Industry & Specialised department
Healthcare revenue cycle support, run as a department
Revenue cycle problems rarely announce themselves. Claims go out with missing information, denials sit unworked past appeal deadlines, and accounts receivable ages quietly. Nexoryl runs the administrative side of the revenue cycle as a managed department, remotely inside your practice management and billing systems, under the data protection terms your regulations require.
The first button opens an email to info@nexoryl.com.
You bring
- Your billing and practice management systems
- Payer rules, fee schedules and policies
- Data protection terms agreed in writing
Nexoryl runs
- Eligibility checks
- Charge entry
- Claims
- Denials
- Payment posting
- AR follow-up
You get
- Cleaner claims on first submission
- Denials worked before deadlines
- Accounts receivable you can see and act on
- Operating model
- A managed department with payer-specific playbooks, prioritised work queues and a monthly revenue cycle dashboard.
- Delivery model
- Remote. Work happens in your practice management system and clearinghouse with role-based access, under agreed data protection terms.
- Usual starting scope
- Denial management and accounts receivable follow-up for one practice or specialty, then front-end checks.
- Typical roles
- A revenue cycle operations lead, billing and AR specialists, and a denials specialist.
- Runs inside
- Your practice management or EHR system and clearinghouse, such as athenahealth, eClinicalWorks, AdvancedMD or Epic.
- Engagement
- Agreements and an assessment first, then a monthly retainer.
Overview
What is healthcare revenue cycle management?
Healthcare revenue cycle management (RCM) is the administrative process that turns patient care into payment: checking insurance eligibility, capturing charges, submitting claims, posting payments, working denials and following up on unpaid balances.
Most revenue leaks happen at the handoffs: a missed eligibility check, a claim missing a modifier, a denial nobody appealed in time. RCM work is repetitive and rules-driven, which is why a consistent process matters more than occasional heroics.
Nexoryl model
What does Nexoryl's Healthcare RCM department do?
It works the administrative revenue cycle remotely: verifying eligibility, entering charges, submitting and tracking claims, posting payments, working denials and following up on aged accounts receivable, inside your systems and to your policies.
Clinical documentation and final coding decisions stay with your clinicians and certified coders. No patient data is accessed until the contractual and data protection terms your regulations require are signed.
- Responsible for
- Eligibility and benefits checks, charge entry, claim submission and tracking, payment posting, denial management, AR follow-up and revenue cycle reporting.
- Not included
- Clinical documentation, final coding decisions, patient-facing clinical advice, and legal or regulatory advice.
- Connects to
- Data & Analytics, AI & Automation, Process Excellence and Customer Support.
The revenue cycle
Eight steps from appointment to payment.
The department usually works steps two to eight. Registration typically stays with your front desk.
- 01
Register
Patient demographics and insurance details captured.
- 02
Verify eligibility
Coverage and benefits confirmed before the visit.
- 03
Capture charges
Services entered from clinical documentation.
- 04
Submit claims
Claims checked and sent through the clearinghouse.
- 05
Post payments
Remittances and payments posted and reconciled.
- 06
Work denials
Denials categorised, corrected and appealed.
- 07
Follow up AR
Unpaid claims chased by age and value.
- 08
Report
Collections, denials and AR ageing reported monthly.
Where revenue leaks
Four common revenue cycle problems.
Each one is preventable with consistent process and clear priorities.
Denials worked too late
- Shows up as
- Denials pile up and appeal windows close.
- We look at
- Denial volumes, reasons and how they're prioritised.
- What changes
- A denial queue worked by reason and deadline, with root causes reported.
Preventable front-end errors
- Shows up as
- Claims rejected for eligibility or demographic errors.
- We look at
- Eligibility checks and registration accuracy.
- What changes
- Eligibility verified before visits, with errors fed back to registration.
Ageing accounts receivable
- Shows up as
- Balances over 90 days growing every month.
- We look at
- AR ageing by payer and by reason.
- What changes
- Follow-up worked by age and value, with payer patterns reported.
No clear numbers
- Shows up as
- Leadership can't see clean claim rate, denial rate or days in AR.
- We look at
- What your systems already report.
- What changes
- A monthly revenue cycle dashboard with consistent definitions.
What the department covers
Healthcare revenue cycle services.
Administrative revenue cycle work, done to your policies inside your systems.
Front-end checks
Problems stopped before the claim exists.
- Insurance eligibility and benefits checks
- Prior authorisation tracking support
- Registration data quality checks
- Patient estimate preparation support
Charge capture
Every service billed.
- Charge entry from documentation
- Charge reconciliation
- Missing charge follow-up
- Coding queries routed to your coders
Claims
Claims that go out clean and are tracked.
- Claim checks and submission
- Clearinghouse rejection handling
- Claim status tracking
- Corrected claims
Payment posting
Payments recorded accurately.
- Remittance and payment posting
- Payment reconciliation
- Credit balance identification
- Refund requests prepared for approval
Denial management
Denials turned into payments where possible.
- Denial categorisation
- Corrections and resubmissions
- Appeal preparation
- Root-cause reporting
AR follow-up
Unpaid balances chased systematically.
- Aged AR prioritisation
- Payer follow-up by phone, portal and email
- Patient statement support
- Collections reporting
How remote delivery works
How a revenue cycle engagement runs.
Agreements and access controls come before anything else.
Step 1: Agree terms
Data protection terms, access and billing policies agreed and signed first.
Step 2: Assess
Current claims, denials and AR data reviewed.
Step 3: Set up
Work queues, priorities and payer-specific playbooks configured.
Step 4: Operate
Daily and weekly queues worked to agreed turnaround times.
Step 5: Report
A monthly dashboard and root-cause review with your billing manager.
No patient data is accessed until the contractual and data protection terms your regulations require are signed. For US providers, that typically includes a HIPAA business associate agreement.
Scope and boundaries
What's included, and what stays with you.
Administrative revenue cycle work only. Clinical and coding judgement stays with your professionals.
Included
- Eligibility and benefits checks
- Charge entry and reconciliation
- Claim submission and tracking
- Payment posting
- Denial management and appeals
- AR follow-up and reporting
Not included
- Clinical documentation or care decisions
- Final coding decisions, which stay with your certified coders
- Legal or regulatory compliance advice
- Handling paper mail or physical records on site
- Guaranteed collection amounts
What you provide
- Role-based access to your practice management system and clearinghouse
- Signed data protection terms
- Payer contracts, fee schedules and billing policies
- A billing manager for escalations and approvals
Tools and platforms
Where the work happens.
Inside your existing systems, with access scoped to the work.
- Practice management and EHR
- athenahealtheClinicalWorksAdvancedMDEpicNextGenTebra
- Clearinghouses
- AvailityWaystarOffice Ally
- Payer access
- Payer provider portals
- Reporting
- Your system's reportsSpreadsheetsYour BI tool
Named as examples of tools we work in. They don't imply a partnership or certification.
Measurement
How a revenue cycle department is measured.
Standard revenue cycle measures, using definitions agreed with your billing manager.
Claims
- Clean claim rate
- First-pass acceptance rate
- Days from service to submission
Denials
- Denial rate
- Denials worked before deadlines
- Appeal success rate
Accounts receivable
- Days in AR
- Share of AR over 90 days
- Collections against expected
Operations
- Payments posted within agreed time
- Age of the queue backlog
- Reports delivered on schedule
These are measurement categories, not promised figures.
Who does the work
The people working your revenue cycle.
Sized to claim volume, payer mix and the size of the AR backlog.
Revenue Cycle Operations Lead
Owns playbooks, priorities and the monthly dashboard.
Billing and AR Specialists
Handle eligibility, charge entry, claims, posting and follow-up.
Denials Specialist
Works denials by reason and deadline and prepares appeals.
A good fit when
- Denials pile up past appeal deadlines
- AR over 90 days keeps growing
- Your billing team is stretched across too many tasks
- You lack clear revenue cycle reporting
Probably not the right fit when
- You need clinical coding decisions made without your own review
- You need paper records handled on site
- You want guaranteed collection increases
Ways to start
Three ways to begin.
The assessment shows where revenue is leaking before any queue is taken over.
Revenue cycle assessment
Claims, denials and AR reviewed, with priorities and a work plan.
Denial and AR backlog project
A backlog worked down as a scoped project, with root causes reported.
Managed department
Ongoing revenue cycle work on a monthly retainer.
Fees depend on claim volume, specialties and scope, and are agreed after the assessment.
Questions
Questions about healthcare revenue cycle support.
If your question isn't here, email us. Requirements vary by provider, payer mix and jurisdiction.
What does a healthcare RCM department do?
It handles the administrative revenue cycle: eligibility checks, charge entry, claim submission, payment posting, denial management and follow-up on unpaid balances, inside the provider's own systems.
Can revenue cycle work be done remotely?
Yes. Revenue cycle work happens in practice management systems, clearinghouses and payer portals, all accessed online with role-based permissions.
How is patient data protected?
No patient data is accessed until the data protection terms your regulations require are signed. For US providers that typically includes a HIPAA business associate agreement. Access is role-based and limited to the work.
Do you do medical coding?
We enter charges from documentation and route coding questions to your certified coders. Final coding decisions stay with your coding professionals.
How do you prioritise denials?
By deadline, value and denial reason, so the most recoverable claims are worked first and recurring causes are reported back to your team.
Which billing systems do you work in?
athenahealth, eClinicalWorks, AdvancedMD, Epic, NextGen and Tebra, among others, plus clearinghouses such as Availity, Waystar and Office Ally.
Can you guarantee higher collections?
No. Collections depend on payers, contracts and documentation. We commit to agreed turnaround times, clear priorities and transparent reporting.
What do you need from us to start?
Signed data protection terms, role-based system access, payer contracts and billing policies, and a billing manager for escalations.
Next step
See where your revenue cycle is leaking.
Tell us your specialty, systems and biggest backlog. We'll start with the agreements and an assessment, then show you where to begin.