RCM manager
Where should I intervene to unblock teams?
Next-best action:
Rebalance denials queue by re-allocating 15 Aetna denials to Specialist Ortiz.
Revenue at Risk
$1,250,000
Unassigned Queues
9 tasks
Team Throughput
84 outcomes/day
| Priority |
ID |
Payer |
Specialty/Client |
Type |
Exposure |
Age |
Owner |
Status |
Evidence |
Next-Best Action |
Actions |
| urgent |
WO-TASK-ASC-CASE-006-missing_implant_supply_charge |
Acc |
ASC Orthopedics |
Missing Implant Supply Charge |
$1,320.00 |
21 days |
Nina Patel |
Human Action Required |
2 files |
Coder should validate the implant log, invoice support, and charge capture checklist before any claim release, for human review. |
Open |
| high |
WO-TASK-ASC-CASE-004-documentation_missing_medical_necessity |
Acc |
ASC Orthopedics |
Documentation Missing Medical Necessity |
$1,800.00 |
21 days |
Nina Patel |
Human Action Required |
3 files |
Coder should validate whether the case includes the required medical-necessity support and build a missing-document checklist for human review. |
Open |
| high |
WO-TASK-ASC-CASE-005-bundled_procedure_risk |
Acc |
ASC Orthopedics |
Coding Review |
$650.00 |
21 days |
Nina Patel |
Human Action Required |
2 files |
Coder should validate whether modifier 59 or XS is supported by separate-site documentation before claim release, for human review. |
Open |