Product Vision

Strategic direction for claims automation and revenue cycle optimization

Mission

To improve revenue cycle performance through automation, AI-driven insights, and standardized workflows that reduce variability and improve first-pass yield.

North Star KPI
Clean Claim Rate

The primary metric that drives all automation and optimization efforts

Supporting KPIs
Key metrics that contribute to overall revenue cycle health
First Pass Acceptance Rate

Percentage of claims accepted on first submission

Denial Rate

Percentage of claims denied by payers

Cost-to-Collect

Average cost to process and collect payment per claim

Touch Time Reduction

Hours saved per claim through automation

Automation Coverage

Percentage of claims processed with automation assistance

Rework Rate

Percentage of claims requiring manual intervention

Strategic Phases
Incremental approach to building comprehensive automation
1
Stabilize → Standardize → Automate → Optimize

Start with claims pre-submission validation, then expand to real-time processing rules

2
Expand automation modules

Build eligibility verification, coding assistance, and pre-submission workflow automation

3
Build ML-powered denial intelligence

Train models on historical patterns to predict and prevent denials before submission

4
Provide unified operational dashboards

Centralized visibility into KPIs, automation performance, and workflow bottlenecks

Key Stakeholders
Teams and roles impacted by automation initiatives
Billing teams

Direct users of claim screening and validation

Coding teams

Benefit from coding guidance and automation

Standardization leaders

Define rules and ensure consistency

Practice administrators

Oversight of revenue cycle performance

Development teams

Build and maintain automation platforms

RCM leadership

Strategic direction and budget allocation