Opervics runs medical billing, coding, claims, denial management and the full revenue cycle for practices, billing companies and healthcare groups — AI-assisted, human-verified, HIPAA-aligned, and staffed 24/7.
Each service runs on the same HIPAA-aligned quality layer — trained healthcare specialists, documented SOPs, AI-assisted checks, and human verification on every output. We run the function, not just the task.
End-to-end medical billing — charge capture, claim scrubbing, submission, tracking and posting — with AI-assisted pre-submission checks and certified billers handling every exception.
Certified coding (CPT, ICD-10, HCPCS) with AI-assisted code screening and audit-ready documentation — so every code decision is both accurate and defensible.
Full-cycle RCM — patient access through final payment posting — with one accountable team, AI-assisted pattern detection, and weekly RCM dashboards.
Payer-specific claim submission and real-time tracking — with AI-assisted scrubbing, correct payer routing and structured follow-up on every pending claim.
Explore claims processing →Root-cause denial analysis, appeals and prevention — not just resubmission. AI-assisted pattern detection feeds back into coding and charge capture to reduce repeat denials.
Explore denial management →Systematic aging-bucket follow-up that stops revenue from quietly aging out — payer-specific outreach, escalations, and 60/90/120+ reporting.
Explore AR follow-up →Real-time and batch eligibility checks before the visit — not after the denial — including benefits verification, coverage limits and patient responsibility estimates.
Accurate, timely charge capture that protects reimbursement — reviewed against encounter documentation and fee schedules, with AI-assisted error checks.
Explore charge entry →ERA/EOB posting, reconciliation and payer variance flagging — with AI-assisted anomaly detection so underpayments don't quietly become write-offs.
Explore payment posting →Payer-specific prior authorization submissions and status tracking — so procedures aren't delayed or cancelled waiting on pending auths.
Explore prior authorization →Appointment booking, reminders and no-show reduction support — with HIPAA-aligned patient communications and structured follow-up.
Explore patient scheduling →Patient and provider support with HIPAA-aligned handling — billing questions, appointment help, portal support and administrative queries.
Healthcare back-office work is different from general BPO. It touches patient data, payer rules, coding standards and compliance — which is why most generic outsourcing arrangements underperform.
We run healthcare operations as a dedicated function — trained healthcare staff, HIPAA-aligned controls, and AI used strictly where it improves accuracy and speed without removing human judgment.
Signed BAAs, access controls, audit trails, and restricted environments built into every healthcare engagement.
CPC, CCS and CRC-certified coders make final coding decisions. AI screens for mismatches before submission.
Clean claim rate, denial rate, days in AR, aged AR, charge lag, collection rate — reported weekly.
AI output is never the final output. Every claim, code and posting runs through human verification.
A quick reference to the core processes, compliance focus and AI opportunities per service. Full detail lives on each sub-service page.
| Service | Core Processes | Compliance Focus | AI Opportunity |
|---|---|---|---|
| Medical Billing | Charge capture, scrubbing, submission, posting | HIPAA, PHI handling, payer rules | Pre-submission scrubbing, rejection prediction |
| Medical Coding | CPT, ICD-10, HCPCS coding, modifier application | Coding guidelines, audit trails | ICD-CPT mismatch detection, code sequence flags |
| RCM | Full revenue cycle — patient access to payment | HIPAA, payer rules, audit trails | Pattern detection, denial root-cause, RCM analytics |
| Claims Processing | Payer-specific submission, tracking, follow-up | Payer rules, submission compliance | Scrubbing, payer routing, status detection |
| Denial Management | Root-cause analysis, appeals, prevention | Payer appeal rules, documentation | Pattern detection, appeal drafting support |
| AR Follow-Up | Aging bucket follow-up, payer escalation | Payer timers, appeals deadlines | Priority flagging, payer behaviour patterns |
| Eligibility Verification | Real-time & batch checks, benefits verification | Payer rules, patient notification | Batch automation, coverage change detection |
| Charge Entry | Encounter-based charge entry, fee schedule alignment | Charge capture compliance | Error checks, charge lag detection |
| Payment Posting | ERA/EOB posting, reconciliation | Payer variance rules, reconciliation standards | Anomaly detection, underpayment flagging |
| Prior Authorization | Submission, status tracking, appeals | Payer-specific prior auth rules | Payer forms assistance, status auto-detection |
| Patient Scheduling | Booking, reminders, no-show reduction | HIPAA-aligned patient communications | Reminder automation, no-show prediction |
| Healthcare Support | Patient/provider support, billing questions | HIPAA-aligned handling, PHI minimisation | Intent classification, response suggestions |
Every healthcare engagement inherits the same baseline security posture, then adds HIPAA-specific controls on top.
Signed BAAs, PHI handling protocols, restricted access, and audit trails built into every healthcare workflow.
NDA-bound, HIPAA-trained staff, role-based access, and auditable logs for every system they touch.
AI output is reviewed by trained specialists before it reaches your systems — no blind automation on clinical data.
Clean claim rate, denial rate, days in AR, aged AR — reported weekly with audit-ready documentation.
Healthcare BPO operates inside regulated constraints: PHI handling, HIPAA alignment, payer rules, coding standards (CPT, ICD-10, HCPCS), and audit requirements. General BPO rarely has the trained staff or the compliance infrastructure to run it properly.
Medical billing, medical coding, RCM, claims processing, denial management, AR follow-up, eligibility verification, charge entry, payment posting, prior authorization, patient scheduling and healthcare customer support — individually or as a full revenue cycle.
Yes. We operate under signed Business Associate Agreements, use access-controlled systems, maintain audit trails, and restrict PHI access to assigned, NDA-bound staff only.
No. AI is used for pattern detection, pre-screening, and rule checks. Certified coders and trained billers make the final decisions — especially on compliance-sensitive coding, appeals and payer nuance.
Pricing depends on scope. Most engagements are priced per FTE, per claim, or as a percentage of collections — agreed upfront with no hidden add-ons for AI tooling, training, or QA.
Yes. Our teams are trained to work inside common EHR, practice management, and RCM platforms, with role-based access set by you.
A 30-minute RCM assessment is usually enough to identify the first high-impact process worth outsourcing.