Healthcare Revenue Cycle Management (RCM)

Document Type

Abstract

Publication Date

Spring 5-1-2025

Abstract

Healthcare Revenue Cycle Management (RCM) is critical for hospitals to track patient payments, insurance claims, and denials effectively. This project addresses the financial risks associated with delayed payments by building a scalable data engineering pipeline on Microsoft Azure services. The system ingests heterogeneous data from simulated electronic medical records (EMR), insurance claims, and public APIs (ICD/NPI codes), and transforms raw data into actionable financial metrics/KPIs. The project leverages Azure SQL DB for storage, Azure Data Factory for ingestion, Azure Databricks for transformation, and Delta Lake tables in a medallion architecture (bronze, silver, gold layers) to ensure data quality and historical tracking. Key performance indicators (KPIs), such as accounts receivable aging (>90 days) and average days in AR, are derived from harmonized fact and dimension tables, empowering hospital administrators to identify bottlenecks, prioritize follow-ups, and reduce defaults. By automating data integration and analytics, this solution helps healthcare providers balance financial health with uninterrupted patient care.

Comments

Completed as part of the Computer Science Senior Capstone Project.

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