RCMGen is an AI-powered revenue cycle management company that never lets AI work alone. Our senior revenue cycle specialists each bring 25+ years of hands-on U.S. RCM experience, and we combine that human intelligence with AI intelligence at every layer of the workflow: eligibility, coding, claim scrubbing, denial management, and follow-up. Every AI output is reviewed by a certified specialist before it touches a claim. No claim is ever submitted autonomously.
Payers are already using AI to deny claims at scale, an arms race we documented in The battle of the bots in RCM. Our answer is deliberate: AI for speed and pattern detection, humans for judgment and accountability, running on HIPAA-aligned, SOC 2 Type II infrastructure with BAAs in place, consistent with HFMA guidance on responsible automation.
AI earns a place in our workflow only where it measurably improves speed or accuracy, and only with a named human reviewer. Across our full RCM service line, these are the six layers where AI assistance is standard today, from front-end eligibility verification and prior authorization through payment variance detection.
Eligibility and benefits checks
AI cross-checks coverage responses against visit types and flags mismatches; verification specialists confirm before the encounter is cleared.
Coding assistance with certified review
AI suggests ICD-10, CPT, and HCPCS candidates; AAPC and AHIMA certified coders on our medical coding team make every final call.
Claim scrubbing edit intelligence
AI learns from historical rejections to strengthen payer-specific edit libraries; edits ship only after specialist validation.
Denial triage and root cause
AI clusters denials by CARC, RARC, payer, and pattern within hours; appeal strategy is set by senior denial specialists.
Appeal drafting with specialist approval
AI drafts first-pass appeal language with policy citations; a payer specialist edits, approves, and signs every appeal.
Payment variance detection
AI compares every remit line to contract terms inside payment posting, surfacing underpayments humans then pursue.
Human-led AI RCM, in numbers
The governance rules our AI never breaks
Hospital CFOs do not need more automation promises; they need controls they can show an auditor. These nine rules govern every AI-assisted workflow we run, for every client, with no exceptions, and they are the reason cautious health systems choose our hybrid model over AI-only vendors. Our leadership explains the strategy in what the WISER model means for providers.
100% human review
No AI output reaches a payer, a claim, or a patient without a named specialist approving it.
No autonomous submission
AI never submits, adjusts, or writes off a claim. Humans hold every commit action.
PHI-safe environments
AI tooling runs under executed BAAs on HIPAA-aligned infrastructure with U.S. data residency.
Audit trails on every output
Every AI suggestion, edit, and approval is logged and reviewable, claim by claim.
SOC 2 Type II infrastructure
Security and availability controls independently audited, covering the systems our AI workflows run on.
Output QA sampling
Statistical sampling of AI-assisted work is re-reviewed by senior auditors on a weekly cycle.
Certified human bench
AAPC and AHIMA certified coders, CDI specialists, and payer appeal writers with 650+ combined years of experience.
Continuous payer-rule updates
Edit libraries and models refresh against current payer policy, LCDs, and NCDs before deployment.
Client transparency
Clients see which workflows use AI assistance, in writing, and can review controls through client login reporting.
Why providers choose RCMGen as their AI healthcare RCM company
Founded by Divya Krishnamoorthy with clinical leadership from Dr. Eduardo de la Torre and senior U.S. revenue cycle leadership including Benjamin Gartner and Kevin Bega, RCMGen built its hybrid model deliberately: where large outsourcers rely on entry-level staffing and bulk automation, we pair 25+ year specialists with governed AI. Meet the full leadership team or read about the company.
The model serves hospitals and clinics and physician groups alike, on performance contracts with defined commitments on clean claim rate, denial rate, days in A/R, and net collection rate. Pricing is transparent on our pricing page, onboarding takes 3 business days with $0 setup fees, and any question reaches a decision-maker through contact.