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RCM Operational Playbook

Master the revenue cycle, one pillar at a time.

The definitive training guide for Healthpro RCM specialists — from credentialing and charge capture to adjudication, posting and compassionate recovery.

Start learning Take the knowledge check

5

Pillars

~25 min

To complete

6

Interactive labs

Revenue cycle illustration

Executive briefing

This playbook codifies the five essential pillars of medical revenue cycle management — from initial provider credentialing and charge capture to adjudication checkpoints, payment posting analytics, and compassionate debt recovery.

The 5 pillars

Follow a claim from provider enrollment to the final patient dollar.

Provider Credentialing & Enrollment

90-Day CAQH Attestation & License Monitor

NPPESPECOSCAQH ProView

Service Delivery & Outgoing Claims

Dual Progress Note & HCFA-1500 Locking

eClinicalWorksAmbient AI ScribesCPT / ICD-10

Clearinghouse Scrubbing & Adjudication

Pre-Adjudication Rejection vs. Denial Sorting

Waystar ClearinghousePayer Gateways

Payment Posting & Denial Management

Senior “Head Chef” Pattern Recognition

ERA / 835EOB Auditing

Patient Collections & Compassionate Recovery

Ethical Adjustments & Flexible Payment Plans

eCW StatementsPatient PortalIn-House AR

Quality & governance

Weekly client reporting cadence

Every Healthpro client receives a weekly scorecard so performance is never a mystery.

97%+

First-pass clean claim target at Waystar

Gross Charges & Net Collections
Benchmarked against rolling 90-day average
First-Pass Clean Claim Rate
Healthpro target: >97% at Waystar
Denial Taxonomy Breakdown
Credentialing vs. Clinical vs. Admin
AR Aging Buckets
Focus on resolving claims >60 days
Provider-Level Action Items
Concise clinical documentation notes