Automating Eligibility Verification to Reallocate 4 Full-Time Equivalents

The Problem: Manual payer-portal eligibility checks cost ~$10 per check, required 5–10 staff, caused errors, denials, backlogs, and poor patient experience. Hiring more people only scaled inefficiency.
The Solution: Implemented a credentialed RPA/AI eligibility bot integrated with scheduling and RCM to auto-query payers, write results into the system, and route exceptions to a staffed queue.
Implementation Timeline: 90-day rollout — scope top 3–5 payers (Weeks 0–2), build and credential (Weeks 3–5), parallel run and tune (Weeks 6–8), full cutover and scale (Days 60–90).
Measurable ROI: Reduced manual work from 6 FTEs to 1–2 oversight roles, redeployed ~$200K/year in labor, achieved break-even by Day 90, and increased throughput 3×.
Operational Gains: Near-100% clean eligibility for automated cases, 30–50% drop in eligibility-related denials, and ~70% reduction in patient wait time tied to verification.
Success Factors & Risks: Tight scope (80/20 payers), strong exception workflow, human validation during ramp, daily KPI tracking, ongoing bot maintenance, PHI security, and clear vendor SLAs.

Download the FREE success story

The Problem: Manual payer-portal eligibility checks cost ~$10 per check, required 5–10 staff, caused errors, denials, backlogs, and poor patient experience. Hiring more people only scaled inefficiency.
The Solution: Implemented a credentialed RPA/AI eligibility bot integrated with scheduling and RCM to auto-query payers, write results into the system, and route exceptions to a staffed queue.
Implementation Timeline: 90-day rollout — scope top 3–5 payers (Weeks 0–2), build and credential (Weeks 3–5), parallel run and tune (Weeks 6–8), full cutover and scale (Days 60–90).
Measurable ROI: Reduced manual work from 6 FTEs to 1–2 oversight roles, redeployed ~$200K/year in labor, achieved break-even by Day 90, and increased throughput 3×.
Operational Gains: Near-100% clean eligibility for automated cases, 30–50% drop in eligibility-related denials, and ~70% reduction in patient wait time tied to verification.
Success Factors & Risks: Tight scope (80/20 payers), strong exception workflow, human validation during ramp, daily KPI tracking, ongoing bot maintenance, PHI security, and clear vendor SLAs.