Case

HIPAA-Oriented RCM Platform Automating Clinical-to-Claim Workflow

Clinical-to-Claim RCM Pipeline & AI Orchestration

Healthcare practices were losing time and revenue to manual eligibility checks, clinical documentation, coding, and claim follow-up — each disconnected and error-prone. ScaleVexo architected a multi-tenant RCM platform automating the clinical-to-claim pipeline: live transcription, AI-assisted clinical notes, medical coding, claim submission, denial handling, and payment reconciliation. Deterministic rules govern payer logic and validation, while AI adds reasoning with human-review gates when confidence is low. Built for HIPAA alignment: PHI masking, redaction, and full audit trails.

RoleAI/Backend Architect — Built the RCM pipeline, AI orchestration, and HIPAA-oriented architecture