This project simulates a Revenue Cycle Management (RCM) workflow and analyzes claim processing efficiency.
To identify inefficiencies in claim approval and denial workflows and suggest data-driven improvements.
- Denial Rate
- Claim Approval Rate
- Reprocessing Efficiency
- High denial rates indicate workflow inefficiencies
- Coding errors and missing information are key drivers of claim denial
- Improving upstream validation can reduce revenue leakage
Reducing denial rate by even 5% can significantly improve revenue realization.
