Healthworks
AI-Powered Healthcare Coding Platform
Strengthening Hospital Coding Accuracy, Compliance, Revenue Integrity, and Workflow Accessibility Through AI-Powered Automation
Client Overview
Client: EVP Innovation
Industry: Healthcare revenue cycle, medical coding, and compliance technology
Objective: Protect revenue and reduce risk through accurate, defensible coding support while improving workflow accessibility for operational users.
Business Challenge
Healthcare organizations operate in a highly complex coding environment where record volume, regulatory pressure, and documentation variability create significant financial and compliance risk. Coding errors can result in denied claims, missed reimbursement, audit exposure, and inconsistent practices across teams.
At the same time, many organizations face a disconnect between technical and non-technical users, making it difficult to adapt workflows, manage data curation processes, and respond quickly without specialized development support.
HealthWorks partnered with ChampSoft to address these challenges by designing a platform that improves coding accuracy, strengthens compliance, supports better decision-making, and expands workflow accessibility across the hospital revenue cycle process.
Solution Overview
The Healthworks Platform was designed to streamline and automate the coding audit and education process within a secure, scalable cloud environment. Using AI-powered language models hosted on AWS Bedrock, the platform helps reduce manual effort while supporting higher-volume review workflows.
At the core of the platform is an orchestration layer that manages the end-to-end workflow, routes records through the appropriate coding steps, and enables structured processing of complex medical record inputs. This is supported by curated instruction libraries, reference content, and governed prompt management, all of which help drive more reliable and consistent coding decisions.
Before analysis begins, medical records are transformed into AI-ready inputs through pre-processing steps such as OCR, deduplication, and token optimization. These steps help preserve relevant clinical context while improving efficiency across downstream processing.
The platform is deployed within a secure AWS architecture designed to support enterprise-grade security and compliance requirements, while helping keep patient data contained within an authorized environment. Secure APIs, administrative controls, testing capabilities, and configurable workflow tools further support controlled access, operational oversight, and ongoing platform refinement by both technical and non-technical users.
Implementation
ChampSoft delivered the Healthworks Platform through a phased approach that combined business-context alignment with production-grade platform engineering. The implementation included a secure AWS foundation, medical record pre-processing, content and matrix management services, secure insights APIs, and operational tooling such as a testing harness and pipeline dashboard, along with workflow capabilities that made the platform more accessible to users with limited coding experience.
This delivery approach enabled the platform to support secure execution, scalable processing, and ongoing refinement in a real-world healthcare environment.
About Healthworks
Healthworks is a healthcare technology platform focused on improving medical coding accuracy, compliance, and revenue integrity. By leveraging AI-driven automation and structured workflows, it enables healthcare organizations to reduce risk, enhance decision-making, and streamline revenue cycle operations while making advanced tools accessible to both technical and non-technical users.
Root Causes of Human Coding Errors
The coding challenge is not only technical but also operational. Human coders are often required to work through large volumes of complex records while relying on fragmented references, evolving coding criteria, and manual interpretation.
This creates several common sources of error:
- Fatigue and oversight: High record volumes and complexity can lead to subtle but costly mistakes.
- Memorization over structured logic: Reliance on memory rather than standardized rules can reduce consistency.
- Experience-based variation: Individual judgment may replace traceable, repeatable coding logic, leading to uneven results across teams.
- Denials due to policy changes: Frequent payer and policy updates can be difficult to track manually, increasing the risk of outdated coding decisions, denied claims, and lost reimbursement.
Together, these issues can contribute to revenue leakage, compliance gaps, increased denials, and reduced confidence in coding quality.
Impact & Business Outcomes
- Increased transparency in coding decisions through traceable documentation and validation.
- Broader clinical insight from a more comprehensive review of the patient record.
- Greater consistency across coding workflows through payer-aligned logic and structured reference content.
- Improved audit readiness and stronger support for compliance-focused review.
- Better reimbursement defensibility through clearer coding rationale and documentation.
- Greater operational visibility through reporting, dashboard monitoring, and secure access to coding insights.
- Continuous improvement driven by review feedback, quality insights, and governed content updates.
- Reduced dependency on technical teams by enabling non-technical users to create and manage complex data curation workflows with minimal coding experience, improving accessibility and operational efficiency.
Key Features & Capabilities
Intelligent Coding Accuracy & Consistency
Accurate, consistent coding supported by curated instruction libraries, reference matrices, and governed prompt management.
AI-Ready Medical Record Pre-Processing
Medical record pre-processing with OCR, deduplication, and token optimization to prepare records for efficient AI analysis.
Proactive Coding Risk Detection
Early identification of coding risks tied to compliance gaps, revenue leakage, and operational exposure.
Enterprise-Grade Security & Compliance
Secure cloud architecture with encrypted storage, role-based access, MFA, and audit logging to support enterprise-grade data protection.
Secure Access & Platform Governance
Authenticated APIs, administrative controls, and dashboard visibility to support secure access, operational oversight, and platform governance.
Performance Testing & Continuous Monitoring
Testing and monitoring tools that help teams validate outputs, track pipeline performance, and improve platform reliability over time.
Configurable AI Workflow Automation
Configurable workflow creation that enables users with minimal coding experience to build and manage complex AI-supported data curation processes.
Why It Matters
Healthworks demonstrates ChampSoft’s ability to combine healthcare domain expertise with modern AI-enabled platform design to solve high-value revenue cycle challenges. By bringing together knowledge of provider workflows, coding complexity, compliance demands, secure cloud architecture, and governed AI operations, ChampSoft delivered a solution that helps healthcare organizations reduce risk, improve coding quality, protect revenue, and make advanced workflow capabilities more accessible to a broader range of users.