TecronixTecronix

Healthcare - Revenue Cycle Management

From patient access and coding to posting, AR follow-up, and appeals-stabilize RCM with staffing or outcome SLAs, QA, controls, and evidence-linked dashboards.

Problems We SolveCapabilitiesStart an RFP
Typical Pain Points
  • Front-end eligibility & authorization errors creating avoidable denials
  • Charge capture and coding backlogs; DRG/HCC accuracy risk
  • Payment posting delays; unapplied/credit balances aging
  • AR follow-up inefficiency by payer class; appeal kits inconsistent
  • Prior-auth and medical necessity requirements changing by payer
  • Fragmented dashboards; no single source for denial taxonomy & trends
Roles We Staff
  • Patient Access: eligibility, benefits, pre-auth, scheduling
  • Charge Entry & Charge Capture QA; Medical Records indexing
  • Coding: ProFee, Facility, HCC, HEDIS abstractions (per scope)
  • Payment Posting & Cash App; credit balance resolution
  • AR Follow-up by payer; Denials/Appeals specialists
  • QA auditors, Trainers, WFM & BI/Reporting analysts
StaffingManaged Services

Outcomes & Examples

  • Clean claim rate ; avoidable denials via front-end QA & checklists
  • Coding accuracy AQL target; backlog burn-down with cycle-time SLAs
  • Cash acceleration: unapplied/credit balances aging
  • AR p90 aging ; overturn % on appeals with standard evidence kits
  • Denial taxonomy & trends visible with drill-to-evidence
  • Audit-ready artifacts aligned to payer/regulatory requirements
Case StudiesCompare Models

Controls & Compliance

  • PHI handling with least-privilege RBAC; JML & quarterly reviews
  • BAA + policy alignment; payer-specific evidence requirements
  • AQL sampling per lane; dual-review for high-risk DRGs/HCCs
  • Change control for payer rules, LCD/NCD, and coding updates
  • Audit trail: who/when/what for claim edits and appeals
Trust CenterIncident ResponseSub-Processors

Tooling Ecosystem

  • EHR/PM: Epic Resolute, Cerner/Oracle, Meditech, NextGen, Athena
  • Clearinghouses & Portals: Availity, Change Healthcare*, payer portals (*replace if needed)
  • Coding: 3M, TruCode, encoder tools; CAC where applicable
  • WFM/QA/Ticketing: ServiceNow/Jira; internal QA consoles
  • BI & Docs: Power BI/Tableau; SharePoint/Confluence evidence

KPIs We Track

  • Clean claim rate; first-pass resolution %
  • DNFB days; coding accuracy AQL; coder productivity
  • Unapplied cash aging; credit balance cycle-time
  • AR aging (p50/p90) by payer; denial overturn %
  • Top denial reasons; avoidable vs. unavoidable mix
  • Audit ask turnaround; definition adherence
Model
Staffing

Patient access, coding, posting, AR follow-up with QA sampling.

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Model
Managed Services

Outcome SLAs (clean claim %, overturn %, aging) with dashboards & evidence.

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Model
Consulting

Diagnostics to design denial taxonomy, appeal kits, and close-the-loop dashboards.

Diagnostics

Accelerate cash. Reduce denials.

Well propose staffing or outcome SLAs for access, coding, posting, AR, and appeals-backed by QA and evidence.

Start an RFPTalk to RCM Lead