Back-office services that sell into healthcare. We run scoped outcomes for RCM teams, billing companies, coding shops, and MSOs — claims processing, denial management, eligibility verification, prior auth support, coding QA. Each completed item carries evidence: a submitted claim, a worked denial, a verified benefit.
RCMBillingCoding
expertise in
Healthcare Services
Building stronger, more connected teams
Healthcare services that actually get finished
When internal hiring can’t keep up, operational backlogs grow fast—and in healthcare that hits patient experience and revenue. Healthcare QOP fixes the bottleneck with targeted recruitment for roles you struggle to fill, and outcome‑based operations support that completes work with predictable results, billed per completed outcome. You get one partner that handles both hiring and execution, engineered to scale across your operational needs.
Built to scale growth
Work measured by results
Hire better talent
Outcome based operations support
Healthcare QOP doesn’t sell seats or shifts—we deliver defined, auditable operational outcomes that matter day to day. Healthcare operations leaders rely on us to remove recurring tasks from internal teams without having to hire, manage, or scale headcount. Our pricing connects directly to finished work with clear completion criteria, focusing your spend on results rather than time, roles, or ambiguous "support."
Claims. Eligibility. Prior auth.
A model built around defined outcomes
Healthcare QOP’s core model is outcome‑based operations support: invoicing is linked to completed work that meets agreed, verifiable rules. We begin with a discovery call to identify which operational services matter most for your clinic, practice, or health system and define what “done” means for your workflows. Then we align on completion criteria and integrate workflows with your current systems so work transitions cleanly across teams. When certain tasks cannot be reliably standardized into defined outcomes, we can also provide a traditional monthly option with a dedicated specialist.
How we help
Appointment Scheduling Coordination
Handle patient appointment requests, bookings, changes, and confirmation documentation
We coordinate appointment workflows end‑to‑end—booking, changes, cancellations, confirmations, and callbacks—with documented outcomes so your team always sees what’s done, what’s pending, and what needs action. Healthcare QOP improves scheduling efficiency, helps front desk operations run smoothly, and reduces patient wait times by preventing silent workflow stalls.
Patient Preregistration and Intake Completion
Collect and finalize patient intake data with clear completion statuses
Healthcare QOP captures intake requirements—demographics, forms, and supporting documents—and log clear dispositions when information is missing so your staff isn’t left chasing details. We improve clinic readiness, reduce intake bottlenecks, and free your front desk and clinical teams to focus on patient care, not paperwork.
Insurance Eligibility and Benefit Verification
Verify patient insurance coverage and capture documented benefit details
We check insurance eligibility and record benefits with documented evidence and clear next steps so your team knows coverage status before care is delivered. Healthcare QOP reduces claim denials, supports more accurate billing, and helps internal staff avoid manual verification burdens by centralizing eligibility and benefit checks.
Prior Authorization Submission and Tracking
Submit and track payer authorizations, logging reference and status updates
Healthcare QOP manages the end-to-end coordination of authorization requests—from initial submission to final determination—with clear documentation at every step. We navigate payer portals and requirements to secure reference numbers and provide real-time status updates, ensuring your clinical team knows exactly which services are cleared. By logging every touchpoint and exception, we help you prevent care delays and avoid technical denials.
Claims Work Execution
Execute claims processing tasks with documented actions and outcomes
We work claim actions, perform follow‑ups, and document exceptions with auditable outcomes so your operations team has clear visibility into claim status. Healthcare QOP boosts claim processing consistency, reduces administrative backlog, and provides structured documentation to support revenue cycle efficiency without taking on financial custody.
Invoice and Statement Sending
Dispatch client-generated invoices/statements and log successful deliveries
Healthcare QOP dispatches system‑generated invoices and statements and record delivery outcomes with timestamps so your billing and revenue teams know what was sent and when. We improve consistency in document delivery, takes routine workload off your internal staff, and ensures auditable logs without taking on payment responsibilities.
Tailored Service
Custom work items built around your workflow
You tell us the workflow you want off your plate. We map it into clear work items, define inputs and “done”, set exception rules, then connect it to the right systems so delivery is consistent and auditable with Healthcare QOP.
Dedicated Full-Time Specialist
Flexible tasks that do not fit our fixed outcome model
If a traditional model fits better, you can work with a dedicated full-time specialist through us. They focus on your workflows day-to-day, integrate into your tools where needed, and handle a wider mix of tasks that are hard to standardize into work items.
Frequently Asked Questions
Common questions
How do we decide what services to start with?
What service line is leaking revenue or dragging cycle times? That’s the starting point. The discovery call identifies where the backlog is costing you — usually aging claims, denial follow-up, or eligibility bottlenecks. We take on work that has a clear completion rule: submitted, worked, appealed, verified.
How does work enter the workflow?
Claims come through your billing platform or clearinghouse. Denials arrive via ERA or payer portals. Eligibility checks come through your RCM tool or payer integrations. Each service has one defined intake path so work flows to one queue, not three.
Do you work in our systems or your systems?
In your billing system — Waystar, Availity, your clearinghouse, Epic Resolute, or whatever your RCM team already works in. For some scopes we use shared spreadsheets, then post the completed result back. The audit trail always lives in your system of record.
How do you define what counts as “complete”?
Written completion rules before any work starts. A submitted claim with confirmation. A worked denial with a disposition code. An appeal filed within the timely filing window. A verified benefit with detail logged. Evidence is attached to the outcome, not documented separately.
How does pricing work?
Per completed outcome. A submitted clean claim has a unit price. A worked denial has a unit price. Most RCM teams run on a monthly credit that draws down as work completes. Volume above the credit bills at the same rate. Denied-at-submission and blocked items don’t count.
What does onboarding look like?
Scope, intake, and completion rules first — what’s being handed off, where it enters your workflow, what a completed item looks like in your system. Then a short ramp on live work (a claims batch, a denial queue) to confirm the rules hold against real cases. Once verified, delivery runs every cycle.
““Claims follow-up was our blind spot. Denials piled up, nobody could say which ones were worked versus sitting, and the aging report got worse every month. Healthcare QOP scoped denial management as completed outcomes — each denial worked to a disposition, each appeal filed within window. The aging report moves now, and we can justify the spend because we pay for what closes.”
What sets it apart is you can see exactly what was completed, what’s in flight, and what’s blocked — not some vague ‘support coverage’. They connected directly into our systems, and we only pay for outcomes we can verify. Our backlog stopped growing, our turnaround times became steady, and internal teams stopped spending hours chasing updates.”
Duncan Owens
VP of Revenue Cycle Management
What clients say