Healthcare operations
A senior tech team for healthcare operations that have outgrown manual work.
We learn how referral intake, clinical QA, coding, documentation, physician orders, and prior authorization work in your business. Then we decide what to build, connect, or automate, do the work, and stay involved after launch.
Healthcare is where we have the most proof, but we work in other industries too. We use AI only in workflows we can support and measure.
Excelin cut coding and OASIS review staff in half. Quality measures stayed the same.
A home health and hospice company was growing faster than its clinical review could handle. Hiring more people no longer made financial sense.
50%
Half as many people doing coding and OASIS review
~$475K
Estimated savings per year
28 → 17
Average days to finish
Held
Quality and star-rating measures tracked
We built Walter to review clinical notes against Excelin’s rules, fix what can be fixed automatically, and send everything else to a clinician with the problem already flagged. Walter covers OASIS review, coding, clinical QA, the 485 workflow, and QA on evaluations and nursing visits. Wilma handles status, follow-up, and triage for physician orders.
Excelin tracked quality, payment, function, compliance, and star-rating measures the whole time. Results stayed within acceptable ranges. Some measures beat the human baseline.
“Since implementing Walter, we’ve seen a measurable reduction in assessment-to-billing time and reduced our average 485 completion time by 10 days... resolved major operational challenges for our multi-site organization.”
Sheena Meeker, Excelin Health
Still supported today. Nearly a year after Walter launched, Excelin and 21 Solutions still meet regularly, and our senior team is still involved.
Read the full Excelin case studyNumbers reported by Excelin leadership and tracked through the project.
Workflows that turn growth into more hires
These are the places where growth stops paying off. People do this work because no system was built to handle it.
Referral intake
Intake documents arrive by fax, portal, and email. Someone reads each one to decide what happens next. Volume here sets the pace for everything after it.
Clinical QA and coding
OASIS review, coding, and clinical QA use licensed clinicians for work that is mostly checking. Automate the checking and send only exceptions to people—that is where staffing costs drop.
Documentation review
Notes, evaluations, and visit records are checked for completeness and compliance before billing. When review slows down, revenue waits.
Physician orders
Orders go out, then someone tracks status, chases signatures, and fixes what came back wrong. This coordination work grows with patient volume.
Prior authorization
Requests often need answers within 24 to 48 hours. Assembling, submitting, and following up is almost all manual work.
Revenue operations
Work that is ready to bill sooner reduces days-to-payment pressure and improves cash flow. At Excelin, the revenue team felt this first.
EHR-adjacent gaps
Your EHR is not the problem and does not need replacing. The problem is the work beside it—in spreadsheets and shared drives—that the EHR was never built to handle.
Multi-site visibility
When each location records work differently, reports cannot be trusted and leaders rely on stories instead of data. Consistency has to be built into the workflow, not asked for in a memo.
Hiring pressure
The usual response to more volume is another coordinator, reviewer, or admin. That growing cost is usually why companies call us.
Prior authorization & utilization
When the software itself is the problem
Sometimes manual work is not the main problem. Sometimes the system meant to fix it has become too expensive and risky to change, so the team builds workarounds inside their own software.
~6 Weeks
Full platform rebuild
90%+
Lower monthly hosting costs
Ongoing
Senior support still active today
Cadence runs a medical prior-authorization service for hospitals, clinics, and payers. Small changes took too much engineering time, bugs were hard to trace across disconnected services, and hosting costs kept rising.
We learned the workflow, kept the features that mattered, relaunched the platform on one well-built system in about six weeks, fixed the fax workflows, and improved how AI output is shown to reviewers.
Read the Cadence case study“Anyone can get software to work once. The question is what it costs to change it on the hundredth or thousandth day.”
Josh Hughes, Founder, Cadence
“Cadence” is a pseudonym used at the client’s request; the engagement and outcomes are real.
Built for operators with workflow pain that affects revenue
We take on a small number of projects at a time, so being honest about fit early saves everyone months.
Strong fit
- Multi-site home health, hospice, post-acute, or clinic operations
- Five or more people spending their day on review, coordination, or documentation
- An EHR that works, with workflows around it that the EHR does not cover
- Leaders accountable for margin, compliance, and quality measures
- Growth that is currently handled by hiring more people
Probably not a fit
- Looking to replace or re-implement an EHR
- Shopping for hourly developers
- One small report or integration
- A generic AI chatbot or pilot with no one owning it day to day
- No executive sponsor for the workflow being changed
The math behind fixing the workflow
At $20K/month for one core operation, you are not comparing us to a cheaper vendor. You are comparing us to the people you would keep hiring, and the revenue stuck in a manual review queue.
Staffing costs
Five or more people on review and coordination is a permanent cost that grows with volume.
What ongoing work includes
Senior tech decisions about what to automate, what stays human, how to prove quality, and how to support the workflow after launch.
Cash flow
Work ready to bill sooner reduces days-to-payment pressure. At Excelin, completion time dropped from about 28 days to about 17.
Start by understanding the business problem.
Everyone starts with a free 30-minute Fit Call. From there, most companies do a $5K two-week Technical Diagnostic. Ongoing work for one core operation starts at $20K/month. Broad multi-system support usually runs $40K+/month. See the engagements page for details.
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We decide what to automate, and what should not be
Some steps need a clinician. Deciding which ones is the work, and it is included—not billed as discovery.
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Quality is measured, not asserted
Excelin tracked quality, payment, compliance, and star-rating measures throughout the project. That kind of measurement is how these projects get approved internally.
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The model is not healthcare-specific
Healthcare is our deepest proof, not our only market. The same approach—understand the business, make tech decisions, execute, and stay involved—works for Apex Trash (multi-site field ops) and Link Biosciences (specialized production). See all case studies.
Pick the next step that fits where you are.
Not ready to talk? Start with the free five-minute Systems Assessment. Already know you need help with a healthcare workflow? Go straight to scheduling.