AI-Accelerated Revenue Diagnosis

The Challenge

Goldilocks Pediatrics is a solo nurse-practitioner pediatric practice in Buckhannon, West Virginia, that opened in January 2026. Its claims were filed through athenahealth's full-service billing service, but five months in, collections were running well below what the practice had charged, and the billing reports did not explain why. The owner could not tell whether the outstanding balance was lost, delayed, or recoverable. A practice of this size has no billing analyst on staff to reconcile thousands of line items and find out.

Our Solution

Convective used Claude to reconcile the practice's full accounts receivable and segment every charge by claim status and age. The analysis traced the shortfall to the front of the billing cycle: payer enrollment gaps and athenahealth scrubber rejections, concentrated in three West Virginia Medicaid managed-care plans. The claims were not failing on clinical coding. A second, independent pass reproduced every figure before the findings went to the client. The result was a clear account of where the receivable stood and what it would take to recover it. The engagement ran in full HIPAA compliance, with all practice and patient data protected throughout.

Results

• Reconciled about $123,000 in outstanding receivables across 830 charges in a single afternoon, a task that would take a biller days by hand
• Identified roughly $54,000 held inside the practice's own billing workflow, the portion fastest to recover
• Traced the shortfall to payer enrollment and claim-scrubber rejections concentrated in three West Virginia Medicaid plans, not to coding errors
• Flagged about $49,000 in claims approaching timely-filing deadlines for immediate attention
• Reproduced every figure in an independent second pass before delivery
• Ran the engagement in full HIPAA compliance, protecting all practice and patient data
• Gave the owner a clear, prioritized view of the practice's receivables

Technologies Used