Healthcare BPO to streamline your services and obtain operational agility

Healthcare BPO to streamline your services and obtain operational agility

Table of Contents

Many healthcare organizations are turning to business process outsourcing to manage their day-to-day operations.

It’s the ideal solution for any healthcare company looking to improve efficiency and lower costs.

This article will cover everything you need to know about healthcare BPO and how it can benefit your business.

What is Healthcare BPO?

Healthcare Business Process Outsourcing (Healthcare BPO) is a practice in which a healthcare provider outsources non-core activities to a third-party. Instead of doing the work themselves, some healthcare organizations hire a third-party firm to do it for them.

While most businesses outsource their activities to dedicated outsourcing firms, some choose to outsource directly to freelancers.

Why do companies do this?

By outsourcing non-core tasks, healthcare facilities and hospitals can concentrate on their core competencies. Outsourcing services such as medical billing and marketing allow healthcare providers to focus solely on what they do best: effectively treating their patients.

So, where can you get help?

People generally think of outsourcing as contracting work to a third party in another country. To save money, many businesses, for example, outsource medical billing services to third-party providers in countries such as India.

You can, however, outsource these jobs to providers in your own country (though you won’t save as much money this way).

See more» Business Process Outsourcing (BPO): What It Is, How it’s Done, and the Benefits of Doing It Right

Healthcare BPO to streamline your services and obtain operational agility

Top Healthcare BPO Services

The healthcare BPO industry handles a wide range of tasks, from data entry to medical claims processing.

Here are some specific healthcare provider services that you can outsource:

Coding And Billing In Medical Care

Every day, hospitals and healthcare professionals process massive amounts of medical records. However, unlike in other industries where coding and billing is relatively simple, medical coding and billing can be difficult.

You must be familiar with the scientific codes used in medical bills and records, such as ICD (International Classification of Disease), CPT (Current Procedural Terminology), and HCPCS (Healthcare Common Procedure Coding System)

That is why dealing with these records necessitates using specially trained personnel. You will encounter significant delays and errors in processing your patient bills and documents if you don’t have knowledge and expertise.

Why not outsource the coding and billing to an expert service provider to avoid hiccups?

Because they are professionals, they are already well-equipped with the resources needed to complete the task accurately and efficiently. This allows you to focus on tasks vital to your company, such as medical research, patient treatment, and care.

Claims Processing

Processing patient claims is an essential aspect of healthcare. Do your patients require accurate medical claims from their insurance companies?

But, with hundreds of claims to process every day, how do you ensure that each one is correct?

Why not outsource your patient claims management to a service provider to ensure compliance?

They have the workforce and technology to process large volumes of medical claims promptly and efficiently. There is no worry about distractions clouding the accuracy of the claims because this is all they’ll be focusing on.

Data Entry

In addition to treating patients, healthcare providers must process and update massive amounts of medical data daily.

They must manage data such as:

  • Tests and lab reports.
  • Prescriptions and drug stock
  • Insurance information for the patient
  • Additional hospital records

Outsourcing your data entry tasks will allow you to devote more time and resources to your core healthcare activities. While data entry is typically the safest activity to outsource due to its simplicity, remember only to outsource it to a reputable healthcare BPO.


Medical data entry is far more technical than most other fields, and you should leave it to a professional.

Healthcare BPO to streamline your services and obtain operational agility

Physician / Doctor Referrals

When they become ill, patients look for hospitals and medical centers. They are unaware of the institute’s most recent treatments. Medical calling services will give prospective customers detailed information about diseases and treatments.

To connect with customers, trained patient support executives make inbound and outbound calls.

Patient Outreach

Clinical services such as patient care (therapy and pharmacy) and diagnostic imaging are increasingly being outsourced by healthcare organizations. The reasoning is that hospitals can provide comprehensive services without spending a lot of money upgrading in-house equipment or hiring specialized healthcare professionals.

Post-Care Patient Survey

It is critical to follow up with patients. This allows customer service representatives to gather feedback. Proper data collection and analysis enables the hospital owner to improve the facilities.

Appointment Scheduling

Another service that many Medical BPO companies offer is appointment scheduling for hospitals, physicians, and doctors. Patients can schedule an appointment with a doctor by calling the BPO provider’s call center. They also offer reminder calling services, meaning no patient will ever be late for an appointment.

Insurance Verification

Almost everyone now has medical insurance. Patients must present their insurance documents when they are admitted to the hospital. These documents can be forwarded to our executives by treatment centre owners. Healthcare BPO services will review insurance documents, verify them, and validate claims.

Revenue Cycle Management (RCM)

Outsourcing your revenue cycle management helps you improve your financial performance by speeding up the medical billing collection process. RCM solutions will help healthcare providers collect medical data more quickly and efficiently while adhering to industry compliances.

Supply chain management

Refers to the resources an organization needs to deliver goods and services to its customers. The healthcare supply chain is a dispersed and complex system that includes acquiring resources, handling supplies, and providing needed goods and services to patients and healthcare professionals.

IT functions

Refer to IT systems and processes to direct electronic health-related information, access patient databases, manage electronic billing and payment systems, operate cloud computing networks, and improve coding and billing procedures.

Finance and accounting

Includes bookkeeping, budgeting, financial management, internal accounting, and auditing economic events affecting a healthcare company’s operations and assets.

Employee training

Offers programs, education, and skills to employees to improve work productivity and performance. Workforce training is an essential component of a healthcare organization’s success. Nurses, nursing assistants, personal care aides, dental assistants, pharmacists, physical therapists, surgeons, and paramedics are typically trained.

Human resources

Is concerned with hiring and recruiting, managing shifts and pay schedules, selecting benefits and compensation, supervising personnel, improving patient satisfaction, and understanding regulatory and legal compliance.

Why should businesses outsource Healthcare Business Processes

According to a 2019 case study of current market trends in the healthcare system, the global healthcare BPO market will reach USD 449,623.8 million by 2023, growing at a 12.3 percent CAGR.

In other words, the healthcare BPO industry will expand exponentially in the coming years.

But why does the healthcare industry outsource now? What triggered this?

Here are three major reasons:

Have more time for core competencies

One of the primary advantages of outsourcing is that it allows businesses to focus on their core competencies.

Healthcare BPO allows healthcare organizations to outsource:

  • Managing bills.
  • Processing claims.
  • Logging data entry.
  • Resolving patient disputes.

They now have more time to focus solely on patient care because they no longer have to manage that themselves. This helps them improve customer experience, which then helps them gain more customers in the long run.

In addition, in a billing dispute, patients can speak directly with the service provider’s staff. Because you are not responsible for this, you can concentrate solely on your core competencies.

Cut down on budget by obtaining services from specialists

To reduce business expenses, most companies outsource their non-core activities.

Many healthcare companies, for example, outsource activities to countries such as the Philippines.


You can save money by hiring talented people at lower wage rates, without sacrificing quality!

There is no worry about any mix-ups because these are trained professionals.

Healthcare BPO to streamline your services and obtain operational agility

Enhances patient experience

Patients benefit from healthcare BPO because it allows companies to focus on providing better patient care.

Your staff can spend time on patient care because they will no longer be managing many different activities.

Your staff is no longer overburdened with claims processing and bill entry. They can simply attend to your patients and provide them with what they require!

How to choose a good Healthcare BPO Partner

There are numerous BPO firms to choose from. So, how to pick the best one?

Find healthcare BPO partners who have:

HIPAA compliance

Any healthcare BPO company you work with must be HIPAA compliant.

What difference does it make?

Because the healthcare industry is mainly digitized, there are numerous privacy concerns regarding patient data.

The Health Insurance Portability and Accountability Act (HIPAA) governs how businesses handle patient information. Any medical company or health practitioner who violates this law faces serious criminal charges and fines of up to $50,000 per violation.

BPO companies must have strict security measures to protect patient data to be HIPAA compliant. Hiring a HIPAA-compliant service provider will ensure that your patients’ information is never compromised.

Track record applied

The potential healthcare BPO should have a long track record of success and be willing to provide references to interested healthcare companies. Obtaining references means that these providers can reveal whether the third-party vendor provides excellent services or meets the expectations and goals of clients. References also inform the BPO that its former clients can be contacted for additional research and background checks to ensure continued good performance.

Quality of work

Outsourcing services to a quality-oriented external provider is one way to address this prevalent issue. Certain areas of the vendor’s processes, such as its training framework and opportunities, team performance monitoring, and quality reports to clients, to name a few, should be scrutinized by healthcare organizations. To ensure that employees are following the most recent protocol.

Healthcare expertise

Healthcare BPO firms are distinct from other BPO firms.

Healthcare BPO firms, unlike regular BPO firms, must undergo rigorous training rounds to ensure that they know what they’re doing. They must understand medical codes, have departmental knowledge, and adhere to government laws and regulations.

Before selecting a healthcare BPO provider, you should confirm their expertise by:

  • Analyze them thoroughly, just as you would when hiring employees.
  • Checking online reviews and ratings and getting referrals from peers in the industry.
  • Checking to see if they have a proven track record of balancing professionalism and cost.
  • Remember that if a service provider has had previous success in this field, chances are they can help you as well.

Customer service

When outsourced healthcare provider-related workers provide excellent customer service, it promotes patient loyalty and retention.

Healthcare organizations must also ensure that their BPO partner has an adequate customer service process flow. This process streamlines the large volume of call centers’ work, such as billing issue resolution, new account creation, technical assistance, and other healthcare-related concerns.

Implementation and communication methods should be as seamless as possible

The ideal healthcare outsourcing partner should have efficient and seamless implementation and communication processes that improve the patient and customer experience. In this regard, the prospective healthcare BPO should use cutting-edge office phone systems to provide high-quality customer service.

Financial efficiency

The healthcare industry, like all others, is a business. The ability of the healthcare BPO to help manage the provider’s revenues and expenses is critical to the provider’s business success.

The third-party vendor should have extensive experience streamlining processes and lowering costs while providing above-average customer service. It should also be constantly looking for ways to improve efficiency at all levels and be capable of dealing with unexpected financial issues.

Good English skills

Healthcare organizations should look for BPO firms in non-English speaking countries that use English as a second language. For example, more than 90% of Filipinos speak and understand English. Filipinos have an outsourcing advantage over other countries due to their ability to adjust their English accents and speak in different conversation tones.

Healthcare providers should consider working with an external vendor who provides accent neutralization training and has a fluent workforce in English (speaking, reading, writing, and listening skills).

The Best Healthcare BPO Service Providers in the World

Infosys BPM

For clients all over the world, the company provides integrated and business process management (BPM) solutions. The BPO assists clients in meeting cost-cutting objectives, improving process efficiencies and effectiveness, and providing an exceptional customer experience. It operates 35 delivery centers in 14 countries and employs approximately 48,000 people of 120 nationalities. According to the company, it processes six million claims annually and provides data management services to at least 15,000 providers.

Outstanding healthcare BPO services include:

  • Claims management
  • Provider network management
  • Member management
  • Care management
  • Plan management
  • Benefit management.

HCL Technologies

With its digital technology transformation approach, HCL, a global IT services company, assists businesses in re-inventing their operations. The India-based company operates in 32 countries and employs over 110,000 people of various nationalities. It provides comprehensive and multiservice delivery in a wide range of industries, including life sciences and healthcare, telecommunications, travel, transportation and logistics, manufacturing, publishing, media.

HCL provides an integrated portfolio of services through a growth strategy known as Mode 1-2-3. Mode 1’s goal is to help clients’ businesses and IT systems become more lean and agile. Mode 2 focuses on customer-centric and outcome-oriented services, whereas Mode 3 focuses on driving the business and IT ecosystem.

Outstanding healthcare BPO services:

  • Cost management
  • Consumer experience
  • Care delivery
  • Digital analytics
  • Application services
  • Infrastructure services
  • Digital process operations
  • Research and development services

Sutherland Global

Sutherland Global has been serving industries such as healthcare, insurance, technology, retail, logistics, hospitality, banking and financial services, and telecommunications for over 35 years. It is a digital transformation company that provides artificial intelligence (AI) and automation-focused services, platforms, and products.

The company, which employs approximately 38,000 global professionals, has a digital backbone that spans over 140 countries, 61 digital centers worldwide, and over 43 million monthly transactions.

Outstanding healthcare BPO services:

  • Revenue cycle management
  • Provider data management
  • Claims processing
  • Experience consulting
  • Contact center
  • Coding, analytics
  • Health information management
  • Population and payment services


Xerox Holdings, headquartered in Connecticut, sells print and digital document products and services in over 160 countries.

Affiliated Computer Services was purchased by the Fortune 500 company for more than $6 billion in 2010. Six years later, it spun off its business process service operations into Conduent.

This new company provides various healthcare services such as patient support, medical billing, Medicaid screening, customer experience management, pharmaceuticals and life sciences solutions, and community health management.

Outstanding healthcare BPO services:

  • Health records automation
  • Virtual health consulting
  • Virtual clinic
  • Interface design and development
  • Digital patient
  • Workflow automation solutions

Omega Healthcare Management Services

The company provides various outsourced solutions that use automation, analytics, and proprietary technologies. The nearly two-decade-old BPO specializes in revenue cycle management business processes and employs over 17,000 people across the Philippines, India, and the United States.

Omega Healthcare also focuses on coding and collections processes, medical billing, and revenue cycle automation tools to reduce costs. It provides virtual nursing services such as clinical documentation improvement, avoidance of readmissions, triage, and care continuation.

Outstanding healthcare BPO services:

  • Payment posting
  • Medical revenue cycle management
  • Patient support solutions
  • Insurance verification
  • Medical coding and billing
  • Account receivables analysis and management
  • Charge entry
  • Insurance and patient follow-up

SYKES Enterprises

SYKES, a subsidiary of the Sitel Group, is one of the largest providers of customer experience solutions. The merger increased the total number of employees to around 160,000 worldwide. Every day, the company serves millions of customers in over 50 languages.

SYKES, a provider of customer engagement services to the world’s top 2,000 companies, provides multi-channel demand generation and assists its clients and partners with customer relationships, care, and support.

Outstanding healthcare BPO services:

  • Claims inquiries and processing
  • Telehealth
  • Lifestyle and wellness coaching
  • Scheduling
  • Billing plans
  • Prescription drug assistance
  • Healthcare system navigation
  • Mail order Rx support

Firstsource Solutions

Firstsource is a global BPO provider of over 100 businesses, including 17 Fortune 500 companies and nine FTSE 100 companies. It’s a branch of the Indian multinational conglomerate RP-Sanjiv Goenka Group. With more than 28,000 workers in India, the Philippines, the United States, and the United Kingdom. This company serves a variety of industries, including healthcare, media and technology, banking and financial services, and communications.

Firstsource employs the “Digital First, Digital Now” strategy, which is a technology-based solution that streamlines complex business processes, improves customer experience, and generates value across business operations.

Outstanding healthcare BPO services:

  • Claims operations
  • Broker management
  • Risk adjustment
  • Appeals and grievances
  • Patient outreach,
  • Medication adherence
  • Telehealth support
  • Provider life cycle management
  • Medical billing


Genpact was founded as a subsidiary of General Electric in 1997 and became an independent company in 2005. It is a professional services firm with over 90,000 employees and operations in over 30 countries.

The publicly traded company specializes in delivering digital transformation through analytics, AI, and consulting skills to clients and partners to reinvent their business processes. Its healthcare solutions aid in reducing revenue loss and improving margins by supervising more than 35 million claims transactions, arbitrating at least one million each year.

Outstanding healthcare BPO services:

  • Procurement and accounts payable processing
  • Enterprise performance management
  • Record to report (R2R) processing
  • Analytics services are the most common


Accenture is a global leader in the provision of low-cost healthcare services. It provides medical and administrative services in over 45 countries worldwide, including India, the Philippines, and the United States.

Outstanding healthcare BPO services:

  • Medical billing and account services
  • Claims processing
  • Medicare services
  • Pharmacy benefits management
  • Cash flow improvement analytics

Parexel International

Parexel, founded in 1982, is a clinical research organization that provides consulting expertise and clinical development services to clients worldwide.

The Massachusetts-based company assists customers in the biopharmaceutical and life sciences industries and translate scientific discoveries into new treatments. Its technical, functional, and therapeutic capabilities include regulatory consulting services as well as the application of real-world insights to distributed clinical trials.

Furthermore, the healthcare provider focuses on early and late phase clinical research, patient and site recruitment, biotechnology, medical device consulting, regulatory and product development consulting, and eClinical solutions.

Outstanding healthcare BPO services:

  • Clinical monitoring
  • Clinical study and project management
  • Data management
  • Statistical programming
  • Biostatistics
  • Pharmacovigilance
  • Regulatory operations
  • Medical writing
  • Medical affairs
  • Translational medicine


IBM, headquartered in New York, is a cloud platform company and the world’s largest technology and consulting employer, employing over 350,000 people in approximately 170 countries and 12 research laboratories across six continents.

IBM Watson Health is a company division that provides healthcare solutions and clinical and medical research to clients through data analytics, cloud computing, and AI. These cutting-edge technologies enable Watson to help healthcare providers predict future outcomes, maximize workforce time, and streamline complex processes.

Outstanding healthcare BPO services:

  • Healthcare digital transformation
  • Patient engagement
  • Revenue cycle management
  • Healthcare data management
  • Clinical trial optimization are the

Unitedhealth Group

UnitedHealth Group is a healthcare conglomerate with two divisions that offer a diverse range of products and services. Optum specializes in information and technology-based health services, and UnitedHealthcare, which provides benefits and healthcare coverage, are two of them.

The diversified public company, founded in 1977, employs approximately 340,000 people who collaborate with governments, partners, providers to serve 146 million clients around the world. It is the world’s eighth-largest corporation, the second-largest healthcare company by revenue, and the largest insurance firm by net premiums.

Outstanding healthcare BPO services:

  • Analytics
  • Revenue cycle management
  • Purchasing and claims processing
  • Ambulatory care coordination
  • Utilization management service
  • Health insurance plans
  • Medicare
  • Medicaid
  • Dental
  • Vision
  • Supplemental plans


With over 16 years of experience, Invensis provides global healthcare BPO and patient support services. The organization is HIPAA compliant and ISO 9001 and 27001 certified.

Outstanding healthcare BPO services:

  • Medical coding and billing
  • Claims processing
  • Data entry services
  • Revenue cycle management (RCM)
  • Payment posting and charge entry services

WNS Global Services

WNS offers a variety of healthcare services to meet the needs of businesses all over the world. They also provide technology solutions to help healthcare providers increase their market share.

Outstanding healthcare BPO services:

  • Medical transcription
  • Medical coding and charge preparation
  • Follow-ups and payer services
  • Medical equipment supply chain
  • Patient care management


Cognizant is a multinational corporation based in the United States that provides cutting-edge healthcare services and outsourcing solutions.

Outstanding healthcare BPO services:

  • Health intelligence and analytics
  • Clinical services and data integration
  • Revenue cycle management
  • Patient care and administration systems
  • Help desk services

Octopus Tech Solutions

Octopus Tech is a leading Indian business process outsourcing provider with clients in Australia, Europe, and the United States. It provides services and solutions to help healthcare providers manage their practices more efficiently.

Outstanding healthcare BPO services:

  • Insurance claim processing
  • Billing and collection services
  • Medical transcriptions
  • Pharmaceutical services
  • Doctor on-call services

See more» Top 20 world Business Process Outsourcing (BPO) Companies 

Future trends that may affect the healthcare BPO market

According to founder of the Philippine-based BPO firm Outsource Accelerator – Derek Gallimore, global outsourcing is still growing due to increased demand, primarily caused by the COVID-19 pandemic, which unexpectedly improved businesses’ confidence in their service providers.

He identifies the major outsourcing trends that will likely impact the entire industry, including healthcare BPOs, over the next ten years.

More work-from-home opportunities

Because of the pandemic, remote working or working from home (WFH) has become a common work arrangement, allowing employees not to travel to an office building or a comparable workplace. Since this global health issue started in 2020, many companies and organizations, including the outsourcing sector, have made this work mode a permanent option for their employees.

According to Gallimore, recent studies have demonstrated the productivity benefits of distance working. Enterprise Technology Research (ETR), a New York-based technology market research firm, predicts that these efforts will soon more than double.

Some BPO companies, however, continue to advise their WFH employees to return to the office gradually. Third-party service providers adhere to stringent policies at work, so a skeleton workforce is required to continue business operations.

Healthcare BPO to streamline your services and obtain operational agility

The popular of cloud computing technology

Cloud technology is critical to BPO companies’ efforts to digitize business processes, particularly in the healthcare sector.

Also, according to Gallimore, cloud-enabled outsourcing services provide more scalability and flexibility to their customers and partners, and the use of virtual storage and cloud-related services will increase for better collaboration among outsourced teams.

The rise of cybersecurity

One of the company’s primary concerns is cybersecurity. As the use of remote working has grown, so has the critical data and private information vulnerability to suspicious online activities or cyber intruders.

According to Gallimore, Sweden reported over 350 cyberattacks in 2020, up from 100-150 the previous year. In London, 47 percent of remote workers were victims of phishing scams, primarily due to human error while at work.

Because of the rise in remote work arrangements, BPOs and clients have tightened their cybersecurity measures and policies. Outsourcing firms increase their efforts to implement more robust data security measures.

Social media is the main channel of customer service

In the coming years, businesses will increasingly use social media networks like Facebook, Instagram, LinkedIn, and Twitter as customer service channels. According to Gallimore, the global social media penetration rate is at a high of 49 percent, indicating that businesses want to be more connected to their customers who use such platforms frequently.

He says that social media allows businesses of all sizes to be where their customers are – online. Thanks to the various platforms, companies can have a more personal and seamless experience with their current and potential customers.


Healthcare BPO and other outsourcing sectors are expected to invest more in AI technology to increase productivity and efficiency. According to experts, using AI in conjunction with automation will give those who invest wisely in AI advantage over their competitors.

AI, in particular, can transform the healthcare industry and assist the community in addressing some of its issues and challenges. AI solutions can also help healthcare providers in various ways, including improving patient experiences, increasing access to healthcare services, and improving efficiency in care delivery and outcomes.

See more» Top 5 BPO trends that will dominate the industry in 2022 and the following years

The reason why the healthcare BPO market will continue to grow until 2026 and beyond

One of the primary reasons that many healthcare providers are outsourcing some of their business processes to third-party providers in countries with low operational costs is the need to reduce rising healthcare costs.

Many healthcare outsourcing firms are based in the United States and Canada. According to MarketsandMarkets, North America accounted for nearly half of the market in 2020 and is expected to grow at a CAGR of nearly 11% over the next five years.

Over the last 50 years, total healthcare spending in the United States has risen. According Centers for Medicare and Medicaid Services (CMS), a federal agency that supplies health coverage to over 100 million people, health expenditures increased from nearly $75 billion in 1970 to nearly $4 trillion in 2019.

The coronavirus resulted in a moderate short-term decrease in healthcare spending due to social distancing practices and patients who postponed medical appointments and procedures. With the worst of the pandemic behind us, CMS predicts that healthcare spending will continue to rise until 2028, reaching more than $6 trillion.

Healthcare BPO save your time and money while providing the care your patients deserve.

However, this is not something that can be accomplished overnight.

Before you begin, carefully identify the activities you want to outsource and evaluate your healthcare BPO partner. Once you’ve done that, you’ll have no trouble finding a configuration that works for your company!

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