RCM Automated Claims Processing Case Study

Driving Exceptional Revenue Growth Through Intelligent Automation

Business Problem:

A leading Revenue Cycle Management (RCM) company faced significant operational inefficiencies limiting its revenue potential. The company’s slow and cumbersome claims processing caused frequent delays, negatively impacting cash flow and staff productivity. Furthermore, its inadequate processes failed to capture all collectible revenue, leading to lost income. The company also suffered because employees spent excessive time manually gathering claims and payment (835) data from various sources, introducing errors and increasing delays.

Our Strategic Solution:

Recognizing the critical need for transformation, Proactive stepped in to create a comprehensive, customized automation strategy designed specifically for the client’s needs. We implemented robotic process automation (RPA) to automatically and accurately collect 835 and claims data from multiple external sources, eliminating extensive manual efforts. This automated solution seamlessly integrated data into a centralized, real-time data warehouse, offering immediate insights into claims statuses and revenue metrics. To further amplify productivity, Proactive introduced a robust, tailored work queue system that optimized claim prioritization and generated organized daily task lists for employees, ensuring efficient and error-free workflow management.

Exceptional Results:

Our targeted intervention delivered remarkable improvements, transforming the client’s operational and financial performance:

• 40% Increase in Claims Collections: Faster and more accurate claims processing directly boosted revenue capture.
• 200% Productivity Surge: Automating manual tasks allowed employees to focus on strategic, high-impact activities.
• 30% Reduction in Denials: Enhanced data accuracy drastically cut down claim rejections.
• $1 Million Revenue Growth: The client experienced a significant financial uplift within just 8 months of implementing our solution.

Example Timeline:

• Phase 1: Process Audit & Strategy Design (2 weeks): Evaluate manual claims workflows and define automation objectives.
• Phase 2: RPA Development & Data Integration (6 weeks): Build bots to collect 835 and claims data; centralize in real-time data warehouse.
• Phase 3: Work Queue System Implementation (4 weeks): Design and deploy task prioritization engine with automated daily workflows.
• Phase 4: Optimization & Monitoring (ongoing): Tune automation workflows and monitor impact on collections, productivity, and denial rates.

Outcome:

The client experienced a significant financial uplift within just 8 months of implementing our solution.