Revenue Cycle (RCM)
Eligibility, charge entry, coding QA, AR follow-up, denials & appeals, underpayment workflows.
Enterprise Healthcare: RCM, Access & Clinical Ops that Scale
Programs for health systems and multi-site groups—built around SLAs, QA, dashboards, and change control. Start with a focused lane (claims or denials) or stand up end-to-end billing and access operations.
Core Capabilities
Patient Access
Scheduling, pre-reg/eligibility, prior auth, referrals, benefits estimates, and financial counseling support.
Clinical Ops Support
HIM requests, chart QA, documentation integrity cues, release of information queues.
Provider Operations
Credentialing & re-credentialing, payer enrollment, directory accuracy, fee schedule updates.
Data & Analytics
Operational dashboards for throughput/quality/reliability, backlog aging, forecast & staffing models.
Controls & Compliance
AQL sampling, defect classes, change control, access reviews, incident response, BAA alignment.
Programs We Run
RCM Throughput & Quality Uplift
Clean-claim improvements, denial reduction, overturn rate lift with evidence-linked QA.
Access Reliability
Hold time/abandon reductions, first-contact resolution, and scheduling accuracy improvements.
Coding Accuracy & Audit
NCCI, LCD/NCD, modifiers; audit plans with feedback loops back to documentation & training.
AR Backlog Recovery
Prioritized worklists by yield & age with payer-matrix playbooks and escalation paths.
Prior Auth Acceleration
Turnaround reduction via templates, checklists, and payer-rule automation opportunities.
Enterprise Dashboards
Single view for SLAs/KPIs with drill-to-evidence tiles and definitions to prevent metric drift.
Method: Assess → Design → Pilot → Scale
- Assess: baselines for TAT, FPY, denial mix, backlog aging, coverage, and access reliability.
- Design: SOPs, SLAs/OLAs, QA rubric (AQL/defects), capacity model, and dashboards with definitions.
- Pilot: 2–4 week lane with success thresholds and rollback; evidence tiles wired to artifacts.
- Scale: tiered huddles, QBRs, continuous improvement, and change control.
We can operate steady-state or transition to your team with clear handoff and controls.
Target Outcomes
- Clean-Claim Rate ↑ and Rejection Rework TAT ↓
- Denial Overturn Uplift with payer-specific playbooks
- Access Reliability: ASA/Abandon ↓, FCR ↑
- Backlog Aging ↓ with predictable burn-down
- Audit-ready evidence and drift-free definitions
Artifacts We Deliver
- Service charter with SLAs/OLAs & metric definitions
- SOPs, QA rubric (AQL/defects), training plan, change control
- Capacity model & coverage grids with surge buffers
- Dashboards with drill-to-evidence tiles
Recent Outcomes
Clean Claim Rate
↑ to 98% with charge entry validation and payer edits tuned to specialty.
Denial Overturns
+27% in two quarters via evidence templates and payer-specific appeals.
Access Reliability
ASA down, abandon ↓, and FCR ↑ after macros and tiered huddles.
Enterprise Healthcare FAQs
Do you work on our EMR/RCM systems?
Yes—most clients have us operate on their stack with least-privilege access and audit trails.
Nearshore/offshore options?
Yes—blended models available where compliant; we always start with a compliance review.
How do you start?
A lane-focused pilot (e.g., claims submission or denials) with success thresholds and rollback.
What do we see weekly?
KPI/defect dashboards, risks & actions, and progress against SLAs and improvement backlog.
Ready to raise RCM and access performance?
We’ll propose a pilot with outcomes, QA, and governance—then scale what works.