Medical Billing & AR · Medical billing & AR company, New Jersey, USA
Recovering $2.4 Million a Year From the Denial Pile
HIPAA-compliant automation across claims, denials and AR for a New Jersey billing company.
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The need
A New Jersey-based medical billing and AR services company serving 60+ independent physician practices across the Mid-Atlantic, handling 120K+ claims per month.
Their denial rate of 14% sat above even the stressed national average, and AR days sat at 47. Staff were working denials reactively, by payer, claim by claim, even though most denials are potentially avoidable.
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The work
- Claims Automation Engine: scrubbing, coding validation and real-time eligibility verification before submission.
- AI-Powered Denial Management: denial prediction scoring, automated appeal drafting and root-cause analytics.
- EHR/EMR Integration: bi-directional connectivity with the practice systems their clients already ran.
- AR Follow-up Automation: worklists prioritised by collectability and timely-filing risk.
- Patient Payment Portal: statements, card-on-file and payment plans.
- Revenue Cycle Analytics Dashboards: denial heat maps by payer, CPT and provider.
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The outcome
- 14% → 6.8% denial rate in 12 months.
- 47 → 31 AR days.
- 96.5% first-pass clean claim rate.
- $2.4M/yr recovered revenue across the book.
In US healthcare, the revenue cycle is the business. The automation made this company's physician clients measurably more profitable.
Based on a client testimonial; details beyond the client's account have not been assumed.