RCM Eligibility Module
Automated Insurance Verification & Duplicate Prevention — Standalone eligibility verification module featuring scheduled batch verification, pre-verification caching, and prior-authorization duplicate prevention.
Problem Statement
Manual patient eligibility checks consumed 15–20 minutes of front-desk morning roster preparation every single day. Patient arrivals were delayed by live verification queries, and duplicate prior-authorization filings caused wasted administrative effort.
Architecture & Verification Flow
Engineered an overnight batch verification queue and pre-verification cache that queries payer clearinghouses ahead of time. Designed duplicate-detection logic to track active prior-authorizations and flag renewals automatically.
Business Outcome
Achieved instantaneous <3 second front-desk check-in responses, eliminated manual morning roster checks, and routed routine clearances automatically, liberating front-desk staff to focus on exception handling.