Each skill is a governed, repeatable capability that agents execute. Start from proven templates, configure for your payer mix and client rules, test against real cases, approve, deploy, and measure.
Showing 26 of 26 skills
Auto + HITL edge cases
Convert denial noise into structured, deduplicated cases with deadlines and context. Ingest ERA/EOB, PM denial postings, and payer messages into single cases with normalized codes, amounts, and appeal windows.
HITL initially
Classify denials and route to the right resolution path — fix/resubmit, appeal, eligibility correction, auth recovery, or coding review — consistently across all team members and clients.
Assist + Approval
Enforce evidence completeness before any appeal is submitted. Validate required clinical documentation, auth/referral presence, payer policy citations, and timeline compliance.
Assist + Approval
Draft the appeal narrative and assemble the submission packet with citations, evidence, and correct formatting per payer requirements. Human approval required before submission.
Assist + HITL
Analyze denial patterns, tag root causes with standard taxonomy, and generate prevention tasks. Turn outcomes into upstream improvements that stop repeat denials.
Auto + Review
Rank work by cash impact and urgency every day. Create "best next work" queues using dollar amount × age × SLA risk × payer behavior scoring.
HITL → Auto
Select the optimal next action for each AR case: portal check, payer call, correction, resubmission, or wait. Enforce cadence rules and escalation triggers.
Assist
Explain why a claim is stalled and recommend the highest-probability resolution path, with citations to specific status messages and system notes.
Auto + Review
Compare expected reimbursement against ERA paid amounts. Flag recoverable variances with calculation traces and contract references.
Assist
Produce defensible "why underpaid" rationale with traceable math. Generate calculation breakdowns tied to specific contract clauses.
Assist + Approval
Draft payer-ready dispute letters and assemble evidence packages for underpayment recovery. All assertions tied to traceable calculation and contract reference.
Auto + Escalate
Verify active coverage and critical plan fields prior to claim submission. Prevent eligibility-related denials before they happen.
Assist + HITL
Detect coordination-of-benefits conflicts and recommend exact remediation steps: update payer order, obtain EOB, or rebill in sequence.
Assist
Identify name/DOB/member ID mismatches that cause rejections. Propose corrections and generate follow-up tasks.
Assist + HITL
Determine if authorization is required given CPT, plan, provider, and DOS. Open auth cases with required documentation lists when gaps are found.
Auto + Escalate
Maintain auth pipeline with follow-up cadence. Capture reference numbers, escalate when service dates approach, and alert on stalled auths.
Auto
Generate standardized medical records requests with case-specific detail, correct recipient routing, and follow-up scheduling.
Assist
Validate received documents against requirements. Flag missing items and trigger re-requests with specific gap descriptions.
HITL initially
Classify and route ERA posting exceptions. Determine whether exceptions require correction, manual review, or write-off consideration.
Assist
Match lockbox deposits against expected payments. Flag variances, missing deposits, and unidentified payments for investigation.
Self-service + Escalate
Answer "Why do I owe this?" with plain-language breakdown backed by ledger data. Present next-step options: pay, plan, dispute, or financial assistance.
HITL initially
Determine eligibility and present policy-approved payment plan options. Capture consent and create plans with full policy-version documentation.
Assist
Standardize dispute intake with reason classification, required info capture, and case creation with complete evidence for billing team review.
Auto + Human decision
Monitor skill outcomes over time. Detect performance drift, degradation, or abnormal error rates. Trigger alerts and suggest rollback or tuning actions.
Auto
Produce audit-ready case packets on demand: complete timeline, evidence index, skill run logs, and executive summary.
Assist
Convert written SOPs into structured skill configurations. Extract rules, thresholds, evidence checklists, and routing logic for SME review.