For Revenue Cycle Managers ·
What you'll accomplish
By the end of this guide, you'll have Claude Pro set up as a persistent RCM operations assistant that knows your payer mix, common denial patterns, SOP library, and billing team structure — so every conversation with it starts from shared context. Instead of hunting through email threads and binder folders, you ask Claude and get answers drawn from your own operational knowledge base.
What you'll need
Go to claude.ai. Click "Sign up" and create an account. Upgrade to Claude Pro from the plan settings (billing icon). You'll be charged $20/month.
What you should see: After upgrading, the left sidebar shows a "Projects" section.
In the left sidebar, click "Projects" → "+ New Project." Name it "RCM Operations — [Your Practice/Health System Name]."
What you should see: A new Project page with: a space for Project Instructions, a file upload area, and a "New conversation" button.
Click "Set project instructions" or the pencil icon. Paste this template — fill in your specifics:
You are the RCM Operations AI assistant for [practice/health system name]. You have access to uploaded policy documents and SOP files. Key context:
ORGANIZATION: [name, specialty, size — e.g., "15-physician orthopedic surgery group, 3 locations, in-house billing department of 12"]
PAYER MIX (top payers by volume):
1. [Payer name] — [% of volume, any special requirements]
2. [Payer name] — [% of volume, any special requirements]
3. Medicare — [% of volume]
4. Medicaid — [% of volume, state]
COMMON DENIAL TYPES WE ENCOUNTER:
- [Denial type 1]: [typical root cause and resolution]
- [Denial type 2]: [typical root cause and resolution]
BILLING PLATFORM: [Epic Resolute / Athena / Cerner / other]
CLEARINGHOUSE: [Availity / Waystar / Change Healthcare / other]
Help me with: denial appeal drafting, payer policy questions, SOP creation, staff training materials, KPI analysis, and operational problem-solving. When I ask about a specific payer, search the uploaded documents for relevant policy information before answering.
What you should see: Your instructions are saved and visible at the top of your Project.
In the Project, look for "Add content" or a file upload icon. Upload these types of documents (PDF or text format):
What you should see: Uploaded files appear in the Project's file list. Claude can now search these when answering questions. Troubleshooting: Files must be text-readable PDFs or .txt/.doc files. Scanned image PDFs won't be searchable — convert them with OCR first.
Start a new conversation inside your Project. Ask: "What are [Payer X]'s coverage criteria for [service type] based on the documents I've uploaded?"
What you should see: Claude answers by referencing the specific uploaded policy document — citing the criteria directly rather than giving generic information.
You can build your SOP library directly through conversations: "Based on our payer mix and common denial types, create an SOP for working a Medicare medical necessity denial. Include escalation criteria and appeal template."
Save Claude's output by clicking "Copy" and pasting into your shared SOP folder. Over time, the Project becomes a living reference for your entire billing operation.
Payer policy lookup:
Based on the uploaded [Payer] documents, what are the coverage criteria and documentation requirements for [service/CPT code]?
Denial appeal drafting:
Draft an appeal for a [Payer] denial of [service] for [clinical scenario]. Reference any relevant coverage criteria in the uploaded documents.
SOP creation:
Create an SOP for [billing process] tailored to our payer mix and billing platform ([EHR/PMS]). Include decision criteria and escalation steps.
Staff training material:
Create a training module for new billers on [topic]. Include: learning objectives, key concepts, a practice scenario, and a 5-question quiz.