RCM Automation Suite (EV • Auth • Claims)
Built multiple internal workflow engines supporting EV, Prior Auth, and Claims operations at scale.
Problem
US healthcare RCM teams run high-volume Eligibility Verification (EV), Prior Authorization, and Claims workflows manually across portals and payer systems. Repetitive data entry, inconsistent validations, and limited retry logic led to slow turnaround and operational bottlenecks.
Solution
Built an internal RCM Automation Suite — multiple workflow engines tailored to EV, Auth, and Claims:
- Automated high-volume workflows across RCM processes
- Standardized validations, retries, and execution checks for stability
- Improved consistency, turnaround time, and operational throughput
Impact: ~40–80% reduction in repetitive effort (varies by workflow)
Approach
- Automated high-volume workflows across multiple RCM processes
- Standardized validations, retries, and execution checks for stability
- Improved consistency, turnaround time, and operational throughput
Stack & Integration
Python and Selenium-based bots with SQL-backed logging, integrated into broader orchestration patterns used across the organization. Workflows align with payer portals and internal RCM tooling used in production operations.