Healthcare Revenue Cycle Management

Healthcare Revenue Cycle Management, Built Around Accuracy and Results.

About Our Company

Your Trusted Revenue Cycle
Management Partner

Healthcare organizations face increasing challenges in managing their revenue cycle efficiently. From accurate medical coding and timely claim submission to insurance follow-up and denial resolution, every stage of the revenue cycle directly impacts financial performance.

We help healthcare organizations address these challenges by providing specialized RCM services through experienced teams and structured processes.

With 5+ years of experience in the RCM industry, we understand the critical importance of accuracy, turnaround time, quality, productivity, and consistent follow-up across every claim encounter.

Accuracy Turnaround Time Quality Productivity Consistent Follow-Up

We work closely with clients to understand their unique operational requirements and develop customized workflows that align directly with their business objectives.

Our Guiding Objective

“Helping Healthcare Providers Improve Their Revenue Cycle While Focusing on Patient Care.”

Our dedicated teams take ownership of complex revenue operations, allowing clinicians and administrative leadership to concentrate on delivering care.

The Revenue Reality

Revenue Doesn't Stop
at the Patient.

Every healthcare encounter triggers a complex operational chain. Claims move through multiple stages — and at any point, an issue can stall or deny revenue.

Core Capabilities

Three Core Capabilities.
One Connected Revenue Cycle.

01

Medical
Coding

Accuracy at the Foundation
of Your Revenue Cycle

From complex diagnosis codes to surgical and specialty procedures, our certified coding team ensures every clinical encounter is coded accurately, validated, and claim-ready before billing begins.

Clinical Documentation
ICD / CPT / HCPCS
Validation
Clean Claim
  • ICD-10-CM & CPT Coding
  • HCPCS Level II
  • E/M & Physician Coding
  • Outpatient & Inpatient Coding
  • Surgical & Specialty Coding
  • Coding Audits & Chart Review
  • Pre-Billing & Denial Coding Review
02

Medical
Billing

Efficient Billing From Charge Entry
to Payment

Our billing team manages every step — from demographic verification and eligibility through charge entry, claim submission, ERA processing, and payment posting — so your revenue cycle operates with speed and precision.

  • Patient Demographic & Eligibility Verification
  • Charge Entry & Claim Creation
  • Electronic Claim Submission
  • Claim Status Monitoring
  • ERA/EOB Processing & Payment Posting
  • Denial Identification & Resubmission
  • Insurance Follow-Up & Reporting
03

Accounts
Receivable
Calling

Turning Outstanding Receivables
Into Resolved Accounts

Our AR team systematically identifies, prioritizes, and pursues outstanding claims — tracking each account through the aging cycle until every recoverable balance is resolved.

01Identify
02Prioritize
03Contact
04Investigate
05Resolve
06Document
  • Systematic AR Account Review
  • Payer-Specific Follow-Up
  • Denial & Rejection Management
  • Payer Communication & Appeals
  • AR Aging Prioritization
  • Resolution Documentation
End-to-End Process

From Patient Registration
to Payment Resolution.

The healthcare revenue cycle is a continuous, interconnected journey. Every stage directly impacts the next.

01

Patient Registration

Front-End RCM

Capturing accurate demographic, insurance, and guarantor data at the point of care to prevent downstream claim rejections.

Demographics Data Validation
02

Eligibility & Benefits Verification

Front-End RCM

Real-time confirmation of active coverage, co-pays, deductibles, and prior authorization requirements before service delivery.

Coverage Check Prior Auth
03

Medical Coding

Mid-Cycle RCM

Certified coders assign accurate ICD-10-CM, CPT, and HCPCS Level II codes with appropriate modifiers following strict compliance standards.

ICD-10-CM CPT Modifiers
04

Charge Entry

Mid-Cycle RCM

Translating coded medical encounters into billable charges with fee schedule validation and scrubbing for completeness.

Fee Schedules Charge Scrubbing
05

Claim Submission

Back-End RCM

Electronic transmission of HIPAA-compliant 837 claim files to clearinghouses and commercial/government payers with 98%+ first-pass target.

EDI 837 Clearinghouse
06

Claim Status Monitoring

Back-End RCM

Active 276/277 electronic status tracking to identify pending, received, or rejected claims immediately upon payer processing.

EDI 277 Status Tracking
07

Payment Posting

Back-End RCM

Posting electronic remittance advice (ERA 835) and manual EOBs with accurate contractual write-offs, deductibles, and secondary balance routing.

ERA 835 EOB Reconciliation
08

Denial Management

Resolution

Root-cause categorisation of CARC and RARC rejection codes followed by targeted correction, clinical appeals, and resubmissions.

CARC / RARC Appeals
09

AR Follow-Up & Calling

Resolution

Systematic payer follow-up phone calls and portal inquiries on aged claims 30+ days to expedite adjudication and overcome delays.

Payer Calling Aged Claims
10

Payment Resolution

Finalization

Final balancing and zero-balance account closure once all primary, secondary, and patient responsibility balances are collected.

Zero Balance Reconciliation
11

Reporting & Performance Analysis

Intelligence

Comprehensive executive dashboards reporting DSO, Clean Claim Rate, denial rates, and actionable revenue cycle intelligence.

Executive KPIs Continuous Insights
AR Aging Intelligence

Every Unresolved Claim
Has a Story.

Unresolved claims age rapidly. Systematic segmentation and prioritized pursuit turn aged balances into recovered revenue.

Prioritization Matrix

Accounts are dynamically prioritized for investigation based on multi-variable risk scoring:

  • Aging Bucket 0-30 | 31-60 | 61-90 | 91-120 | 120+ Days
  • Claim Dollar Value High-Value Balance Prioritization
  • Payer Category Commercial, Medicare, Medicaid Rules
  • Denial Code Type Auth, Timely Filing, Medical Necessity
  • Recovery Probability Statistical Likelihood of Collection

Timely Filing Vigilance

Strict adherence to payer-specific appeal windows to eliminate preventable write-offs caused by filing expiration.

Specialized Calling Representatives

Trained AR callers proficient in navigating complex payer IVR systems and representative negotiations.

Root-Cause Feedback Loop

Insights from unresolved accounts are fed directly back into front-end registration and coding workflows to prevent future denials.

Operations & Technology

People. Process. Technology.

Codexperia utilizes technology-enabled workflows and centralized tracking systems to streamline operations.

Claim Tracking & Status

End-to-end tracking of every claim from initialization through clearinghouse acceptance to adjudication.

Work Queue Management

Intelligent task distribution ensuring specialist attention on critical denial batches and urgent AR.

AR Monitoring Engine

Automated aging triggers that flag accounts as they approach critical aging threshold milestones.

Denial Intelligence

Systematic tracking of payer remittance codes to isolate recurring error patterns across providers.

Productivity & Quality Reporting

Granular audits tracking coder accuracy rates, claims processed per hour, and resolution milestones.

Process Analytics

Executive oversight into cash flow acceleration, days in AR, and gross-to-net collection metrics.

Quality Assurance

Quality Isn't a Final Check.
It's Built Into the Process.

A closed-loop quality management system that drives continuous operational refinement across every encounter.

STEP 01

Specialized Training

Rigorous onboarding on client-specific billing guidelines and payer rules.

STEP 02

Process Understanding

Detailed mapping of clinical documentation workflows and specialty protocols.

STEP 03

Production Execution

High-precision coding, entry, and claim creation by dedicated team pods.

STEP 04

Quality Auditing

Independent internal audits reviewing random and high-dollar sample encounters.

STEP 05

Error Identification

Instant flagging of discrepancies, missing modifiers, or charge mismatches.

STEP 06

Root-Cause Analysis

Deep dive to determine if errors stem from documentation, policy, or entry.

STEP 07

Corrective Action

Immediate remediation, feedback sharing, and targeted refresher modules.

STEP 08

Continuous Improvement

Refined standard operating procedures to permanently eliminate recurring errors.

Performance Metrics

What Gets Measured
Gets Improved.

Key operational performance indicators monitored systematically across every engagement.

Medical Coding KPIs

Accuracy
  • Coding Accuracy Rate
    99%+ Target
  • Charts Processed / Hour
    High Yield
  • Turnaround Time (TAT)
    < 24h Target
  • Internal Quality Audit Score
    Audited
  • Error / Discrepancy Rate
    < 1% Target

Medical Billing KPIs

Speed
  • First-Pass Clean Claim Rate
    98%+ Target
  • Submission Turnaround
    Daily Batch
  • Clearinghouse Rejection Rate
    Minimized
  • Charge Entry Accuracy
    Verified
  • Payment Posting TAT
    Same-Day

AR Calling KPIs

Recovery
  • Total Accounts Worked
    100% Queue
  • Payer Calls Completed
    Active Dial
  • Follow-Up Productivity
    Monitored
  • Days in AR (DAR) Trend
    < 35d Target
  • Aged Balance Resolution Rate
    Maximized

Denial Management KPIs

Resolution
  • Initial Denial Volume
    Downward
  • Denials by Category (CARC)
    Classified
  • Clinical Appeal Volume
    Prioritized
  • Appeal Overturn Success Rate
    High Rate
  • Recurring Denial Reductions
    Continuous
Why Codexperia

Built on Accuracy,
Process & Reliability.

Delivering consistent healthcare revenue cycle management backed by deep operational expertise.

5+ Years

RCM Industry Experience

Proven operational background navigating evolving healthcare regulatory landscapes and payer billing mandates.

Expert

Dedicated Specialists

Certified medical coders, billing analysts, and seasoned AR calling professionals assigned to your accounts.

Quality

Process-Driven Operations

Multi-tier audit checkpoints and standardized operating procedures embedded into every encounter.

Speed

Rapid Turnaround

Swift claim creation, electronic filing, and proactive AR follow-up to shorten revenue turnaround cycles.

Confidential

Data Security Protocols

Robust access controls, secure communications, and rigorous compliance with healthcare data protection standards.

Scalable

Flexible Engagement Models

Seamlessly scale operational capacity to accommodate volume growth or target backlogged claims.

Our Methodology

Understand. Analyze. Implement.
Monitor. Improve.

A continuous 5-stage framework designed for long-term revenue optimization.

01

Understand

Assessing current revenue workflows, payer mix, billing challenges, and target deliverables.

02

Analyze

Evaluating historical claim denial patterns, process bottlenecks, and aging accounts.

03

Implement

Deploying dedicated specialist teams, standard operating protocols, and reporting cadences.

04

Monitor

Real-time daily auditing of claim accuracy, submission speed, and productivity milestones.

05

Improve

Translating audit insights into preventive upstream improvements and feedback.

Who We Serve

Supporting Healthcare Providers
Across the Care Spectrum.

Tailored revenue cycle solutions adapted to specific provider environments and operational models.

Hospitals & Health Systems
Physician Practices
Medical Groups
Specialty Practices
Outpatient Clinics
Ambulatory Providers
Independent Healthcare Providers
Healthcare Organizations
Data Governance

Trust Is Built Into Every Process.

Protecting sensitive patient data and ensuring confidentiality through structured administrative and technical controls.

Controlled Role-Based Access

Strict least-privilege permissions restricting data visibility strictly to authorized billing and coding personnel.

Confidentiality Protocols

Comprehensive non-disclosure agreements, clean-desk standards, and secure operating environments.

Secure Information Handling

Encrypted data transfer protocols and secure client portal integrations for document sharing.

Employee Compliance Training

Regular recurring employee training on healthcare data privacy, security best practices, and risk mitigation.

Get in Touch

Have an RCM Challenge?
Let's Talk.

Whether you need dedicated medical coding support, full-service billing, denial management, or targeted AR follow-up, our experienced team is ready to deliver measurable results.

Request a Consultation Contact Us
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