management software

• Redesigned RCM portal using the Crown library

• Bulk actions in the cases queue

• Custom pickers for frequency of treatments

• Drop down menus with most commonly used option for fields

Results

Since launching the Revenue Cycle Management tool in August 2020,

• Specialists completing insurance verifications 2X faster

• 50% increase in team efficiency

• 21,000 IVs done

• Over 8000 hours saved for our dental practices
  

Next Steps

• Continue to monitor data to find areas for optimization

• Have conversations with the insurance verification team and customer to further improve the experience

• Automate more of the manual processes in the insurance verification workflow to offer the service more profitably

Tools: Figma, Invision, Respondent, Dovetail