Claims Management
Track claims from creation and submission through payer response, payment, rejection, or denial.
Services
Revenue Cycle Services
EncounterOps provides healthcare organizations with structured operational support across the revenue cycle.
Service overview
Support across the work surrounding reimbursement.
Engagements can focus on one workflow or coordinate multiple stages of the revenue cycle.
Medical Billing
Structured billing workflows designed to support timely claim submission, follow-up, and clear accountability.
Medical Coding
Coding support focused on documentation alignment, applicable guidance, and disciplined quality review.
Denial Management
Categorize denials, prioritize follow-up, address eligible items, and identify recurring root causes.
Accounts Receivable
Structured review and follow-up for outstanding balances and aging claims across the A/R lifecycle.
Eligibility & Verification
Support insurance eligibility and benefits-verification workflows before services are billed.
Payment Posting
Organized posting and reconciliation workflows that support accurate account records.
Revenue Cycle Review
Assess denial patterns, A/R aging, documentation gaps, and operational bottlenecks.
Capabilities
Define the scope around your operating needs.
Responsibilities, systems, access, security requirements, staffing, and reporting expectations are established during discovery.
- Charge and claim workflows
- Claim submission support
- Claim-status monitoring
- Billing workflow management
- Payer follow-up
- Professional coding support
- ICD-10-CM, CPT, and HCPCS
- Modifier review
- Documentation-to-code alignment
- Coding quality review
- Denial categorization
- Root-cause analysis
- Follow-up prioritization
- Corrected-claim and appeal-support workflows
- Denial trend reporting
- A/R aging review
- Follow-up prioritization
- Outstanding-claim tracking
- Payer follow-up
- Revenue-recovery workflows
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Claims Management
- Claim creation and submission tracking
- Rejection and denial status
- Payer response monitoring
- Payment or follow-up disposition
- Operational reporting
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Eligibility & Benefits Verification
- Coverage verification support
- Benefits-information workflows
- Pre-service exception identification
- Clear responsibility and documentation
- Escalation of unresolved items
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Payment Posting
- Payment and adjustment posting
- Account-level reconciliation support
- Exception identification
- Organized records
- Handoff to denial or A/R workflows
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Revenue Cycle Assessment
- Denial pattern review
- A/R aging analysis
- Workflow bottleneck identification
- Coding and documentation observations
- Operational improvement priorities
Medical coding services are available when appropriately qualified personnel are assigned. Coding follows applicable coding, payer, and client requirements and does not guarantee coverage or reimbursement.
Engagement models
Pricing built around your workflow.
Pricing depends on scope, claim volume, specialty, payer mix, systems, staffing, and the services required.
Percentage of collections
Fixed monthly fee
Per-claim pricing
Project-based pricing
Denial or A/R engagements
Request a Custom Proposal Expanding Healthcare Operations Capabilities
Building toward a broader healthcare operations platform.
EncounterOps is being built as a broader healthcare operations company, with future capabilities planned around clinical documentation, records processing, healthcare data operations, and technology-enabled workflow support. These are planned areas and are not currently presented as active services.
- Clinical documentation review
- Chart abstraction
- Medical-record processing
- Healthcare data services
- Documentation analytics
Start with the workflow that needs attention.
We’ll define the operational need, available information, responsibilities, and a practical scope before work begins.