AlterMed RCM Company Profile

Background

Overview

AlterMed RCM is a healthcare revenue cycle management (RCM) company specializing in medical coding, billing, and provider credentialing services. Established in 2024, the company is headquartered in Pennsauken, New Jersey, United States. AlterMed RCM is dedicated to enhancing the financial performance of healthcare providers by streamlining administrative processes and ensuring compliance with industry standards.

Mission and Vision

AlterMed RCM's mission is to provide comprehensive and efficient RCM solutions that maximize revenue for healthcare providers while maintaining the highest standards of accuracy and compliance. The company's vision is to become a trusted partner for healthcare practices, enabling them to focus on patient care by handling the complexities of revenue cycle management.

Primary Area of Focus

The company's primary focus is on delivering end-to-end RCM services, including medical coding, billing, and provider credentialing. By offering these services, AlterMed RCM aims to improve cash flow, reduce claim denials, and ensure timely reimbursements for healthcare providers.

Industry Significance

In the evolving healthcare landscape, efficient revenue cycle management is crucial for the financial sustainability of medical practices. AlterMed RCM plays a significant role in this sector by providing specialized services that address the challenges associated with billing, coding, and credentialing, thereby contributing to the overall efficiency and profitability of healthcare providers.

Key Strategic Focus

Core Objectives

AlterMed RCM's core objectives include:

Maximizing revenue for healthcare providers through optimized billing and coding processes.

Ensuring compliance with healthcare regulations and industry standards.

Reducing claim denials and accelerating reimbursement cycles.

Providing tailored RCM solutions that cater to the unique needs of each healthcare practice.

Specific Areas of Specialization

The company specializes in:

Medical Coding & Billing: Ensuring accurate coding and billing to facilitate prompt and correct reimbursements.

Provider Credentialing: Managing the credentialing process to enable providers to participate in insurance networks and receive reimbursements.

Medical Billing Consulting: Offering expert advice to optimize billing processes and improve financial performance.

Key Technologies Utilized

AlterMed RCM employs advanced technologies to enhance its services, including:

Medical Coding Software: Utilizing certified coders proficient in ICD-10, CPT, and HCPCS coding standards to ensure accuracy and compliance.

Billing Management Systems: Implementing systems that streamline claim submission, payment posting, and denial management.

Credentialing Platforms: Using platforms that facilitate efficient provider credentialing and re-credentialing processes.

Primary Markets Targeted

The company's services are designed for a diverse range of healthcare providers, including:

Physician Practices: Supporting individual and group practices across various specialties.

Hospitals: Assisting in managing complex billing and credentialing processes.

Durable Medical Equipment (DME) Suppliers: Ensuring accurate billing and coding for DME services.

Behavioral Health Providers: Addressing the unique billing and credentialing needs of mental health professionals.

Financials and Funding

Funding History

As of the latest available information, AlterMed RCM has not publicly disclosed details regarding its funding history, total funds raised, or specific funding rounds. The company operates as a private entity, and such financial information is not readily accessible.

Notable Investors

Due to the private nature of the company, specific details about investors are not publicly available.

Intended Utilization of Capital

While specific utilization plans are not disclosed, it is common for companies in the RCM sector to allocate capital towards:

Technology Development: Enhancing software platforms and integrating new technologies to improve service delivery.

Staff Expansion: Hiring additional personnel to support growing client needs and service offerings.

Market Expansion: Exploring new geographic markets and expanding the client base.

Pipeline Development

AlterMed RCM focuses on continuous improvement and expansion of its service offerings. Key areas of development include:

Service Expansion: Introducing new services such as payer enrollment, licensing services, primary source verification, privileging, and CAQH profile management to provide comprehensive RCM solutions.

Technology Integration: Developing proprietary software solutions like CredHawk to streamline credentialing, licensing, and payer enrollment processes.

Client Acquisition: Targeting a broader range of healthcare providers to diversify the client portfolio and increase market share.

Technological Platform and Innovation

Proprietary Technologies

AlterMed RCM has developed CredHawk, an all-in-one software designed to simplify credentialing, licensing, and payer enrollment processes. This platform aims to enhance efficiency and accuracy in managing provider credentials.

Significant Scientific Methods

The company employs certified coders proficient in ICD-10, CPT, and HCPCS coding standards to ensure compliance and accuracy in claim submissions. Additionally, AlterMed RCM utilizes advanced billing management systems to streamline claim submission, payment posting, and denial management processes.

Leadership Team

Ajay Gurung – CEO & Founder

Professional Background: Ajay Gurung serves as the CEO and Founder of AlterMed RCM. Prior to founding the company, he worked at Nath Outsourcing Solutions Pvt. Ltd. as a Senior Team Lead in Accounts Receivable. He holds a Bachelor of Science in Zoology, Chemistry, and Botany from Hemwati Nandan Bahuguna Garhwal University.

Tashi Gialchhan – Co-Founder

Professional Background: Tashi Gialchhan is the Co-Founder of AlterMed RCM. Before co-founding the company, he served as Manager of Healthcare Services at Apaana and as Team Lead in Credentialing at EMPClaims. He earned a Bachelor of Commerce from Chandigarh University.

John Negi – Co-Founder

Professional Background: John Negi is the Co-Founder of AlterMed RCM. He previously worked as a Credentialing Subject Matter Expert at Knack Global. He holds a Bachelor of Commerce in Accounting and Business Management from Swami Vivekanand Subharti University.

Competitor Profile

Market Insights and Dynamics

The healthcare revenue cycle management industry is experiencing significant growth, driven by the increasing complexity of billing and coding processes, regulatory changes, and the need for healthcare providers to optimize financial performance. The market is characterized by a diverse range of service providers, from large, established companies to emerging startups offering specialized solutions.

Competitor Analysis

Key competitors in the RCM industry include:

R1 RCM Inc.: A leading provider of RCM services, offering comprehensive solutions to hospitals, health systems, and physician groups across the United States. R1 RCM provides services such as pre-registration, financial clearance, charge capture, coding, billing, and follow-up.

Change Healthcare: A healthcare technology company that provides a comprehensive suite of solutions for revenue cycle management, payment management, and health information exchange. Change Healthcare offers data-driven RCM analytics, self-service clearinghouses for claims processing, and payment accuracy tools.

AltuMED: A Michigan-based medical billing company that focuses on maximizing reimbursements and providing a stress-free billing experience for medical practices, healthcare systems, and medical billing companies.

Strategic Collaborations and Partnerships

AlterMed RCM has developed strategic partnerships to enhance its service offerings:

CredHawk: The company has developed CredHawk, an all-in-one software designed to simplify credentialing, licensing, and payer enrollment processes, aiming to streamline administrative tasks for healthcare providers.

Operational Insights

AlterMed RCM differentiates itself through:

Specialized Services: Offering tailored RCM solutions that cater to the unique needs of various healthcare specialties.

Technological Innovation: Developing proprietary software like CredHawk to enhance efficiency in credentialing and billing processes.

Client-Centric Approach: Focusing on building strong relationships with clients to understand their specific challenges and provide customized solutions.

Strategic Opportunities and Future Directions

AlterMed RCM is well-positioned to capitalize on several strategic opportunities:

Service Diversification: Expanding service offerings to include payer enrollment, licensing services, primary source verification, privileging, and CAQH profile management to provide comprehensive RCM solutions.