What’s in scope.
The list below describes the standard work breakdown. Every engagement is scoped to client volume, line of business, and platform. Bespoke scope is the default, not the exception.
- 01
Rejection Triage
Front-end rejection categorization by root cause, with automatic rework on the deterministic ~70%.
- 02
Denials & Appeals
Agents draft first-level appeals from documentation; complex appeals escalate to a credentialed reviewer.
- 03
Payment Posting
ERA/EOB parsing, payment posting to AR, contractual adjustment validation, and patient-balance routing.
- 04
Prior Authorization
Status checks, follow-up calls (via TTS), and submission packaging to payer portals.
- 05
Cash Reconciliation
End-of-day cash reconciliation between deposits, postings, and bank feeds. Variance escalation on threshold breach.
- 06
Patient Estimation & Out-of-Pocket
Eligibility-aware estimates pre-service; portal nudges and payment-plan routing post-service.