Healthcare Back-Office BPO
Non-clinical operations for health systems and revenue cycle organizations.
Medical billing, coding, prior authorization, RCM analytics, patient access, and HIM support operated from our delivery centers. HIPAA-ready posture, BAA available.
What this is
We run the non-clinical operations that determine whether a health system collects what it earned. Coding accuracy, denial management, prior auth turnaround, and patient access velocity are the levers, and they all benefit from operational discipline.
What we deliver
The work, itemized.
- 01
Medical billing and coding (CPC and CCS credentialed)
- 02
Prior authorization processing with payer-specific workflows
- 03
Patient access and scheduling support
- 04
RCM analytics and reporting
- 05
Health information management and records support
Who it is for
Regional health systems, multi-specialty groups, RCM firms, and ambulatory networks looking to scale back-office capacity without expanding their domestic headcount.
Engagement-type
- MSP
- Uitbesteed Team
- Project / SOW
How the engagement runs
What we own. What you own. What you get back.
01
Workflow assessment
- We own
- Process mapping, denial root-cause analysis, payer mix review
- You own
- Access to billing system, denial reports, payer contracts
- Duration
- 2 weeks
- Deliverable
- Current-state report with prioritized intervention list
02
Credentialing and provisioning
- We own
- Coder credential verification, billing system access setup, BAA execution
- You own
- Access provisioning approvals, BAA counter-signature
- Duration
- 1 to 2 weeks
- Deliverable
- Operationally ready team with documented credentials
03
Pilot batch
- We own
- Live coding or billing on a defined volume, daily QC
- You own
- Daily review of pilot output, escalation calls
- Duration
- 2 weeks
- Deliverable
- Pilot QA report and approval to scale
04
Scale-up
- We own
- Ramp to target volume, denial-management workflow live
- You own
- Approval of any process changes that affect your downstream systems
- Duration
- 2 to 4 weeks
- Deliverable
- Steady-state throughput with weekly metrics
05
Continuous improvement
- We own
- Monthly metrics, payer-mix-specific tuning, training updates
- You own
- Quarterly business review, scope changes
- Duration
- Continuous
- Deliverable
- Monthly clean-claim rate, DSO, and denial-resolution metrics
Recent engagement
Lifted clean-claim rate from 78% to 94% in four months.
A 12-location specialty group practice had a clean-claim rate of 78% and DSO of 56 days. We took over coding, claim scrubbing, and denial management. Within four months clean-claim rate reached 94% and DSO fell to 38 days.
- Clean-claim rate
- 78% to 94%
- DSO (days)
- 56 to 38
- Time to stable state
- 4 months
FAQ
Questions buyers ask.
Are your coders certified?
Yes. CPC certification is standard. CCS is available on demand for inpatient and outpatient hospital coding.
What is your HIPAA posture?
HIPAA-ready. BAA available on request. Workforce trained on HIPAA, ePHI handling, and incident response. SOC 2 Type I is on our roadmap, targeted to coincide with our first health-system client engagement.
Do you work with our existing billing system?
Yes. Epic, Cerner, Athenahealth, Allscripts, NextGen, eClinicalWorks, and AdvancedMD are standard. Other systems on request, plus we work with clearinghouses including Availity, Waystar, and Change Healthcare.
How do you handle denials?
Denial root-cause analysis on every denied claim, with appeal-letter generation for legitimate reversals and process correction for upstream issues. Weekly denial trend report.
What is the minimum engagement size?
Five FTE equivalents of throughput, roughly $40k in monthly fees. Below that, project-based engagements for backlog clearance are a better fit.
Related services
Pair this with.
Compliance Ops
Regulatory work runs on a clock. We are on the clock.
KYC, AML, audit support, SOX testing, vendor due diligence, and regulatory reporting operations staffed from our delivery centers. Daily SLAs, monthly metrics.
RPO
We run hiring at scale. You focus on the business.
Embedded recruiters, sourcing capacity, and offer-management operations delivered from our global footprint, billed against agreed throughput rather than your headcount.
Healthcare Back-Office BPO. Built to your scope.
Send us the brief. We respond within 48 hours with a worked plan, an indicative price, and a named team.