Healthcare — Revenue Cycle · Managed Services
Clean-Claim Rate Lift for Multi-Specialty Clinic
Carenox charge-entry & claim-scrub pods with payer-edit playbooks, AQL QA, and rejection-recovery windows. Clean-claim rate and first-pass yield moved quickly without EMR disruption.
- Defect taxonomy by payer and claim type with examples
- Rejection queue SWAT: 24–48h recovery SLA
- Evidence tiles linking edits to policy and corrections
Clean-claim rate +11.8 ptsFirst-pass yield +9.1 ptsRejection TAT ≤ 48h
Read MoreHealthcare — Patient Access · Hybrid
Prior Authorization Turnaround & Approval Uplift
Centralized prior-auth desk with coverage grids, payer-specific checklists, and escalation macros. Visibility improved, denials trended down, and surgical schedule risk dropped.
- Payer-specific checklists & clinical-criteria prompts
- Escalation matrix with time-boxed callbacks
- Capacity model by interval aligned to clinic booking
Median auth TAT −32%Approval rate +7.4 ptsDay-of-surgery cancels −41%
Read MoreHealthcare — Revenue Integrity · Consulting
Denials Reduction via Root-Cause Program
Four-week diagnostic, then a pilot on top denials. Introduced denial-code→cause mapping, worklist rules, and appeal templates. Handover package enabled client scaling without us.
- Denial Pareto with preventable vs unpreventable split
- Appeal templates mapped to policy with evidence
- Definition locks for dashboard tiles to prevent drift
Preventable denials −27%Appeal win rate +12.2 ptsDays in AR −8.5%
Read MoreHealthcare — AR Follow-Up · Managed Services
30/60/90+ AR Aging Recovery
Dedicated AR follow-up pods with payer sequencing logic, high-dollar lane, and claim lifecycle notes. Backlog burned down while keeping current clean.
- Lane design: high-dollar, near-statute, and re-work guardrails
- Call-documentation macros & callback cadence
- QA sampling to verify evidence completeness
Aging >90 days −19.6%Collections yield +13.3%Touch rate +22% with stable adherence
Read MoreHealthcare — Coding Accuracy · Consulting
Coding Quality & Audit Readiness
Built a coding QA program with defect classes (NCCI, modifiers, LCD/NCD), reviewer calibration, and coaching notes tied to exemplars. Audit findings trended down.
- AQL targets by specialty and visit type
- Calibration sessions & drift checks with examples
- Training records version-linked to SOP changes
Coder QA pass rate +10.5 ptsRework −23%External audit findings −31%
Read MoreHealthcare — Front-End RCM · Staffing
Eligibility & Benefits: Real-Time Checks and Exceptions
Front-end team standardized eligibility/benefits checks with payer APIs and exception queues. Reduced downstream denials and patient billing confusion.
- Real-time eligibility integration where available
- Exception rules with same-day resolution targets
- Patient-responsibility estimate macro updates
Front-end exception TAT same-day 92%Eligibility-related denials −18%Patient billing escalations −21%
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