Our workflow transforms complex revenue cycle management into a repeatable, auditable system. Each phase has clear ownership, SLA commitments, and quality checkpoints.
1
Patient Intake & Eligibility Verification
Owner: Front-End Team
SLA: 2 hours from patient registration
We verify insurance coverage in real time, confirm benefits, and flag authorization requirements before services are rendered. This prevents denials at the source.
Audit Checkpoint: 100% verification rate within business hours
2
Encounter Documentation Review
Owner: Clinical Documentation Specialists
SLA: 24 hours post-encounter
Our team reviews clinical notes for completeness, medical necessity, and compliance. Missing data is flagged for provider clarification before coding begins.
Audit Checkpoint: Documentation quality score ≥ 95%
3
Professional Medical Coding
Owner: Certified Coders (CPC, COC)
SLA: 48 hours from documentation approval
We apply ICD-10, CPT, and HCPCS codes with precision, ensuring every claim reflects the highest appropriate reimbursement while remaining audit-proof.
Audit Checkpoint: Monthly coding accuracy audit ≥ 98%
4
Claim Scrubbing & Submission
Owner: Claims Operations
SLA: Same-day submission after coding
Every claim passes through automated and manual scrubbing to catch errors before submission. We submit electronically to clearinghouses for immediate tracking.
Audit Checkpoint: Clean claim rate ≥ 98.6%
5
Payment Posting & Reconciliation
Owner: Payment Processing Team
SLA: 24 hours from remittance receipt
We post all payments, contractual adjustments, and patient balances with precision. Each EOB is matched to the claim, and discrepancies are escalated immediately.
Audit Checkpoint: Zero unposted remittances > 48 hours
6
Denial Management & Appeals
Owner: Denial Resolution Specialists
SLA: 5 business days from denial
We categorize every denial, identify root causes, and submit appeals with clinical documentation. Our goal is to overturn 70%+ of initial denials within 30 days.
Audit Checkpoint: Appeal success rate ≥ 70%
7
Accounts Receivable Follow-Up
Owner: AR Recovery Team
SLA: Weekly aging review, 30-day touch cycle
We work unpaid claims systematically, contacting payers and patients to resolve outstanding balances. Every account is tracked until collected or written off with your approval.
Audit Checkpoint: AR > 90 days < 15% of total
8
Analytics & Performance Reporting
Owner: Revenue Cycle Analysts
SLA: Monthly dashboard + quarterly strategic review
You receive real-time dashboards showing KPIs: clean claim rate, days in AR, collection ratio, denial rate by payer, and more. We turn data into actionable insights.
Audit Checkpoint: 100% data accuracy, monthly review cadence