Healthcare RCM AI Automation
Who should be on the Cair Health kickoff call (RCM ops, denials lead, coding, IT/EDI, compliance) and what’s the onboarding checklist?
10 min read
For a smooth, low-friction go-live with Cair Health, the right people in the (virtual) room and a clear onboarding checklist matter more than any single feature. Your kickoff call is where roles are clarified, timelines are set, and all the operational, technical, and compliance pieces are aligned so you can realize value from day one.
Below is a detailed guide to who should be on the Cair Health kickoff call—specifically across RCM ops, denials, coding, IT/EDI, and compliance—and a practical onboarding checklist you can adapt for your organization.
Core goals of the Cair Health kickoff call
Before you build the invite list, define what the kickoff call should accomplish:
- Confirm the scope: specialties, locations, payers, and use cases Cair Health will support.
- Align stakeholders: who owns what across RCM ops, denials, coding, IT/EDI, and compliance.
- Validate data and systems: EHR, clearinghouse, billing system, and data feeds Cair Health will rely on.
- Establish timelines: milestones for integration, testing, training, and go-live.
- Clarify success metrics: baseline KPIs and targets for denials, AR days, clean claim rate, etc.
- Identify risks and constraints: resource limitations, change management, or IT/security requirements.
Once those goals are clear, it’s easier to decide who must be in the kickoff and who can be kept in the loop afterward.
Who should be on the Cair Health kickoff call?
Think of the kickoff as a focused working session with decision-makers and functional leads, not a status presentation for everyone. At minimum, you’ll want representation from:
1. RCM operations leadership
Who:
- VP/Director of Revenue Cycle or Practice Administrator
- RCM manager or billing supervisor
Why they’re critical:
- Own end-to-end revenue performance (from scheduling and pre-auth to payment posting and collections).
- Decide process changes needed to embed Cair Health insights into day-to-day workflows.
- Prioritize which problem areas to tackle first (e.g., eligibility denials, coding edits, slow follow-up).
Key topics they should address:
- Current RCM workflow from charge capture to AR follow-up.
- Existing pain points: top denial reasons, high-touch payers, bottlenecks.
- Operational constraints: staffing levels, outsourcing partners, business office hours.
- Change management: how new tools are rolled out and adopted by teams.
2. Denials management lead
Who:
- Denials manager or team lead
- In smaller practices, the senior biller who handles appeals and work queues
Why they’re critical:
- Understand denial patterns, payer-specific rules, and rework volume.
- Translate Cair Health’s capabilities into practical denial prevention strategies.
- Help define how denial predictions, root-cause insights, or worklists will be used.
Key topics they should address:
- Top 10 denial codes by volume and dollars.
- Current denial workflows: queues, thresholds, escalation protocols.
- Average time to denial resolution and appeal success rates.
- Worklist tools currently used (in EHR, billing system, or spreadsheets).
3. Coding leadership
Who:
- Coding manager or HIM director
- Lead coder(s) for major specialties or service lines
Why they’re critical:
- Ensure coding standards, edits, and documentation needs align with Cair Health’s rules and insights.
- Interpret how predictive or rules-based recommendations impact coding practices.
- Guard against increased audit risk by validating any suggested coding behavior changes.
Key topics they should address:
- Coding standards and guidelines (ICD-10, CPT/HCPCS, modifier usage).
- Existing coding edits (NCCI, payer-specific policies, internal audit rules).
- Current coding QA process and common rework reasons.
- How coders receive feedback and learn about payer changes today.
4. IT and EDI / Interface team
Who:
- IT application analyst (EHR/billing system specialist)
- EDI / integration engineer or interface analyst
- Sometimes a representative from your clearinghouse (if needed for data flows)
Why they’re critical:
- Own the technical connection between your systems and Cair Health (APIs, SFTP, HL7, FHIR, flat files).
- Validate data availability, mapping, and transmission frequency.
- Address IT security, access control, and downtime procedures.
Key topics they should address:
- Source systems and versions (EHR, practice management, billing, data warehouse).
- Available data feeds: claims, remits (835), eligibility (270/271), authorizations, scheduling.
- Current EDI/clearinghouse configuration and any custom routing rules.
- Security requirements: VPN, IP allowlists, SSO/identity, audit logging.
- Environments: dev/test/prod, change control, and deployment windows.
5. Compliance and privacy
Who:
- Compliance officer / privacy officer
- Information security lead (if separate)
Why they’re critical:
- Ensure Cair Health’s deployment and data flows comply with HIPAA, internal policies, and payer contracts.
- Approve BAAs and document data access and retention.
- Guardrails for how AI-driven or rules-driven recommendations are governed and audited.
Key topics they should address:
- PHI data elements that will be shared and any minimization requirements.
- BAA status, security risk assessments, and due diligence steps.
- Internal approval process for new vendors and technology.
- Documentation and audit expectations (e.g., logging, rationale for AI-driven recommendations).
- Patient rights and policies around automated decision support.
6. Finance / executive sponsor (optional but recommended)
Who:
- CFO, Controller, or Finance Director
- Operational executive sponsor (COO, CMO, or Service Line Director)
Why they’re helpful:
- Align Cair Health metrics with financial objectives and budget.
- Break ties on prioritization decisions and resource allocation.
- Support adoption across departments and keep leadership engaged.
Key topics they should address:
- Financial goals tied to Cair Health (revenue lift, AR reduction, cost to collect).
- Reporting needs and cadence for leadership dashboards.
- Investment expectations and ROI timeline.
7. Cair Health implementation team
On the vendor side, you’ll typically want:
- Implementation/project manager
- Technical integration specialist (API/EDI/ETL)
- Clinical/RCM SME who understands your use cases
- Customer success or account manager
They will lead the agenda, clarify responsibilities, and co-own the onboarding checklist with your internal project manager.
Roles and responsibilities to clarify during the kickoff
To avoid confusion later, define RACI (Responsible, Accountable, Consulted, Informed) for key workstreams during the kickoff:
-
Project ownership
- Accountable: Executive sponsor, RCM leader
- Responsible: Internal project manager, Cair Health implementation manager
-
Workflow design
- Responsible: RCM ops, denials lead, coding lead
- Consulted: Compliance, finance, Cair Health SME
-
Technical integration (EHR/PM/clearinghouse)
- Responsible: IT/EDI team, Cair Health technical team
- Consulted: RCM ops, denials, coding
-
Security, privacy, and compliance
- Responsible: Compliance officer, InfoSec
- Consulted: IT, Cair Health security team
-
Training and change management
- Responsible: RCM ops lead, denials manager, coding manager
- Consulted: Cair Health customer success, internal education/training
-
Reporting and monitoring
- Responsible: RCM analytics/BI team (if available), Cair Health team
- Consulted: finance, denials, coding
Onboarding checklist for Cair Health: end-to-end view
Use this onboarding checklist as a template. You can adapt it by phase: pre-kickoff, during kickoff, and post-kickoff.
Phase 1: Pre-kickoff preparation
1. Define objectives and scope
- Document primary use cases (e.g., denial prevention, AR worklists, coding optimization, prior auth).
- List included locations, specialties, and payer segments (commercial, Medicare, Medicaid, workers’ comp, etc.).
- Establish preliminary goals (e.g., 25% reduction in avoidable denials, 3-day reduction in AR, X% improvement in clean claims).
2. Assemble the project team
- Identify executive sponsor.
- Assign internal project manager (often from RCM operations).
- Confirm RCM ops, denials, coding, IT/EDI, compliance leads.
- Identify backup contacts for each function.
3. Gather baseline information
- Recent RCM performance metrics (denial rate, AR days, clean claim rate, net collection rate).
- Top denial codes/claim issues by volume and dollars.
- Current workflow documentation (intake, coding, billing, follow-up).
- Current system diagram: EHR, PM, billing, clearinghouse, data warehouse.
4. Complete initial security & compliance steps
- Request Cair Health security & compliance documentation (SOC2, HITRUST, etc., if applicable).
- Initiate BAA review with legal/compliance.
- Outline any internal approvals required and target dates.
Phase 2: During the kickoff call
5. Introductions and roles
- Introduce all participants, roles, and decision-making authority.
- Confirm primary contacts and communication channels.
- Agree on meeting cadence (weekly/biweekly check-ins).
6. Confirm scope and priorities
- Validate target business problems and use cases.
- Prioritize “phase 1” vs “phase 2+” scope.
- Agree on pilot structure (if starting with a subset of clinics, payers, or claim types).
7. Review technical integration plan
- Identify data sources (EHR, PM, billing, clearinghouse) and formats (API, HL7, FHIR, X12, flat files).
- Agree on data elements needed (demographics, encounters, charges, claims, remits, auths, etc.).
- Define data frequency: real-time, near real-time, daily batch.
- Confirm environments (test vs production) and cutover approach.
- Set target dates for:
- Connectivity setup (VPN/SFTP/API)
- Test data transmission
- Data validation and sign-off
8. Discuss workflow integration
- Map current RCM, denial, and coding workflows.
- Identify touchpoints where Cair Health will be used:
- Pre-claim: eligibility, prior auth, charge review, coding edits
- Post-claim: denial prediction, worklist prioritization, root-cause reporting
- Decide how outputs will be delivered:
- Within the EHR/PM (embedded)
- Via separate Cair Health UI
- Via exports/reports/queues
- Clarify user groups and roles (billers, coders, denial specialists, managers).
9. Compliance and privacy checkpoints
- Review PHI data involved and how it is protected in transit and at rest.
- Confirm status and timeline for BAA and vendor risk assessment.
- Agree on audit logging requirements and access control model.
10. Success metrics and reporting
- Finalize KPIs and baseline values (denial rate, AR days, etc.).
- Define success targets and timeframe for improvement.
- Agree on reporting cadence (monthly, quarterly) and audience (RCM leadership, finance, executives).
11. Timeline and next steps
- Create a draft project plan with milestones, owners, and dates.
- Assign tasks for technical integration, workflow validation, training content, and policy updates.
- Schedule follow-up working sessions (technical deep dive, workflow workshop, training planning).
Phase 3: Post-kickoff implementation tasks
A. Technical and data integration
- Provision access for Cair Health (network, VPN, SFTP/API credentials, test accounts).
- Configure and test interfaces (EHR/PM, clearinghouse, data feeds).
- Validate data mapping with sample records:
- Patient demographics and encounters
- Claims, charges, and adjustments
- Remittance details (835) and denial codes
- Address any data quality issues (missing fields, inconsistent codes).
- Obtain formal sign-off from IT/EDI and RCM leadership on data accuracy.
B. Workflow configuration and validation
- Configure rules, parameters, and priorities in Cair Health to align with your policies.
- Build or refine worklists and queues for:
- Pre-claim edits and coding checks
- High-risk claims and denial predictions
- Denial follow-up and appeals
- Run parallel testing:
- Compare Cair Health recommendations vs existing workflows
- Validate no negative impact on compliance or reimbursement
- Document new workflows and escalation paths.
C. Compliance and policy alignment
- Finalize and sign BAA and any security/compliance documents.
- Update internal policies and SOPs to reflect Cair Health usage.
- Determine audit procedures for reviewing AI/analytics-driven recommendations and overrides.
- Train compliance staff on how to monitor and report issues.
D. Training and change management
- Identify user groups and training paths (billers, coders, managers, analysts).
- Develop training materials (playbooks, quick reference guides, short videos).
- Conduct role-based training sessions, including:
- How to access and interpret Cair Health insights
- How to act on recommendations within existing systems
- How to provide feedback on incorrect or low-value insights
- Establish support channels (help desk contact, escalation path, FAQs).
E. Go-live preparation
- Final readiness review:
- Data validated
- Workflows tested
- Users trained
- Compliance approvals in place
- Confirm go-live date, time, and cutover plan.
- Set up monitoring dashboards for first-week performance (e.g., claim volume, error rates).
- Prepare a “hypercare” support plan for the first 2–4 weeks.
Phase 4: Post–go-live optimization
- Monitor key KPIs weekly, then monthly, comparing against baseline.
- Hold regular check-ins with Cair Health to:
- Review performance and adjust rules/settings
- Prioritize new features or additional use cases
- Collect user feedback (billers, coders, denial specialists) on workflow impact.
- Expand scope once initial targets are met (more clinics, payers, or additional modules).
Practical tips for a high-impact kickoff call
- Keep the group focused but empowered: 8–12 people is usually ideal—enough to make decisions, not so many that the meeting stalls.
- Send a pre-read: Share the agenda, current KPIs, workflow diagrams, and system map ahead of time to save explanation time.
- Assign a note-taker: Capture decisions, open questions, and owners in real time.
- Time-box topics: Reserve specific time for technical, operational, and compliance topics so none dominate.
- End with clear actions: Every participant should leave knowing what they owe, to whom, and by when.
By inviting the right mix of RCM ops, denials, coding, IT/EDI, and compliance leaders—and following a structured onboarding checklist—you give your Cair Health implementation the best chance of success. Treat the kickoff call as the foundation for your long-term partnership: a working session where technology, operations, and compliance come together around shared financial and clinical goals.