All work
Claims operations platform
Claims lived in treatment files, spreadsheets, and payer portals; status was whoever remembered. Now one system carries each claim from treatment file to payer acknowledgment to reconciliation.
- Treatment files inchecked on arrival
- Claims builtvalidated per payer before anything leaves
- Submittedthe payer acknowledgment is the evidence
- Trackedevery status visible to every biller
- Reconciledan export that matches the books
- One queueinstead of three tools and a spreadsheet
Before
- A billing company serving twenty-plus provider clients, thousands of claims a month, with a state payer as the primary destination.
- Treatment files arrived from providers, claims were assembled by hand, submitted through portals, and tracked in spreadsheets.
- Whether a claim was batched, submitted, or acknowledged depended on who had touched it last.
What we built
- Treatment-file intake that checks each file on arrival and turns it into claims the payer will accept.
- A claim-building step that validates against payer rules before anything leaves the building.
- Submission with the payer’s acknowledgment recorded as the evidence a claim actually went out.
- A tracker every biller can see, so status is in the system instead of in someone’s head.
- A reconciliation export that matches the books line for line — no re-keying.
What it means day to day
- Billers work from one queue instead of three tools.
- Every claim shows where it is and what it is waiting on.
- Month-end reconciliation is an export, not a project.
1A call2A short look at the real workflow3A fixed price with milestones4Working software every week5Handoff — you own it
How an engagement runsRunning something like this on spreadsheets and memory? Tell me what’s broken.
Call or text (623) 252-4330