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Client Context
Data Platform Modernization for Healthcare Revenue Cycle Provider
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Industry:
Healthcare – Revenue Cycle & Payment Integrity
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Geography:
Multi-state U.S. hospital network
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Engagement Type:
Enterprise Data Engineering & Cloud Modernization
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Scope:
Migration from legacy SQL/flat-file reporting to cloud-based analytics
Challenges
Challenges
- Reporting processes relied on siloed SQL scripts and manual spreadsheet workflows.
- Data refresh cycles took 5–7 days, delaying operational and financial decision-making.
- Lack of a unified data model across EHR systems, payer responses, and denial codes limited visibility.
- Executives required clear KPIs on expected versus paid amounts, denials, underpayments, and payer behavior.
Our Apporach
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Designed and deployed a cloud-based lakehouse architecture integrating EHR, clearinghouse, claims, and ERA data.
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Built automated ETL/ELT pipelines with quality and exception monitoring.
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Established canonical data models for CPT codes, contract terms, denial categories, reason codes, and payments.
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Delivered interactive Power BI dashboards for CFO, COO, and RCM directors with drill-downs by facility, payer, specialty, and encounter type.
Impact Delivered
- Reduced data refresh cycles from 5–7 days to near real-time (hourly).
- Uncovered approximately 18% revenue leakage from underpayments and avoidable denials within the first 30 days.
- Improved follow-up prioritization accuracy by 2.4× using AI-driven payer tendency scoring.
- Empowered leadership with predictive insights into monthly cash flow and denial risk.
30+ years of Industry experience in delivering pioneering data and QA solutions.
