Move claims forward with fewer avoidable errors.
Risk adjustment, outpatient, and and inpatient medical coding, plus, plus eligibility, billing, A/R follow-up, and denial management. Take one piece or the whole cycle, each with a named owner and a written scope.
01Coding specialties
Coding is where we started
Our coders work to your guidelines and client-specific rules, with every chart reviewed against the agreed coding workflow.
Risk adjustment (HCC) coding
Chart review for health plans and coding vendors, capturing the conditions supported in the documentation and mapping them to the HCC model your program uses.
- Retrospective chart reviewCoding completed encounters against documentation
- Documentation supportEach captured condition tied to evidence in the note
- Query flaggingUnclear or incomplete documentation flagged, not guessed
- Second-level QAA reviewer checks a sample of every coder's work
Outpatient coding
Office visits, procedures, and outpatient encounters coded from the documented services.
Inpatient coding
Inpatient stays coded for diagnoses and procedures, reviewed against the full record.
Certified coders (AAPC and AHIMA credentials), with a reviewer on every team.
02The revenue cycle
One connected workflow
Problems that show up as denials often start earlier. Running the stages together means fixes reach the step that caused them.
- 01
Verify
Confirm active coverage and relevant benefits before services are billed.
You seeEligibility issues flagged before billing - 02
Code
Translate documented services into standardized codes, reviewed against the agreed workflow.
You seeCoded charts plus open queries - 03
Bill
Prepare and manage billing from documented services and your agreed rules.
You seeClaims ready for submission - 04
Follow up
Submit, monitor, and work aging accounts receivable to a next action.
You seeA/R status by age and payer - 05
Resolve
Analyze denials, correct preventable issues, and support resubmission or appeal.
You seeRecurring denial causes, named
03How we plug in
Clear scope, clear boundaries
Pick the part of the cycle you want us to own. We write down exactly what that includes, and what stays with your team.
What we own
- Coding and abstraction to your agreed guidelines
- Claim preparation, submission, and follow-up in your systems
- Denial analysis, correction, and resubmission support
- Quality review, exception logs, and regular reporting
What stays with you
- Clinical documentation and answers to provider queries
- Payer contracts, fee schedules, and write-off approvals
- Final decisions on coding policy
- Patient and member communication
We won't promise guaranteed reimbursement or zero denials. We will show you where claims are stuck, why, and what is being done about it.
04Quality controls
Reviewed before it reaches you
Coding quality depends on clear rules and a second pair of eyes. Both are set up in the Define stage, before the first chart.
- 01Documented rules
Your guidelines and client-specific rules written into a coding reference the team works from.
- 02Second-level review
A reviewer checks a sample of each coder's work before it is returned.
- 03Query process
Unclear documentation is flagged back to you, never coded on assumption.
- 04Feedback loop
Review findings go back to coders, and recurring issues show up in your report.
05Getting started
What to send us first
Five answers are enough for us to come back with a scoped approach and a pilot plan.
- Coding type and specialtyRisk adjustment, outpatient, inpatient, or the full cycle.
- Monthly volumeCharts, encounters, or claims per month, and any backlog.
- Systems and toolsYour EHR, coding platform, and billing system.
- Quality expectationsHow accuracy is measured today and what you need it to be.
- Start dateWhen the work needs to begin and any deadlines that matter.
06Start with the requirement
Where are your claims stuck?
A coding backlog, aging A/R, or denials that keep coming back. Tell us which, and we’ll reply with how we would scope and own it.
or email info@agilysnxt.com