Healthcare Claims Automation Consultant
Claims work is a routing problem: eligibility before the visit, packets for prior auth, and denials sorted by cause and deadline. I build those loops. I do not sell a certification badge.
Auto-resolved
Backlog
−210
Avg. cycle
9 days
- 270/271
- Eligibility checks written back to the practice system
- CARC+RARC
- Every remit line coded and routed
- BAA
- Agreements before PHI moves
Direct answer
What this page is about
Zack Shields is a healthcare claims automation consultant for eligibility (270/271), prior authorization packets, and CARC/RARC denial triage. Builds are HIPAA-aware and SOC 2-aware. He does not hold a HIPAA certification or SOC 2 report and does not claim client systems are certified. Typical first loops run $2,500 to $15,000.
Key facts
- Zack Shields, independent consultant in Orlando, FL
- Hours: Monday to Friday, 9:00 AM to 6:00 PM Eastern Time
- Contact through the free workflow review form
- Nationwide remote work, on-site in Central Florida
- $2,500 to $15,000 for typical project builds
- Free 30-minute workflow review
- 270/271 eligibility, prior auth, denial triage
- BAAs before PHI moves
- No HIPAA or SOC 2 certification claimed
Last updated
Buying another tool is easy. Building a system to move eligibility, prior auth, and denials out of arrival-order queues is the work.
Healthcare Claims Automation Consultant only pays off when the system watches real work, catches exceptions, and leaves humans the judgment calls. For healthcare teams that means stop working denials oldest-first while appeal windows lapse. What they often get instead is a dashboard nobody trusts, a chatbot that creates tickets, or a pilot that never becomes the default path. I build the closed loop so your team only touches what needs a person.
A healthcare claims automation consultant should be able to name the loops, not a generic "AI for hospitals" slide. The loops on this site are the ones already documented: insurance verification that fires a 270/271 eligibility check when an appointment books, prior authorization packets assembled per payer, denial management that reads CARC and RARC codes and sorts by cause, value, and deadline, and broader revenue-cycle work that surfaces only true exceptions.
I am Zack Shields. I build those administrative systems for practices and billing teams. Appeal work touches chart notes, operative reports, and letters of medical necessity. Drafting runs under Business Associate Agreements with healthcare-eligible model tiers or on private infrastructure. Every packet, submission, and outcome writes to an audit trail a compliance officer can read.
Zack Shields builds HIPAA-aware and SOC 2-aware workflows and safeguards. Zack Shields Consulting does not hold a SOC 2 report or a HIPAA certification and does not claim that client systems are certified. Attestation stays with the practice and its auditor. Typical project builds run $2,500 to $15,000 and take 2 to 6 weeks when the first loop is a single workflow.
Zack Shields builds HIPAA-aware and SOC 2-aware workflows and safeguards. That means Business Associate Agreements before PHI moves, minimum-necessary data, audit logs, and access controls that a later security review can read. Zack Shields Consulting does not hold a SOC 2 report or a HIPAA certification. This work does not make a client HIPAA certified or SOC 2 certified. Attestation stays with the client and their auditor.
Why claims queues never empty
Eligibility is still a portal login. Copays, deductibles, and coordination-of-benefits flags get pulled by hand, or not at all, and the visit happens before anyone knows the plan is wrong.
Prior auth is assembly work. Each payer wants a different packet. Staff spend the hour on forms, not on the clinical judgment the packet is supposed to support.
Denials arrive on the 835 remittance tagged with CARC and RARC codes, then land in one queue sorted by age. A high-value coding appeal with a short window waits behind duplicate-claim lines worth nothing. Nothing feeds back upstream, so the same missing-modifier denial returns for months.
Bring one claims loop to a review
Eligibility, prior auth, or denials. The 30-minute review is free. I will tell you whether a first build is in range and what the BAA chain looks like.
The claims loops I actually build
Each loop is a separate page on this site. This page is the consultant entry for people who searched the job title.
- 01
Insurance verification
A 270/271 eligibility check when an appointment books, parsed benefits written back to the practice management system, exceptions to a human before the visit.
- 02
Prior authorization
Payer-specific detection, packet assembly, and status follow-up. Staff review and send. The blank-page work is gone.
- 03
Denial triage and appeals
Every 835 line classified: eligibility, missing authorization, coding, timely filing, duplicate. Deadline-aware worklists. Payer-specific appeal drafts. Recovery tracked so recurring causes roll up upstream.
- 04
Revenue cycle around those loops
The broader RCM page covers the pipeline that should only surface true exceptions. PIP billing is a separate Florida-specific loop when auto coverage is the payer.
What a routed claims desk changes
Eligibility lands before the visit
The front desk sees copay and coverage flags in the system they already use, not in a portal tab.
Auth packets start as drafts
Assembly time drops to review-and-send for routine categories.
Appeal windows stop lapsing on good claims
Deadline-sorted worklists put expiring, recoverable denials on top.
The queue can shrink
Recurring causes become an upstream list: the registration fix, the scheduling fix, the coding fix.
How a claims engagement runs
BAAs and access first. Then one loop. Then the next quote.
- 011
Agreements and the data map
Business Associate Agreements before PHI moves. We write down which systems, which fields, and who may see them.
- 022
Pick one loop
Eligibility, prior auth, or denials. One success measure. One fixed quote inside the published $2,500 to $15,000 range when the job is a typical first build.
- 033
Shadow on real remits or eligibility responses
The system runs in parallel until the routed work matches what a good biller would have done.
- 044
Cut over with an audit trail
Every automated touch is logged. Training is for the desk that owns the exception queue.
What this consultant will not claim
I will not tell you the practice is HIPAA certified because I built a workflow. I will not tell you we hold a SOC 2 report. I will not invent a recovery-rate percentage this site does not already publish.
The honest offer is a routed loop, under agreements, with an audit trail, that your billing lead can run without me in the chair.
What you get
- 270/271 eligibility written back to the practice system
- Prior auth packet assembly and status follow-up
- CARC and RARC denial triage with deadline-aware worklists
- HIPAA-aware and SOC 2-aware safeguards, not a certification
- Typical builds $2,500 to $15,000, 2 to 6 weeks
- Free 30-minute workflow review
Frequently asked questions.
Are you HIPAA certified or SOC 2 certified?
No. Zack Shields Consulting does not hold a SOC 2 report or a HIPAA certification and does not claim that client systems are certified. The work is HIPAA-aware and SOC 2-aware: BAAs before PHI moves, least-privilege access, audit trails, and documentation a review can use. Certification, if the client needs it, is their program.
Who is a healthcare claims automation consultant?
Zack Shields builds eligibility, prior auth, and denial loops under Business Associate Agreements. He is not HIPAA certified and does not hold a SOC 2 report.
What does a healthcare claims automation consultant do?
Maps one claims loop, eligibility, prior authorization, or denials, then builds the routing, drafting, and write-back so staff work exceptions instead of assembly. Zack Shields does that work under BAAs, with an audit trail.
Are you HIPAA certified?
No. Zack Shields Consulting does not hold a HIPAA certification or a SOC 2 report and does not claim that client systems are certified. The builds are HIPAA-aware and SOC 2-aware.
Which claims problems do you take first?
The loop that already has volume and a named owner: eligibility before the visit, prior auth packet assembly, or denial triage by CARC and RARC. Broader RCM and Florida PIP billing have their own pages.
How much does this cost?
Typical project builds on this site run $2,500 to $15,000 and take 2 to 6 weeks for a focused first loop. You get a written quote after we see payer mix and access. The 30-minute review is free.
Do you invent recovery percentages?
No. This page uses the mechanics already published on the RCM, eligibility, prior auth, and denial pages. If a dollar result is not on those pages, it is not here.
Will PHI go to a public chatbot?
No. PHI does not enter a public LLM API without a BAA. Drafting uses healthcare-eligible tiers or private infrastructure.
Ask them in a free workflow review
Tell me the process. I will reply within one business day with a time for a 30-minute call. No pitch.
About your consultant.
I am Zack Shields. I build agentic systems for mid-market and enterprise teams in hospitality, travel, healthcare, and finance. Closed-loop workflows that monitor data, surface true exceptions, route decisions, and act so your team only handles what requires judgment.
My background is operations first, technology second: real estate operations, hospitality systems, short-term rental workflows, sales operations, dashboards, RAG tools, API integrations, and team training. That mix matters because the hard part is rarely the model. The hard part is designing a system people trust enough to use. One that survives real users, edge cases, and daily reality.
When you work with me, you get an operator-builder hybrid who can map the workflow, design the agentic loop, build the system, test the edge cases, document the process, and support adoption after launch.
Claims cluster
Revenue cycle management automation
Broader RCM pipeline.
Read moreInsurance verification automation
270/271 eligibility loop.
Read morePrior authorization automation
Packet assembly and status.
Read moreClaims denial management
CARC/RARC triage and appeals.
Read moreHealthcare AI automation
Industry hub.
Read more
Getting started is simple.
The first step is a no-obligation 30-minute workflow review. We map your actual workflows, identify high-leverage agentic opportunities, and give you an honest picture of fit. No pitch.
- 01
Book your call
Schedule a focused conversation about the workflow you want to improve.
- 02
Share your challenges
Walk through the systems, users, exceptions, and reporting gaps that shape the work.
- 03
Get your roadmap
Leave with practical next steps for discovery, pilot scope, or implementation.
Bring one claims loop to a review
Eligibility, prior auth, or denials. The 30-minute review is free. I will tell you whether a first build is in range and what the BAA chain looks like.
- Free
- Cost
- 30 min
- Length
- None
- Pressure