Medical billing, coding, prior authorization, and insurance verification — fully managed from the Philippines at 65% less than US local hiring. Your staff. Your EHR. HIPAA-compliant from day one.
The US is facing a critical shortage of trained medical billers, coders, and prior authorization specialists. Healthcare admin roles have some of the worst turnover in any industry — and every unfilled seat directly impacts your cash flow, your denial rate, and your clinical staff who end up doing admin work instead of seeing patients.
Base salary for an experienced medical biller in the US is $42,000–$55,000. Add payroll taxes, benefits, training costs, and credentialing time, and you are spending $65,000+ per seat — for a role with 40%+ annual turnover.
The average prior authorization takes 1–3 business days to process and 16% are initially denied. An understaffed auth team means approvals pile up, procedures get delayed, and physicians spend clinical hours chasing paperwork instead of treating patients.
The industry average claim denial rate is 15%. At that rate, a practice billing $5M annually leaves $750,000 on the table every year in denied or written-off claims — much of it recoverable with better coding and follow-up.
Business Associate Agreement (BAA) executed on day one. All staff complete HIPAA training before handling any PHI. Data flows through your EHR — no PHI touches Nezda systems.
We do not just place billing staff. We build a fully managed revenue cycle and administrative function — from claims submission to prior auth to patient scheduling — staffed by trained specialists who work inside your EHR.
End-to-end claims management: charge capture review, claim submission to payers, payment posting, denial management, and AR follow-up. Worked inside your existing billing software.
ICD-10-CM, CPT, and HCPCS coding across primary care, specialties, and ancillary services. CPC and CCS certified coders available for complex specialties. Clean claim rate target: 95%+.
Initiating, tracking, and following up on prior authorization requests across all major commercial payers and Medicare Advantage plans. Appeal management for initial denials. Reduces physician admin burden immediately.
Real-time eligibility and benefits verification before every appointment. Co-pay, deductible, and out-of-pocket maximum confirmation. Reduces day-of billing surprises and improves patient collection rates.
Inbound and outbound scheduling across your PM system, referral coordination, new patient registration, and demographic data entry. Reduces front-desk burden and no-show rates.
Systematic review and re-submission of denied claims. Root cause analysis by denial code (CO-4, CO-97, PR-96). Recovery rate target of 85%+ on appealed denials. Monthly denial trend reporting.
Our recruiters maintain pre-screened pipelines of credentialed, EHR-trained healthcare admin professionals ready to join your practice.
Handles end-to-end claims processing: charge entry, claim submission, payment posting, and AR follow-up for commercial and government payers. Experienced across Epic, AdvancedMD, Kareo, and Athenahealth.
ICD-10-CM, CPT, and HCPCS coding for physician practices and facilities. Specialties include primary care, orthopedics, cardiology, and behavioral health. CPC and CCS certified coders available.
Initiates and tracks prior auth requests across major payers (Aetna, BCBS, UnitedHealth, Cigna, Humana). Manages peer-to-peer requests, tracks approval timelines, and escalates overdue requests daily.
Verifies patient eligibility and benefits in real time before every appointment. Confirms co-pays, deductibles, out-of-pocket maximums, and authorization requirements. Reduces claim denials at their source.
Manages inbound scheduling calls and online appointment requests, referral coordination, recall outreach, and cancellation backfill. Trained on your PM system and scheduling protocols.
General clinical admin support: referral letters, documentation requests, patient communication, lab result follow-up coordination, and provider inbox management. Reduces physician admin burden by 30–40%.
A transparent, step-by-step breakdown of exactly how we build, onboard, and launch your HIPAA-compliant healthcare admin team — with no black boxes.
We map your EHR, practice management system, payer mix, monthly claim volume, current denial rate, and admin pain points. We design the exact team — billers, coders, auth specialists, or a mix — and the workflow that fits your practice.
Business Associate Agreement signed on day one. We establish the HIPAA compliance framework: access controls, data handling protocols, and PHI security procedures — all before any patient data is accessed.
Our healthcare-specialist recruiters activate pre-screened pipelines. Every candidate is verified for claimed certifications (CPC, CCS, AHIMA) and EHR experience before being shortlisted. You receive 3–5 candidates per role within 7–10 days.
You run structured 30-minute interviews with your shortlisted candidates. For coding roles, we include a coding assessment on your specialty. You choose your team. No one joins without your sign-off.
All staff complete mandatory HIPAA training and sign the required acknowledgments before handling any PHI. EHR access is provisioned through your system. Staff are trained on your billing workflows, payer contracts, and coding guidelines.
Your team goes live with supervised first-week oversight by a Nezda healthcare delivery manager. Weekly KPI reporting from week one: clean claim rate, denial rate, AR days, and auth turnaround. Monthly QBRs from month 2.
Denial rates, AR days, clean claim rates, and cost reductions — real results from active Nezda Outpost healthcare admin engagements.
A 12-physician multi-specialty group in Dallas, Texas was running a $9M annual revenue cycle with a 17% denial rate and an average AR of 52 days. Their 5-person in-house billing team was overwhelmed, underpaid, and turning over every 10 months on average.
Their practice administrator had looked at domestic billing companies but found the cost was comparable to internal staff — without the control. They needed dedicated billers who worked inside their Athenahealth environment and were accountable to the practice directly.
Nezda audited 6 months of claims data, identified top denial codes (CO-4, CO-97, PR-96), and found $1.2M in AR older than 90 days that had not been systematically followed up.
3 billers, 2 coders, and 1 prior auth specialist shortlisted. All had Athenahealth experience. The practice administrator selected all 6 in a single half-day of interviews.
All 6 staff completed HIPAA training. Athenahealth access provisioned through the practice admin. First claims submitted on day 19 of engagement.
Systematic AR follow-up recovered $1.2M over 90 days. Denial rate fell from 17% to 5.8% as cleaner coding and pre-auth checks took effect. AR days reduced from 52 to 18 by month 4.
Every healthcare plan includes sourcing, credential verification, HIPAA training, EHR onboarding, HR, payroll, compliance, and a dedicated account manager.
💡 5 Nezda healthcare admin staff ($1,900/FTE) = $114,000/yr. The same 5 locally in the US = $330,000+ fully loaded.
Many healthcare clients also build patient-facing customer experience teams and back office operations alongside their revenue cycle function.
Book a free 45-minute revenue cycle discovery call. We will audit your current denial rate, AR days, and team structure — and show you exactly what a Nezda healthcare team would look like for your practice.
Tell us about your practice and we will design a HIPAA-compliant team within 48 hours.