By role · Billing manager
You are working denials that intake created.
A third of what lands in your queue traces back to something that happened before the claim existed — an authorization nobody watched, a credential that lapsed, a member ID typed twice. You can appeal them all and the same ones arrive next month.
Reviewed with an RCM firm founder. Every billing screen was built against a real billing operation.
Your week
Six things that eat the time you don't have.
None of these are clinical problems. All of them are seams between systems that were never designed to know about each other.
A week a month spent moving 835 lines from a portal into a billing system, one claim at a time.
A clearinghouse rejection tells you a number, days later, and you reconstruct what went wrong.
Appeal windows close quietly. What nobody owned becomes a write-off with extra steps.
A claim paid at eighty percent of contract posts as paid unless something compares it to the contract.
Unsigned notes hold claims, and finding them means asking clinical.
Authorization, credentialing and eligibility failures all land in billing regardless of where they originated.
What changes
Each one, and where it lives.
- Remittance posting
835 imported, matched line by line, payments and adjustments posted in one pass.
- Remittance posting
- Rejections
Scrubbing before submission that highlights the failing field and the reason, in plain language.
- Claim scrubbing
- Denials
A worklist with reason, dollars at risk, appeal deadline and a named owner on every item.
- Denials queue
- Underpayments
Contracted rates loaded per payer, so every remittance is compared to what it should have paid.
- Contracts & rates
- Authorization gaps
Units and expiry visible at booking, so the gap never becomes your problem.
- Prior authorizations
- Patient balances
Calculated from the remittance, collected by link, with plans that run themselves.
- Patient balances
Questions you can finally answer
Four you are probably asked, and cannot answer today.
Claims carry an expected amount and a scrub result, so first-pass rate is a number rather than a feeling.
Claim scrubbingDenials grouped by reason and dollars, which tells you whether the fix is in billing or upstream.
Denials queueEvery remittance line compared against the loaded fee schedule, with variances surfaced.
Contracts & ratesUnsigned encounters are visible with the claim attached, so releases stop being a phone call.
Documentation clockCase study
What this looks like in a real program.
Where to look next
The pages that carry most of this role's week.
Revenue cycle
Claim scrubbing
Validation runs before the claim leaves, highlights the exact field that will get it kicked back, and says why in plain language — not a rejection code you have to look up.
Read more →Revenue cycle
Remittance & bulk posting
Read the ERA, match the lines to the claims, post the payments and adjustments, and route what didn't match to the denials queue.
Read more →Revenue cycle
Denials work queue
Every denial and underpayment lands in a queue with the reason, the dollar amount, the deadline, and the person responsible.
Read more →Revenue cycle
Payer contracts & rates
Contracted rates stored per payer and per service, so the expected payment is on the claim before it goes out and underpayments are visible the moment the remittance posts.
Read more →Get started
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