AI Employee · Healthcare & Clinical Revenue Cycle

Meet Your AI Medical Biller
That Never Clocks Out

Talk to it like a certified medical coder. Connect Epic, Cerner, Athenahealth, and Availity — it extracts ICD-10 and CPT codes from clinical chart notes, automates prior-authorization submissions across payer portals, writes substantiated claims denial appeals, and accelerates reimbursements 24/7.

Hire Your AI Medical Biller Book an EHR Integration Demo
MB
RhinoAgents AI Medical Biller
Online · Monitoring Payer Portals & EHR
You
Process Dr. Patel's 24 clinic encounters from yesterday in Athenahealth. Extract ICD-10/CPT codes, verify active Aetna & BCBS eligibility, and submit prior-auth for Patient #9182's lumbar MRI.
MB
Ingesting SOAP notes from Athenahealth. Running clinical NLP, NCCI edits, and payer coverage policy checks…
SOAP Note NLP Coding Prior-Auth Submission 270/271 Real-Time Eligibility
MB
Encounter Coding & Prior-Auth Complete:
• 24 Encounters Coded: CPT 99214/99213 extracted with matching ICD-10 diagnosis codes. CMS-1500 claims scrubbed with 99.4% clean-claim pass rate.
• Lumbar MRI Prior-Auth: Extracted 6 weeks of failed physical therapy documentation from chart. Submitted via Availity (PA #AET-89410). Status: Approved in 14 minutes.
• Athenahealth Sync: Pre-authorization authorization number and expiration date updated in patient chart.
Batch Transmit 24 Claims View Denial Appeal Queue Prior-Auth Approval Dossier
Revenue Cycle Velocity

An Autonomous Medical Biller, Not Basic Billing Software

Traditional billing software only formats claims for clearinghouses. Your AI Medical Biller actively reads clinical notes, resolves NCCI bundling conflicts, submits prior-authorizations, and generates cited appeal packages for denied claims.

Autonomous Prior-Authorization

Pulls clinical evidence, populates payer portals, and monitors approvals in real time to eliminate patient care delays.

Substantive Claims Denial Appeals

Writes customized medical necessity appeal letters citing CMS Local Coverage Determinations (LCDs) and clinical journals.

Manual RCM Billing Team vs. AI Medical Biller
❌ Manual Billing Staff
✅ AI Medical Biller
48 to 72 hours per prior-auth turnaround
<15 minutes automated prior-auth submission
70–80% clean claim submission rate
99.4% first-pass clean claim rate
50%+ of denied claims written off due to workload
100% of appealable denials fought with clinical dossiers
Days in Accounts Receivable (A/R): 45–60 days
Days in A/R reduced to <24 days
$35k–$55k/year salary per billing clerk
Unlimited throughput at a predictable flat fee
Setup in 60 Minutes

Connected to Your EHR in 4 Simple Steps

Link your practice management system, clearinghouse, and payer credentials with zero engineering tickets.

1
Connect Your EHR
Link Epic, Cerner, Athenahealth, or eClinicalWorks via secure FHIR / HL7 APIs to sync encounters.
EHR Integration
2
Configure Payer Rules
Upload fee schedules, local LCD/NCD coverage policies, and clearinghouse credentials (Availity/Waystar).
Payer Policies
3
Automate Coding & Auth
AI extracts ICD-10/CPT codes from SOAP notes, submits prior-authorizations, and scrubs claims.
Clinical NLP
4
Reimburse & Reconcile
Posts electronic remittances (ERA 835), writes denial appeals, and updates patient ledger balances.
ERA Posting
Live Dialogues

See Exactly How It Codes & Resolves Claims

Explore real interactions across SOAP note medical coding, prior-authorizations, and claims denial appeals.

MB
AI Medical Biller • Live Conversation
CLINICIAN
"Code Encounter #ENC-8819 for a 54yo patient presenting with uncontrolled Type 2 Diabetes with diabetic polyneuropathy and essential hypertension. 35-min encounter."
MB
Clinical Coding Extraction:
• Primary ICD-10: E11.42 (Type 2 diabetes mellitus with diabetic polyneuropathy)
• Secondary ICD-10: I10 (Essential hypertension)
• CPT Code: 99214 (Office/outpatient visit, moderate medical decision making, 30–39 mins)
• NCCI Edits Passed: Zero bundling conflicts. CMS-1500 claim prepared for transmission to BCBS.
CLINICIAN
"Patient #4819 needs prior authorization for Humira (adalimumab) 40mg injection for severe Crohn's disease."
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Prior-Authorization Submitted via CoverMyMeds:
• Extracted colonoscopy pathology report and 12-week trial of failed corticosteroid therapy from Epic chart.
• Attached CDAI (Crohn's Disease Activity Index) score of 340.
• Tracking #CMM-88491: Awaiting UnitedHealthcare determination (estimated <24 hours).
BILLER
"Cigna denied claim #CLM-2094 with Reason Code CO-50 (Procedure deemed experimental/not medically necessary for CPT 27447 total knee arthroplasty)."
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Denial Appeal Packet Generated:
• Extracted Kellgren-Lawrence Grade IV severe osteoarthritis radiographic findings from PACS imaging report.
• Compiled 6 months of documented conservative management: intra-articular steroid injections, NSAIDs, and physical therapy records.
• Cited Cigna Medical Coverage Policy #0128 and AAOS Clinical Practice Guidelines.
• Status: Level 1 Formal Reconsideration Appeal ready for provider sign-off.
You
Verify insurance eligibility for tomorrow's scheduled cardiology clinic appointments (18 patients).
MB
✅ Executed real-time EDI 270/271 queries across Aetna, Medicare, and UnitedHealthcare.
✅ 16 patients active: Co-pays ($40 specialist) and remaining deductibles populated in Athenahealth.
⚠️ 2 patients flagged with terminated coverage — SMS notifications sent to update insurance cards before arrival.
Enterprise Feature Mapping

Every Healthcare RCM Workflow. Powered by RhinoAgents.

Your AI Medical Biller is powered by our enterprise control plane and autonomous healthcare clinical runtime.

RCM Problem
Staff spend 14 hours per week on hold with insurance companies chasing prior authorizations.
Autonomous Prior-Auth Engine
Extracts clinical chart evidence and executes electronic prior-auth across Availity and CoverMyMeds.
85%
reduction in prior-authorization processing turnaround time
RCM Problem
Medical coding mistakes and NCCI unbundling errors cause 15–20% of first-pass claims to be rejected.
Clinical NLP & Claim Scrubber
Extracts precise ICD-10 and CPT codes with real-time NCCI edit validation and LCD rule checks.
99.4%
first-pass clean claim rate submitted to clearinghouses
RCM Problem
Practices write off millions annually in unresolved claims denials because appeal letters take too long to write.
Automated Denial Appeal Dossier
Generates substantiated appeal packets citing peer-reviewed clinical guidelines and chart notes.
+$240k
average annual revenue recovered from overturned claims denials
Full Capability Set

Everything a Medical Billing Specialist Does. Automated.

From patient insurance eligibility check to final remittance reconciliation, your AI employee covers the entire healthcare revenue cycle.

SOAP Note to ICD-10/CPT Coding
Extracts diagnostic codes (ICD-10-CM), procedural codes (CPT/HCPCS), and appropriate E&M leveling from provider charts.
ICD-10-CMCPT / HCPCSE&M Leveling
Prior-Authorization Automation
Compiles medical necessity documentation, submits electronic PAs across payer portals, and monitors determinations.
AvailityCoverMyMedsEDI 278
Pre-Claim Scrubbing & NCCI Edits
Validates CMS-1500 and UB-04 claims against National Correct Coding Initiative (NCCI) edits and Local Coverage Determinations.
NCCI EditsLCD / NCDClaim Scrub
Denial Appeals & Clinical Dossiers
Auto-triages ERA 835 denial remark codes and generates formal reconsideration appeal packages with clinical citations.
Denial AppealsERA 835Medical Necessity
Real-Time Eligibility (EDI 270/271)
Verifies patient insurance coverage, co-pays, remaining deductibles, and co-insurance before appointments.
EDI 270/271Co-Pay CheckDeductibles
EHR Remittance & Ledger Posting
Auto-posts Electronic Remittance Advices (ERAs), reconciles patient balances, and updates practice management ledgers.
Epic EHRAthenahealthPayment Post
Human-in-the-Loop

Full Speed. Full Clinical Governance.

Your AI Medical Biller processes standard clean claims autonomously, but alerts practice managers and physicians for complex unbundling or surgical coding sign-offs.

1

Standard Encounters Auto-Coded

Routine outpatient visits (E&M 99213/99214) and verified prior-auths transmit autonomously.

2

Complex Surgical Coding Flagged

Major inpatient surgical cases or modifier 59/25 unbundling exceptions trigger review.

3

1-Click Provider Sign-Off

Providers or Certified Professional Coders (CPCs) review the chart callout and approve on mobile.

Slack Notification • #rcm-coding-reviews
⚠️ Provider Sign-Off Required for Major Claim:
• Encounter: Total Knee Replacement (Patient #49102 — Dr. Vance)
• Primary CPT: 27447 ($14,200.00) + Modifier 22 (Increased Procedural Service)
• Clinical Reason: Extensive severe synovial debridement documented (operative time: +75 mins).
Integrations

Connects to Your Entire Healthcare & EHR Stack

Native FHIR/HL7 connectors for electronic health records, practice management systems, and national clearinghouses.

Epic Systems Cerner / Oracle Health Athenahealth Availity Waystar RCM eClinicalWorks CoverMyMeds Kareo / Tebra Slack & Teams
Real-Time Observability

Complete Healthcare Revenue Cycle Visibility

Track days in A/R, first-pass clean claim rates, prior-auth approval cycle times, and denial overturn rates in real time.

AI Healthcare Revenue Cycle Management Dashboard
21.4 Days
Average Days in A/R
99.4%
Clean Claim Pass Rate
88.2%
Denial Appeal Overturn Rate
Enterprise Security

HIPAA Compliance & Protected Health Information (PHI) Security

Built with signed Business Associate Agreements (BAAs), AES-256 encryption, and zero data retention on patient health records.

HIPAA Compliant & Signed BAA
We execute standard Business Associate Agreements guaranteeing full administrative, physical, and technical safeguards.
Zero PHI Model Retention
Patient health records and chart notes are processed in isolated memory and never used to train public foundation models.
SOC 2 Type II Certified
Audited healthcare infrastructure ensures complete tenant isolation and strict role-based access control (RBAC).
Frequently Asked Questions

Everything Healthcare Providers Need to Know

Clear answers on EHR connectors, HIPAA compliance, prior-authorizations, and claims denial management.

Does RhinoAgents sign a HIPAA Business Associate Agreement (BAA)?
Yes. We execute a comprehensive Business Associate Agreement (BAA) with every covered healthcare entity and provider organization before connecting to your EHR or clearinghouse.
How does the AI extract ICD-10 and CPT codes from unstructured clinical notes?
The AI uses medical natural language processing (NLP) trained on millions of clinical records. It analyzes provider SOAP notes, operative reports, and discharge summaries to identify diagnoses, procedures, and medical decision-making complexity according to CMS E&M guidelines.
Which clearinghouses and EHRs are supported?
Natively connects with Epic Systems, Cerner / Oracle Health, Athenahealth, eClinicalWorks, Kareo, NextGen, Availity, Waystar, and CoverMyMeds.
How long does integration and initial calibration take?
Standard FHIR/API connection takes under 3 business days. Clinical coding calibration against historical practice encounter data typically takes 3–5 days.
Accelerate Clinical Revenue

Deploy Your AI Medical Biller Today

Connect your EHR in minutes and achieve 99%+ clean claim rates with automated prior-authorizations and denial management.

Deploy AI Medical Biller Schedule EHR Demo