Revenue Cycle Assessment Services

The issuing government authority in Nevada is seeking a vendor to conduct a comprehensive, enterprise-wide assessment of its revenue cycle processes, covering both the Hospital and Professional lines of business. The agency needs to identify inefficiencies, risks, and opportunities to improve financial performance and operational efficiency. The selected vendor will deliver a roadmap with actionable strategies based on this assessment. The scope of work requires conducting interviews with stakeholders across multiple departments, including patient access, health information management, patient financial services, screening providers, acting physician advisors, and case management. The project covers reviewing workflows for case management, utilization management, payer contracts, supply chain, patient access, health information management, patient accounting, and revenue integrity. The agency is also asking for an analysis of performance indicators such as discharge planning, supply chain controls, accounts receivable days, Case Mix Index, denial rates, net revenue, pre- and post-bill denial data, status downgrades, and billing data. The vendor must evaluate systems, tools, and integration capabilities to identify root causes of revenue leakage and compliance concerns. The agency requires benchmarking of staff performance and staffing ratios, as well as the establishment of metrics, reporting, and dashboards to sustain its Clinical Documentation Improvement program and denials management enhancements. The scope also includes implementing and supporting proprietary software technologies to enhance Clinical Documentation Improvement efforts, analyzing medical necessity documentation, and reviewing clearinghouse operations and claim submission workflows. Eligible bidders must be onshore organizations based in the United States. The agency requires the performance of the work to be conducted onsite. Bidders may submit their responses digitally via email or through an online portal. The agency has not disclosed a specific budget and is looking for proposals to determine the cost. Bidders must submit all questions regarding this opportunity no later than October 06, 2025.