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RCM Optimization & Denial Reduction Project
Overview
A healthcare organization was experiencing recurring claim denials, delayed reimbursements, increased accounts receivable (A/R), and workflow inefficiencies impacting revenue performance.
I conducted a comprehensive Revenue Cycle Management (RCM) review to identify denial trends, analyze root causes, and implement process improvement recommendations that enhanced claim acceptance and reduced revenue leakage.
Scope of Work:
✔ Denial trend analysis across multiple payers
✔ Root Cause Analysis (RCA) of recurring claim rejections
✔ Workflow and documentation review
✔ Quality audit and compliance assessment
✔ Process improvement recommendations
✔ Revenue recovery opportunity identification
✔ KPI tracking and reporting
Key Actions:
✔ Analyzed denial patterns and rejection reports
✔ Identified workflow breakdowns causing repeat denials
✔ Reviewed claim clinical documentation and payer requirements
✔ Conducted RCA and documented findings
✔ Recommended corrective actions and workflow enhancements
✔ Developed reporting mechanisms for ongoing monitoring
✔ Supported teams with denial prevention strategies
Results & Impact:
✔ Improved claim processing efficiency
✔ Reduced recurring denial trends
✔ Increased first-pass claim acceptance
✔ Enhanced workflow compliance
✔ Strengthened documentation accuracy
✔ Improved revenue recovery opportunities
✔ Reduced rework and operational inefficiencies
Skills Demonstrated:
✔ Revenue Cycle Management (RCM)
✔ Medical Billing & Claims Management
✔ Denial Management
✔ Root Cause Analysis (RCA)
✔ Quality Auditing
✔ Process Improvement
✔ Revenue Recovery
✔ Healthcare Compliance
✔ Reporting & Analytics
Tools & Platforms
athena one
eClinicalWorks (eCW)
Kareo
Epic
Office Ally
Claim Scrubber Tools
Microsoft Excel
Reporting & Analytics Dashboards
Client Value:
By combining denial analysis, audit expertise, and workflow optimization, I helped identify operational gaps, reduce revenue leakage, and improve overall reimbursement performance.
#RevenueCycleManagement
#MedicalBilling
#DenialManagement
#Athenahealth
#AthenaCollector
#ClaimsManagement
#RootCauseAnalysis
#QualityAudit
#RevenueRecovery
#ARFollowUp
#HealthcareConsulting
#ProcessImprovement
#MedicalClaims
#HealthcareOperations
#RCMSpecialist
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