Healthcare Revenue Cycle ♾️

Production engineering reference for automating EDI medical-billing claim processing, scrubbing, and the denial/appeal loop — CPT, ICD-10, HCPCS, and ANSI X12 (837/835/277CA), HIPAA-safe Python.

Synthetic healthcare claims (837I/837P) + rules-based adjudicator, with a fidelity scorecard graded against CMS DE-SynPUF

CodeSilver is an ambient AI prototype that translates clinical language into operational healthcare insights using synthetic data and public CMS rules, helping reduce documentation gaps without interrupting clinicians.

SQL-based Healthcare Revenue Cycle & Business Intelligence analysis using star schema database design. Includes financial performance, collection rate analysis, CPT utilization, payer reimbursement, and demographic reporting.

Healthcare Data Analytics Portfolio | Revenue Cycle | SQL | Power BI | C++ | KPI Reporting | Denials & Authorizations

🩺 Translate clinical discussions into real-time hospital operations data to reduce errors and improve workflow efficiency.

Checks medical claims for NCCI bundling and unit-cap edits before submitting. Reasons for each flag are provided.

X12 EDI Claims Pipeline — 270/271 eligibility, 837P professional claims, 835 remittance advice with revenue cycle analytics. Built with Synthea FHIR R4 synthetic data.

835/837 → payor mix, denial root cause, contracted-rate variance, AR aging cohort. Agentic AI for healthcare RCM.

AI agent that classifies denied insurance claims, retrieves CMS/payer policies via RAG, and generates policy-cited appeal letters

Revenue cycle analytics platform for denial prevention, appeal prioritization, payer friction, underpayment discovery, work queues, ML scoring, and GitHub Pages deployment.

AI remittance-adjudication engine for dental revenue cycle: grounded, cited RAG that interprets EOBs, reconciles to the cent, and fails closed.

AI-powered insurance claims pipeline monitor for mental healthcare platforms: tracks outstanding claims, generates escalating payor outreach, classifies denial codes, and routes each claim to the correct resolution path automatically.

R1 RCM is a major US corporation and Fortune 1000 company. The R1 RCM API provides programmatic access to its platform services, data, and integrations for enterprise customers and partners.

Parses HL7v2 message logs (ADT, ORM, DFT) into an EHR analytics warehouse, reconciles clinical orders against posted charges, and prices missed charge capture and discharge-to-bill lag. 0.977 detection recall, ~30K msg/s.

Curated resources for healthcare payer risk, denial prevention, and revenue cycle management

Governed AI agents for healthcare providers and payers - denial management, prior auth, clinical admin, patient access, UM, coding, care management, contact center. Built on AWS Bedrock + AgentCore with HIPAA controls.

Ambience Healthcare — AI clinical operating system / Ambient AutoScribe