CEOs, CFOs, COOs, RCM leaders, payer/provider operators, and healthcare AI founders
High-level AI solution design for healthcare revenue cycle, prior authorization, claims intelligence, payer/provider workflow, and governed agentic orchestration.
Read the operating briefThe buyer problem
This is the problem leadership must make legible before adding more pipeline, tooling, headcount, or implementation burden.
The organization is surrounded by AI point solutions, but the work still lives across payer rules, portals, EHR data, CRM, RCM queues, documentation, humans, and exceptions. Without a design layer, automation can create more fragmentation.
What gets built
The scope is organized around the artifacts, operating rules, and decision cadence the team needs to keep using after the engagement.
Solution architecture across signal intake, context assembly, agentic work blocks, human review, system action, and proof loops.
RCM and denial-prevention design patterns for eligibility, documentation, coding review, authorization packets, appeals, and underpayment triage.
Prior authorization orchestration model for APIs, portals, payer rules, evidence packets, status monitoring, and escalation.
Governance model that defines where AI can recommend, draft, route, monitor, or score, and where human approval is required.
Measurement spine for cycle time, clean-claim rate, denial prevention, appeal yield, A/R days, access speed, and staff capacity.
Proof patterns
Claims and referral leakage surfaced through claims forensics.
AI-assisted RevOps patterns across lifecycle architecture, scoring, attribution, and revenue-quality reporting.
Payer/VBC and provider-network operating fluency across reimbursement, workflow, access, and value proof.
Decision questions
Which revenue-cycle or access workflow is costly enough and bounded enough to design first?
What evidence sources, rules, exceptions, and approvals must be assembled before action?
Where can AI safely draft, score, route, or monitor without replacing human judgment?
Which proof metric would make the CFO, COO, or founder believe the system is working?
Trust boundary
Connected context
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