Third-Party RCM Service Provider

Scope of Services

The selected service provider will support AdvantixxRCM with assigned revenue cycle functions, which may include:

• Medical billing
• Claims preparation and submission
• Clearinghouse rejection management
• Insurance A/R follow-up
• Denial management
• Corrected claims
• Reconsiderations and appeals
• Payment posting
• ERA/EOB processing
• Insurance eligibility verification
• Benefits verification
• Prior authorization support
• Credentialing and payer enrollment support
• Claim status follow-up
• Underpayment identification
• Aging A/R management
• Revenue reconciliation
• Billing quality assurance
• Client implementation
• RCM reporting
• Workflow development and implementation

Startup & Implementation Support

During AdvantixxRCM's startup and expansion phase, the service provider will assist with establishing and supporting operational workflows for new clients.

This may include:

• Setting up client billing workflows.
• Assisting with EHR/Practice Management implementation.
• Establishing clearinghouse workflows.
• Configuring payer workflows.
• Reviewing existing client A/R.
• Establishing claim-submission processes.
• Establishing denial-management processes.
• Supporting client transitions from previous billing companies.
• Assisting with data migration and transition when applicable.
• Establishing reporting processes.
• Helping implement AdvantixxRCM SOPs.
• Providing operational capacity while AdvantixxRCM scales its internal workforce.

Ongoing RCM Services

The selected provider will be expected to perform actual production work.

The provider may be assigned specific clients, accounts, work queues, specialties, or RCM functions and will be responsible for completing assigned services within AdvantixxRCM's established requirements.

The provider must maintain sufficient qualified personnel and resources to support assigned workload.

Compensation

The service provider will receive:

Example:

If covered client accounts generate $500,000 in qualifying collections, the service provider's compensation would be:

$500,000 × 1% = $5,000

If covered accounts generate $1,000,000, compensation would be:

$1,000,000 × 1% = $10,000

There is no guaranteed salary or hourly compensation under this service-provider arrangement unless separately agreed in writing.

The final Service Agreement will define qualifying collections, assigned clients, calculation periods, payment dates, refunds, recoupments, reversals, exclusions, and reconciliation procedures.

Service Expectations

The selected provider must be capable of delivering consistent, measurable RCM performance, including:

• Timely claim submission
• Accurate claims
• Timely insurance follow-up
• Appropriate denial resolution
• Proper documentation
• Timely payment posting
• A/R management
• Timely filing protection
• Appropriate escalation of payer issues
• Accurate reporting
• Compliance with AdvantixxRCM procedures
• Protection of client and patient information

Performance Standards

Performance may be monitored using metrics such as:

• Clean claim rate
• Claim rejection rate
• Denial rate
• Days in A/R
• A/R over 90 days
• Net collection rate
• Claim turnaround time
• Payment posting turnaround
• Denial resolution
• Appeal recovery
• Quality audit results
• Client-specific performance requirements

Provider Requirements

The service provider should demonstrate:

• Significant healthcare RCM experience.
• Experience providing medical billing services to healthcare organizations.
• Medicare and Medicaid billing experience.
• Commercial payer experience.
• A/R and insurance follow-up experience.
• Denial and appeals experience.
• Payment posting experience.
• Experience with clearinghouses and payer portals.
• Ability to work across multiple EHR/Practice Management platforms.
• Strong data-security practices.
• Adequate staffing to support assigned workloads.
• Ability to meet established service levels.
• Professional client and internal communication.

HIPAA & Data Security

Because the service provider may receive access to Protected Health Information and client systems, the selected provider must comply with applicable HIPAA privacy and security requirements.

Before access is provided, the service provider may be required to execute:

• Master Services Agreement (MSA)
• Business Associate Agreement (BAA)
• Nondisclosure/Confidentiality Agreement
• Data Security Agreement
• Applicable client-specific security documentation

The provider will be responsible for ensuring that its personnel and approved subcontractors comply with applicable contractual privacy and security requirements.

Independent Service Provider Relationship

The selected organization will operate as an independent third-party service provider.

Nothing in the engagement is intended to establish an employer-employee relationship between AdvantixxRCM and the service provider's personnel.

The provider will remain responsible for its own personnel, payroll, taxes, insurance, equipment, internal supervision, and other obligations established in the final agreement.

What AdvantixxRCM Is Looking For

We are looking for an RCM service provider that can work alongside our internal team and actually perform the work.

This is not an engagement where we are looking for someone simply to review our operation and provide recommendations.

We need a provider capable of supporting:

Implementation → Billing → Claims → A/R → Denials → Payments → Follow-Up → Reporting

The ideal provider will be capable of supporting AdvantixxRCM immediately while allowing us to scale client volume without sacrificing quality or operational performance.

Ideal Provider

This opportunity may be appropriate for:

Medical billing companies • RCM companies • Healthcare back-office service providers • Established RCM teams • Healthcare BPO organizations

Providers with experience supporting multiple U.S. healthcare practices and specialties are strongly preferred.

Opportunity Overview

AdvantixxRCM is seeking an experienced Third-Party Revenue Cycle Management (RCM) Service Provider to support the launch, implementation, and ongoing operations of our growing medical billing and revenue cycle management company.

This opportunity is intended for an established independent service provider, medical billing company, RCM company, or qualified RCM team capable of providing hands-on operational services.

This is not an employment position and not a consulting-only engagement. The selected provider will actively perform assigned RCM services and supplement AdvantixxRCM's internal operations and workforce.