Healthcare Provider and Payer Industry Solutions

Healthcare Provider and Payer Industry Solutions

Industry Experience

Healthcare organizations are constantly challenged by industry-wide reform initiatives as well as their need to grow and profit while complying with a wide range of complex and rapidly changing regulations. Whether your top concern is payment reform, regulatory compliance, improving revenue, managing costs, evaluating and safeguarding protected health information, or leveraging new technology, Protiviti brings deep industry knowledge and skill to help healthcare organizations manage risks and maintain their financial health. At Protiviti, our teams of dedicated healthcare professionals work with a variety of healthcare providers and payers including large multi-hospital health systems, community hospitals, post-acute delivery systems, physician-owned hospital management companies, managed service organizations, Medicare Advantage plans and other private healthcare insurance payers.

Healthcare Providers

Protiviti’s professionals assist healthcare providers with managing reimbursement risks and improving technology, privacy, compliance, finance and revenue cycle efficiency and effectiveness, resulting in improved operational performance and lower costs.

The healthcare industry continues to face intense regulatory demands at a time when revenue is decreasing and expenses are increasing. To respond to the pressure to improve access, quality and efficiency, under these financial constraints, healthcare providers must engage in risk assessment and management. Service quality, revenue cycle and regulatory compliance effectiveness are central to the viability and success of providers, regardless of size. Also notable is the implementation of electronic health record and enterprisewide integrated information systems, which is sorely needed and strongly advocated by related industries.

Protiviti’s team of industry experts understands the challenges faced by healthcare providers.

Our professionals help providers achieve growth and profitability through effective risk management in the following areas:


  • Reimbursement
  • Revenue Cycle and CDM/Charge Capture
  • Finance Transformation
  • Cost Reduction and Supply Chain
  • Capital Projects and Construction
  • Internal Audit
  • Regulatory Compliance
  • Security and Privacy
  • Technology
  • Electronic Health Record (EHR) Implementation Risk Management

    Healthcare Payers

    Protiviti’s professionals partner with healthcare payers to manage risk and improve the efficiency and effectiveness of their operations and compliance activities.

    From members, employers and providers to regulators and investors, healthcare payers have to delicately balance the competing demands of their many stakeholders to succeed. They must develop and deliver innovative solutions and seamlessly manage a business that involves frequent change. And they must identify and manage the business risks associated with this dynamic environment.

    At Protiviti, we are in the business of developing and delivering innovative solutions. We know how to manage change effectively and efficiently. And we are leaders in risk management. We partner with our health plan clients to bring deep skills and proven methodologies to bear on the problems that matter. In doing so, we help our clients gain a competitive advantage and satisfy the competing demands of their many stakeholders.

    Information and Data: We understand the criticality of information, as well as the systems necessary to accumulate, manage and report massive amounts of data. Our capabilities allow us to bridge the gap between information technology (IT) and the business to make improvements in areas such as Project Governance, Performance Metrics and Analytics, IT Organizational Effectiveness, and Information Security and Privacy.

    Governance, Compliance and Risk: Effective communication and oversight are essential in meeting stakeholder demands. Protiviti has the methodologies, tools and capabilities to help make incremental improvements in areas including Internal Audit, Regulatory Compliance, Enterprise Risk Management, and Model Audit Rule or Sarbanes-Oxley Compliance.

    Operations and Finance: As a health plan’s products and services evolve, so too must the processes that support the business. We offer a wide variety of solutions in areas such as Financial Process Optimization, Revenue Recognition and Reconciliations, Spend Analysis and Procurement Streamlining, and Claims Cycle Effectiveness.


    Susan Haseley (Dallas)
    Managing Director, Global Industry Lead
    [email protected]

    Richard Williams (Dallas)
    Managing Director, Central Region Lead and Provider Solutions Lead
    [email protected]

    Alex Robison (Phoenix)
    Managing Director, West Region Lead
    [email protected]

    William Thomas (Tampa)
    Managing Director, East Region Lead
    [email protected]



    Ready to work with us?