Build AI Agents for Medical Billing Automation

Full-Cycle AI RCM Agent for eClinicalWorks (EHR UI Automation + AI Voice Agent) ### **Project Summary** We are seeking an experienced **AI, RPA, and Telephony Systems Engineer** (or specialized Dev Team) to build a fully autonomous Revenue Cycle Management (RCM) agent that handles the **complete end-to-end medical claims cycle** inside **eClinicalWorks (eCW)** without API access. The system will leverage a combination of **browser/vision automation (Playwright/Stagehand)**, **Medical LLMs (Claude 3.5 Sonnet / GPT-4o)**, and a **Live AI Voice Agent (Retell AI/Vapi + Twilio)** to create claims, post payments from 835 ERAs, call insurance payers on the phone to resolve denials, and resubmit corrected claims. --- ### **Core Responsibilities & Technical Scope** #### **Module 1: Claim Generation & eCW UI Automation** * Build resilient browser automation scripts (Python + Playwright / Stagehand / Computer Vision) to log into eCW, read clinical encounter notes, and extract billable data. * Integrate an LLM agent to validate ICD-10/CPT coding compatibility, NCCI edits, and required modifiers. * Automate the entry of line items into eCW’s Claim Entry screen, run eCW claim scrubbing, and handle UI popups/errors. #### **Module 2: ERA 835 Parsing & Payment Posting** * Automate the daily retrieval of 835 Electronic Remittance Advice (ERA) files from eCW/clearinghouse directories. * Parse 835 files to post payments, patient responsibility, and contractual write-offs to patient ledgers in eCW. * Automatically capture CARC/RARC denial codes (e.g., CO-16, CO-45) and route failed claims to an active AR Follow-Up Queue. #### **Module 3: AI Voice Agent for Insurance Follow-Up (Inbound/Outbound Telephony)** * Develop a conversational AI Voice Agent using **Retell AI, Vapi, or Bland AI** integrated with **Twilio**. * Program the agent to dial insurance payer customer service lines and dynamically navigate complex IVR phone trees using DTMF tones (passing NPI, TIN, Member ID, DOS). * Enable the agent to speak with human insurance reps to inquire about claim status, obtain denial reasons, ask for claim re-processing, and secure call reference numbers. * Transcribe, summarize, and auto-attach call logs and reference numbers to the claim file in eCW. #### **Module 4: Denial Resolution & Resubmission Engine** * Automate claim corrections in eCW based on structured call outcomes (e.g., adding missing modifiers, updating subscriber IDs). * Generate AI-written clinical appeal letters for medical necessity denials. * Provide a Web Dashboard / Human-in-the-Loop interface for staff to review high-dollar exceptions or complex denials. --- ### **Required Technical Stack** * **Web & UI Automation:** Python, Playwright, Puppeteer, Stagehand, or Anthropic Computer Use / Vision LLMs. * **AI & NLP:** OpenAI API (GPT-4o/Realtime), Anthropic Claude 3.5 Sonnet, LangChain/LlamaIndex. * **Telephony / Voice AI:** Retell AI, Vapi.ai, Bland AI, Twilio API, WebRTC, Deepgram (STT), ElevenLabs/Cartesia (TTS). * **EDI & Billing Formats:** Experience parsing HIPAA EDI 835, 837, and 277 response files. * **Security:** Strict HIPAA compliance, encrypted payload storage, and BAA-compliant infrastructure. --- ### **Application Requirements** When applying, please submit: 1. Examples of UI automation/RPA tools or browser agents you have deployed in production. 2. Experience building AI Voice Agents (specifically handling IVR navigation or inbound/outbound phone calls). 3. Any prior experience with healthcare RCM, medical coding, or EHR software (eClinicalWorks, Epic, AthenaHealth).