Payment Integrity (PI) Portal
Project Overview
Healthcare providers responding to payment integrity audit requests navigated old, disconnected and fragmented systems. I led the UX efforts to design Optum’s Payment Integrity Portal, a centralized web platform that replaced paper and fax-heavy audits. Providers can submit documents and track audits in one place, reducing effort, frustration, and turnaround time.
The Problem: Siloed, Fragmented, Painfully Manual Audit Processes
Research & Insight
Through initial discovery, pilot feedback, and hospital workflow validation; we uncovered a few major pain points:
Multiple Disjointed Systems: Providers had to juggle numerous payer-specific portals, paper letters, faxes, and emails for different audits. Billing specialists frequently logged into four different insurer websites just to keep track of audit record requests.
Cumbersome, Slow Workflows: Staff printed records from Electronic Health Records (EHR) and mailed or faxed them back, leading to weeks of delay, lost faxes, illegible scans, and exhausting manual workarounds.
The "Information Black Hole": Once records were sent, providers had no visibility, confirmation, or status updates, forcing them to chase updates via support hotlines and causing high anxiety over potential missed deadlines.
High Provider Abrasion: The sheer complexity and slowness created administrative burnout and delayed cash flows for providers, while internal Optum teams were flooded with constant support calls.
Problem: Fragmented, Manual Audit Processes
The audit-response workflow for providers was fragmented and manual, leading to major pain points:
Too many systems: Providers juggled multiple payer portals, paper letters, and faxes for different audits, with no unified view.
Slow, labor-intensive process: Mailing or faxing records took weeks and lots of staff time; many resorted to repeat faxes or long phone calls to confirm receipt.
No status visibility: After sending documents, providers received no updates or feedback. They were left in the dark on whether records were received or if further action was needed.
Frustration and delays: This inefficient process caused provider abrasion (stress, burnout) and delayed claim payments, as audits could stretch 30–90 days or more.
We planned and facilitated three research rounds spanning discovery, pilot feedback, and hospital workflow validation. Interviews and prototype walkthroughs with billing specialists, managers, and facility staff revealed consistent needs for:
Consolidation: One place to manage requests across participating payers.
Confidence: Clear upload confirmations and access to submission history.
Transparency: Understandable statuses, deadlines, and next steps.
Efficiency at scale: Tools to prioritize large workloads without relying on spreadsheets.
UX Frameworks & Strategic Alignment
To ground our design decisions in human needs, we leveraged core UX frameworks:
Jobs to Be Done (JTBD): We defined key job statements, such as: "When an audit request arrives, a billing specialist needs to submit the required records quickly and correctly, so the claim can be paid without delay." This kept our focused on speed, accuracy, and efficiency.
Empathy Mapping: We mapped provider behaviors, thoughts, and emotions (Say, Think, Do, Feel). This led to our core design principles: "No Black Holes" (guaranteeing constant visibility to eliminate anxiety) and "Respect the User's Time" (cutting out unnecessary clicks and logins).
Feature Mapping & Design Solutions: Connecting User Needs to Product Solutions
Consolidated Audit Dashboard
An at-a-glance homepage lists all open audit cases for a provider across all participating payers in a clear, unified table format.
It provides immediate visibility into key case details including patient name, claim info, request date, status, due date, and payer.
Advanced Filter, Search, and Sort
Flexible filtering tools allow users to slice and dice data by status, payer, or due date, transforming high-volume workload management.
Quick search functionality enables users to instantly find specific cases by patient name or claim number.
Automated "Needs Action" Queue
A dedicated tab (such as "Waiting for Records") acts as an automated to-do list that prominently surfaces cases requiring immediate provider input.
It ensures nothing gets overlooked and allows staff to clear items efficiently as documents are submitted.
Multi-File Digital Upload & Instant Confirmation
Replaces slow faxes and mail with a drag-and-drop digital upload tool supporting common formats (PDF, DOC, JPEG) and large files.
Instantly delivers on-screen and email confirmation with a unique reference number and timestamp to remove uncertainty.
Real-Time Status Tracking & Visual Timeline
Features plain-language status labels (e.g., "Waiting for Records," "Under Review," "Completed – Adjustment Issued") instead of confusing internal jargon.
Includes an end-to-end visual progress timeline marking milestones so users can track audit progress without making phone calls.
Centralized Document Repository
Acts as a single source of truth by securely storing all relevant documents per case, including initial request letters, uploaded files, and closure notices.
Allows users to download historical files anytime for internal reporting, compliance, or appeals.
Proactive Alerts & Notifications
Sends automated email notifications and portal alerts for new audit requests, approaching deadlines, and status changes.
Prevents missed deadlines by matching provider habits and alerting them proactively when action is required.
Integrated Support & Contextual Guidance
Houses a built-in help center with FAQs and a streamlined contact-support feature that auto-attaches relevant claim context.
Feature Mapping & Design Solutions: Connecting User Needs to Product Solutions
Every feature in the PI Portal was intentionally mapped to resolve specific user pain points:
To ensure every design choice was intentional and directly solved provider pain points, our team mapped core product features directly to the primary user needs uncovered during discovery and research. Below are the key features and functionalities built into the PI Portal:
1. Single Sign-On (One-Stop Portal Access)
Providers use a single secure login (One Healthcare ID) to access all audit requests across multiple participating payers.
This consolidates disparate channels into one interface, eliminating the need to juggle multiple website logins, paper letters, and fax numbers.
9. Integrated Support & Contextual Guidance
Houses a built-in help center with FAQs and a streamlined contact-support feature that auto-attaches relevant claim context.
Incorporates helpful tooltips and inline guidance to clarify complex terminology (such as itemized bill requests or IBR).
10. Facility-Scale Batch Processing & Custom Fields
Supports high-volume hospital needs through batch processing features like bulk upload and download capabilities for large attachments.
Tailors the interface with specialized columns and data points—such as patient Member ID and total claim charge amounts—to accommodate complex facility workflows.
11. Built-in Security & HIPAA Compliance
Operates on a secure backend infrastructure meeting strict HIPAA requirements with encrypted data transmission.
Provides providers with a sanctioned, private channel to transmit sensitive Protected Health Information (PHI) with total confidence.
Design Solutions & Key User flows
Uploading Records for an Audit
Uploading documents is done online in one portal, with the ability to attach multiple files in one submission (replacing faxing or mailing pages one by one).
The portal provides instant confirmation (on-screen and email) that documents were received, including a reference number and timestamp.
It clearly lists what documents are required for each request (e.g. specific dates or forms) and shows the due date, so staff know exactly what to gather and by when.
Result: Submitting records now takes minutes instead of days. Providers have peace of mind that files reached the auditor, and they no longer worry about lost faxes or missing info.
Tracking Audit Status and Next Steps
Real-time status updates are displayed for each audit (e.g., “Waiting for Records,” “Under Review,” “Completed”), so users always know the current state without making calls.
Each case has a progress timeline or history (from request opened → documents submitted → under review → outcome) that makes the process transparent.
Providers receive automatic notifications (email alerts or in-app) for status changes – for example, if an auditor requests additional documents or when an audit is completed with results.
Result: Providers always know where each audit stands and what’s next. This transparency reduces anxiety and eliminates most support calls. Staff can confidently pass updates to leadership or physicians because they have up-to-date information at their fingertips.
Managing Multiple Audit Requests (Workload Management) - Providers tracked audits using spreadsheets and calendars, since requests came from different sources
All open audit requests across payers appear in one consolidated dashboard, eliminating the need for manual trackers. Users can see every active case in a single list.
Filter and search tools help organize the workload (e.g., filter by payer or status, sort by due date or dollar amount), so users can prioritize urgent or high-value audits quickly.
A dedicated “Needs Action” queue (e.g., a tab for “Waiting for Records”) highlights audits that require the provider’s attention, ensuring nothing falls through the cracks.
Result: The portal makes it much easier to stay on top of dozens of audits. Billing teams can manage their workflow efficiently, focusing on priority items first. This leads to more timely responses, fewer missed deadlines, and less stress overall, even in high-volume environments.
Feature Mapping: Connecting User Needs to Product Solutions
Design solutions directly addressed the core user needs identified
Need: One-stop access to all audit requests (no multiple logins).
Key Feature: A unified portal dashboard consolidating requests from all payers in one place, so providers use a single secure login and interface
Need: Quick, easy record submission with proof of receipt.
Key Feature: Digital multi-document upload (drag-and-drop) with immediate confirmation and reference number for each submission, replacing fax/mail and uncertainty.
Need: Visibility into status and next steps.
Key Feature: Real-time status indicators and a case timeline, plus email notifications for updates, give providers full transparency on where each audit stands and if any action is needed.
Need: Handle high volumes without missing deadlines.
Key Feature: Dashboard tools like filtering, sorting, and due-date alerts (and a “Needs Action” queue) help users prioritize and manage tasks so that urgent or important cases get attention first and nothing is overlooked.
Need: Reliable support and guidance.
Key Feature: Built-in help (FAQs, tooltips, and a support contact link) and clear in-app instructions at each step (e.g., accepted file types, how to resolve errors) reduce confusion and the need to call for help, building trust in the system.