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AI and automation by role · frontline

How Medical billing / coding specialists can use AI and automation

Below are 11 common tasks for Medical billing / coding specialists, most common first. For each one you get the best fix (AI, automation, a feature in software you already have, or a simpler process), the steps to set it up and, for AI fixes, a prompt to copy.

Also called: Medical Biller, Medical Coder, Billing Specialist, Revenue Cycle Specialist, Certified Professional Coder, CPC, AR Specialist

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Task 1 · typically 120 min, every day

Code visits and check the documentation supports them

Software featureBest fix

Use computer-assisted or AI coding to suggest codes

Computer-assisted and AI coding tools read the documentation and suggest codes with the supporting text highlighted. Coders review and approve, and simple visits can be coded automatically.

Typically saves about 35% of the time4 h to set up
  1. 1Ask your revenue cycle leader what coding tools are available (Solventum 360 Encompass, Optum, Fathom, CodaMetrix or your EHR's coding assistant).
  2. 2Start with high-volume, simple visit types.
  3. 3Audit a sample of AI-coded charts each week.
  4. 4Send documentation gaps back to clinicians as education, not one-off queries.
  5. 5Only use tools your organization has approved and covered by a HIPAA business associate agreement (BAA) for anything with patient information.

Tools: Solventum 360 Encompass · Optum CAC · Fathom · CodaMetrix · Epic Penny (coding and appeals assistant)

One more way to fix it
Software feature

Use an ambient AI scribe to draft the visit note

An approved ambient scribe listens to the visit (with the patient's consent) and drafts the note, orders and patient instructions in the EHR. You review and sign. Most clinicians get back part of their evening, not all of it.

Typically saves about 40% of the time1 h to set up
  1. 1Ask your organization which ambient scribe is approved: Microsoft Dragon Copilot (formerly DAX Copilot), Abridge, Ambience, Suki, Nabla or the one built into your EHR (such as Epic's AI Charting).
  2. 2Do the short training and set your note preferences (sections, length, style).
  3. 3Tell each patient and get consent, as your policy requires.
  4. 4Review every draft carefully before signing; you are responsible for the note.
  5. 5Only use tools your organization has approved and covered by a HIPAA business associate agreement (BAA) for anything with patient information.

Tools: Microsoft Dragon Copilot · Abridge · Ambience · Suki · Nabla

How to automate this task

Task 2 · typically 120 min, every day

Work denied claims and write appeals

AIBest fix

Have approved AI draft the appeal or letter of medical necessity

AI drafts a clear, well-structured appeal from the denial reason, the policy and the clinical facts. You check every fact and sign. Use only your organization's BAA-covered AI for anything with patient details.

Typically saves about 45% of the time10 min to set up
  1. 1Gather the denial letter, the payer policy and the key clinical facts.
  2. 2Use only your organization's approved, BAA-covered AI tool. If you do not have one, remove all patient identifiers first.
  3. 3Use the prompt below.
  4. 4Check every clinical fact and code before sending.
Prompt to copy
Draft an appeal letter for a denied [SERVICE / MEDICATION]. Denial reason: [PASTE REASON]. Payer policy criteria: [PASTE POLICY TEXT]. Clinical facts: [DIAGNOSIS, HISTORY, TREATMENTS TRIED AND RESULTS, WHY THIS IS NEEDED NOW]. Address each policy criterion one by one with the matching fact. Keep it under one page, professional and factual. Mark any criterion without supporting facts as [MISSING]. Do not invent clinical details.

Tools: Your organization's approved, BAA-covered AI assistant

One more way to fix it
Process fix

Track the top denial reasons and fix them at the source

Most denials come from a few repeat causes such as eligibility, missing auths or coding. Fixing those upstream prevents work instead of redoing it.

Typically saves about 30% of the time2 h to set up
  1. 1Run a report of denials by reason and payer for the last 90 days.
  2. 2Pick the top three causes.
  3. 3Fix each at the source with the front desk, clinicians or coders.
  4. 4Recheck the numbers monthly.

Tools: Your PM system or clearinghouse reports

How to automate this task

Task 3 · typically 60 min, every day

Fix claim errors and rejections before they go out

Software featureBest fix

Let the claim scrubber catch errors before claims go out

Clearinghouse and PM claim edits check codes, modifiers and payer rules before submission, so you fix problems once instead of working rejections later.

Typically saves about 40% of the time3 h to set up
  1. 1Pull your top 10 rejection reasons from the clearinghouse.
  2. 2Turn on or build edits for each one (Waystar, Availity, Experian Health or your PM system).
  3. 3Fix the cause upstream (registration, charge entry) where you can.
  4. 4Review edit hits weekly.

Tools: Waystar · Availity · Experian Health · athenaOne or your PM system

One more way to fix it
Process fix

Track the top denial reasons and fix them at the source

Most denials come from a few repeat causes such as eligibility, missing auths or coding. Fixing those upstream prevents work instead of redoing it.

Typically saves about 30% of the time2 h to set up
  1. 1Run a report of denials by reason and payer for the last 90 days.
  2. 2Pick the top three causes.
  3. 3Fix each at the source with the front desk, clinicians or coders.
  4. 4Recheck the numbers monthly.

Tools: Your PM system or clearinghouse reports

How to automate this task

Task 4 · typically 60 min, every day

Wait on hold with insurance companies about claims

Software featureBest fix

Check claim status in portals or with AI calling instead of waiting on hold

Claim status checks through clearinghouse or payer portals take seconds. For payers that need a call, AI calling services can now wait on hold and get the answer for you.

Typically saves about 40% of the time1 h to set up
  1. 1Use automated claim status checks in your clearinghouse (Waystar, Availity) before calling.
  2. 2Bookmark payer portals and save logins in a password manager.
  3. 3Ask your manager about AI calling services for payer calls (for example Infinitus or Thoughtful AI).
  4. 4Keep phone calls for complex appeals.

Tools: Waystar · Availity · Infinitus · Thoughtful AI

How to automate this task

Task 5 · typically 60 min, every day

Post payments and match remittances

AutomationBest fix

Turn on automatic payment posting from electronic remittances

Electronic remittances (ERAs) can post payments and adjustments automatically. Staff only work the exceptions.

Typically saves about 65% of the time2 h to set up
  1. 1Enrol in ERA and EFT with your top payers.
  2. 2Turn on auto-posting in your PM system or clearinghouse.
  3. 3Set rules for what posts automatically and what goes to review.
  4. 4Work only the exceptions queue each day.

Tools: Your PM system · Waystar or Availity

How to automate this task

Task 6 · typically 45 min, every day

Do prior authorizations

Software featureBest fix

Submit prior authorizations electronically from the EHR

Electronic prior authorization pulls the patient and clinical details from the chart, shows the payer's questions, and often returns an answer in minutes. New federal payer rules are making this more common through 2026 and 2027.

Typically saves about 40% of the time1 h to set up
  1. 1Ask which ePA tools are connected to your EHR (CoverMyMeds or Surescripts for drugs; Availity, Cohere or your EHR's payer platform for services).
  2. 2Start the request from the order in the EHR instead of a fax form.
  3. 3Save templates for your most common requests.
  4. 4Track pending requests in one work queue instead of a spreadsheet.
  5. 5Only use tools your organization has approved and covered by a HIPAA business associate agreement (BAA) for anything with patient information.

Tools: CoverMyMeds · Surescripts · Availity · Cohere Health · Epic Payer Platform

One more way to fix it
AI

Have approved AI draft the appeal or letter of medical necessity

AI drafts a clear, well-structured appeal from the denial reason, the policy and the clinical facts. You check every fact and sign. Use only your organization's BAA-covered AI for anything with patient details.

Typically saves about 45% of the time10 min to set up
  1. 1Gather the denial letter, the payer policy and the key clinical facts.
  2. 2Use only your organization's approved, BAA-covered AI tool. If you do not have one, remove all patient identifiers first.
  3. 3Use the prompt below.
  4. 4Check every clinical fact and code before sending.
Prompt to copy
Draft an appeal letter for a denied [SERVICE / MEDICATION]. Denial reason: [PASTE REASON]. Payer policy criteria: [PASTE POLICY TEXT]. Clinical facts: [DIAGNOSIS, HISTORY, TREATMENTS TRIED AND RESULTS, WHY THIS IS NEEDED NOW]. Address each policy criterion one by one with the matching fact. Keep it under one page, professional and factual. Mark any criterion without supporting facts as [MISSING]. Do not invent clinical details.

Tools: Your organization's approved, BAA-covered AI assistant

How to automate this task

Task 7 · typically 45 min, every day

Check insurance eligibility and benefits

AutomationBest fix

Run insurance eligibility checks automatically before each visit

Batch eligibility checks run the night before and flag only the patients with a problem, instead of checking every patient by hand on payer websites.

Typically saves about 65% of the time2 h to set up
  1. 1Ask your billing team or clearinghouse to turn on batch real-time eligibility (Waystar, Availity, Experian Health or your PM system).
  2. 2Schedule it 1 to 3 days before appointments.
  3. 3Work only the flagged list each morning.
  4. 4Call patients about coverage problems before they arrive.

Tools: Waystar · Availity · Experian Health · Your PM system

How to automate this task

Task 8 · typically 45 min, every day

Answer patient questions about bills

Software featureBest fix

Give patients clear online bills, text-to-pay and payment plans

Clear digital statements with a pay link and self-service payment plans answer most billing questions before patients call.

Typically saves about 40% of the time2 h to set up
  1. 1Check whether your PM system or billing partner offers text-to-pay and online statements (Cedar, Phreesia, InstaMed, Waystar, Rectangle Health).
  2. 2Turn on self-service payment plans.
  3. 3Add a short FAQ about common bill questions to the statement.
  4. 4Track call volume before and after.

Tools: Cedar · Phreesia · InstaMed · Waystar · Rectangle Health

One more way to fix it
Software feature

Let a healthcare AI phone agent handle routine calls

Healthcare voice agents (with a BAA) answer, book and reschedule appointments, take refill requests and answer simple questions, and pass clinical or upset callers to staff.

Typically saves about 40% of the time4 h to set up
  1. 1Pull a week of call reasons from your phone system.
  2. 2Pick the routine ones (scheduling, directions, refill requests, billing balance).
  3. 3Trial an AI phone agent built for healthcare with a BAA (for example Hyro, Assort Health, Notable or Hello Patient).
  4. 4Connect it to your scheduling system and set clear handoff rules.
  5. 5Listen to a sample of calls weekly.

Tools: Hyro · Assort Health · Notable · Hello Patient

How to automate this task

Task 9 · typically 30 min, every day

Copy the same information between systems or spreadsheets

AutomationBest fix

Connect the two systems so data moves itself

A Zapier, Make, n8n or Power Automate flow copies new records from one system to the other the moment they appear.

Typically saves about 80% of the time2 h to set up
  1. 1Write down the trigger ("new row in", "new form submission", "deal marked won") and where it should go.
  2. 2Check if the two tools already have a built-in integration; turn it on if so.
  3. 3If not, build a two-step flow in Zapier, Make, n8n or Power Automate.
  4. 4Run it next to your manual process for a week, then stop copying by hand.

Tools: Zapier · Make · n8n · Microsoft Power Automate

One more way to fix it
AI

Have AI pull the details out into a table you can paste

Paste emails, PDFs or forms and get back clean rows in the exact columns your system needs.

Typically saves about 60% of the time5 min to set up
  1. 1Collect the source text (emails, PDFs, screenshots).
  2. 2Give the AI the column names you need.
  3. 3Paste the table into your spreadsheet or import file.
  4. 4Spot-check a few rows against the source.
Prompt to copy
Extract the following fields from the text below into a table with exactly these columns: [COLUMN 1], [COLUMN 2], [COLUMN 3]. One row per [ITEM]. Leave a cell blank if the value is not stated. Do not guess.

[PASTE TEXT OR ATTACH FILES]

Tools: ChatGPT, Claude, Gemini or Microsoft Copilot

How to automate this task

Task 10 · typically 60 min, once a week

Build or update spreadsheet reports by hand

AIBest fix

Let AI build the formulas, pivots and summary

Copilot in Excel, Gemini in Sheets, or uploading the file to ChatGPT or Claude can build the pivot, the chart and the commentary in minutes.

Typically saves about 50% of the time10 min to set up
  1. 1Export or open the data.
  2. 2Ask Copilot in Excel or Gemini in Sheets, or upload the file to an approved AI assistant.
  3. 3Describe the report you want, including the breakdowns.
  4. 4Check the totals against the source before you share.
Prompt to copy
Here is [DESCRIBE THE DATA]. Build a summary that shows [THE NUMBERS YOUR MANAGER WANTS] by [BREAKDOWN], compared with [LAST PERIOD]. Give me the Excel formulas or pivot setup to reproduce it, and three sentences on what changed and why it matters.

Tools: Copilot in Excel · Gemini in Google Sheets · ChatGPT or Claude with file upload

One more way to fix it
Automation

Build the report once so it refreshes itself

Connect the spreadsheet or dashboard straight to the source so next week's report is already done.

Typically saves about 80% of the time4 h to set up
  1. 1List where each number comes from.
  2. 2Use Power Query (Excel), a connected sheet, or a Google Data Studio or Power BI dashboard pulling from the source.
  3. 3Schedule the refresh and send the link instead of an attachment.

Tools: Excel Power Query · Power BI · Google Data Studio (formerly Looker Studio) · Google Sheets connectors

How to automate this task

Task 11 · typically 45 min, every day

Sort through and reply to email

AIBest fix

Have AI draft replies to routine email

Paste the thread and a one-line instruction; edit the draft instead of writing from a blank page. Most routine replies take a minute instead of five.

Typically saves about 35% of the time5 min to set up
  1. 1Open the AI assistant your company allows (or the one built into Outlook or Gmail).
  2. 2Paste the email thread, or use the built-in "draft reply" button.
  3. 3Tell it the point you want to make in one line.
  4. 4Read the draft, fix anything wrong, and send.
Prompt to copy
Draft a reply to the email below. My point: [WHAT YOU WANT TO SAY IN ONE LINE]. Keep it under 120 words, friendly and direct, and match the tone of the sender. Do not invent facts or commitments.

Email:
[PASTE THE EMAIL]

Tools: ChatGPT, Claude, Gemini or Microsoft Copilot · Gmail "Help me write" or Outlook Copilot

One more way to fix it
Process fix

Batch email twice a day and let rules file the noise

Rules move newsletters, notifications and CCs out of your inbox, and checking at set times stops email from cutting your day into pieces.

Typically saves about 25% of the time20 min to set up
  1. 1Create rules that move notifications, newsletters and emails where you are only CC'd into folders.
  2. 2Turn off desktop and phone notifications for email.
  3. 3Pick two or three set times a day to process the inbox to zero.
  4. 4Tell your team that anything urgent should come by phone or chat.

Tools: Outlook or Gmail rules

How to automate this task

Quick wins

Have you tried…

Have you had AI draft a reply to a tricky or routine email?
You paste the email and say the point you want to make; the AI writes a draft you edit. Outlook and Gmail now have this built in.
Have you connected two apps so information copies itself between them?
Tools like Zapier, Make or Power Automate watch for something new in one app and create it in the other, so nobody retypes it.
Have you asked AI to build a spreadsheet formula, pivot or chart for you?
You describe the result you want in plain words, and Copilot in Excel or Gemini in Sheets builds it. ChatGPT or Claude can also analyze an uploaded file.
Have you used an ambient AI scribe that drafts your visit note while you talk with the patient?
With the patient's consent, an approved tool like Microsoft Dragon Copilot or Abridge listens to the visit and drafts the note for you to check and sign. Only use the tool your organization has approved.
Do you submit prior authorizations electronically from the EHR instead of by fax?
Electronic prior authorization fills in the patient details from the chart and often gets an answer in minutes. Tools include CoverMyMeds and payer platforms linked to your EHR.
Have you had your organization's approved AI draft an appeal letter?
AI can draft a clear appeal that answers the payer's criteria one by one. Use only the BAA-covered tool your organization approves, and check every fact.
Has your clinic tried an AI phone agent for booking and routine calls?
Healthcare AI phone agents book and move appointments and take refill requests, and pass anything clinical to staff. They must be covered by a HIPAA agreement.
Have you let an AI notetaker write your meeting notes and action items?
Tools like Copilot in Teams, Zoom AI Companion or Otter join the call, write the summary and list who owes what. You just check it and send.

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