Working with you to take Healthcare
to the next level

What We Do

Millions Lives Served

States Covered

% Quality

HEALTHCARE
ADMINISTRATION

  • Comprehensive suite of Healthcare administrative services

  • Broad range of clients from national/regional Payors & Providers

  • Innovative service models

ADMINISTRATIVE SUPPORT FOR MEDICAL MANAGEMENT

  • Fully customizable and integrated medical management service offerings

  • Comprehensive strategies for revenue recovery

  • Cost-effective solutions to meet regulatory requirements

Services

Healthcare Administration

Our Managed Care Claims Examiners consist of dedicated teams of experienced Claim Examiners. Deep experience in all lines of business producing exceptionally high quality adjudication.

Our Benefits team provides clients with a standard benefit plan setup & interpretation, with standard event classes & benefit rules. We handle benefit calculations, calculating OOP from plan cost & tracking benefit costs.

Our Eligibility Specialists support a stringent process of verification of member eligibility records and update of member records by verifying Eligibility details online from Health Plans and State enrollment records.

Our Review team performs an increased level of research, investigation and independent evaluation of Appeal data in compliance with standard protocols and overall clinical objectives.

The HCC team comprises of expert, clinically-trained coders (CPC, CPC-H) and physicians who engage in highly efficient chart reviews to recover valuable ICD-10 codes for accurate coding of the member population risk level.

We offer support to New MSO buildouts across three key areas including System Evaluation & Selection, Process & Org Design, Delegation contracting with P&P design, and Pre-delegation readiness support.

Administrative Support for Medical Management

The Calibrated UM Program offers clinical and non-clinical levels of prospective, concurrent, and retrospective reviews to ensure quality-based, cost-effective management of healthcare resources.

Calibrated employs trained clinicians to partner with hospitalists or attending physicians to facilitate a safe and effective discharge plan from an inpatient or skilled nursing level of care. Clinicians perform concurrent review to determine medical necessity of admission, continued stay, and appropriateness of level of care.

Calibrated aims to support hospital revenue cycle recovery programs through aggressive appeal management for medical and behavioral acute care denials.

Calibrated can provide clients with specialty referral tracking services that include assisting dependent members with specialist appointment scheduling, confirming appointment adherence, and assistance with provider exchange of information through the contact center

Calibrated aims to support clients in the accurate processing of denial, modification, or pend notifications to ensure communications meet regulatory guidelines in terms of content, form, and timeliness

Calibrated clinical documentation improvement team reviews retrospective ED claims to ensure the appropriate level of care for cost effective use of healthcare resources.

Leadership

Madhu Vijayan

President

25+ years of leadership in private equity/Venture Capital world managing and investing in a diverse portfolio across industries mainly in Asia and North America.

Jovita Montes De Oca

CEO

Seasoned healthcare executive with 30+ years of diverse management experience in the healthcare industry; extensive experience in IPA and MSO Management.

Amy Grant

VP, Global Finance

Professional accountant with 13 years of experience in corporate accounting, taxation and public spending.

Atul Sharma

SVP, India

Extensive experience planning and strategizing healthcare business operations in an offshore environment.

Contact Us

Headquarters

3633 Inland Empire Blvd., Suite 301, Ontario CA 91764

(866) 955-0044 | (909) 605-0044

(877) 891-7292

[email protected]

India Office

516, Udyog Vihar, Phase III, Gurgaon. 122015

+91-124-4171500 | +91-124-4006016

[email protected]

Philippines Office

Penthouse, One World Place, 32nd Street,
Fort Bonifacio, Taguig City 1630, Philippines

[email protected]

Message Us

If you wish to be considered for employment at Calibrated Healthcare, please do not send us a message here – instead, please apply through our Careers page and our Human Resources department will contact you after their review of your submitted application.

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