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AI agent for team leads

Coding Backlog Triage Agent

High-value, aging and complex charts are coded first by the right coder

PlanningAutomationHealthcareManagement
See how it worksGet access
Coding Backlog Triage Agent: what goes in, what the agent does and what you get

What it does

Coding supervisors watch the discharged-not-final-billed list grow while coders pick charts in the order they appear. This agent sorts the backlog every morning. It reads each uncoded encounter, checks whether documentation is complete, estimates complexity from length of stay, procedure count and service line, and checks days since discharge against the payer filing window. It then builds work lists by coder skill and credential. Charts missing a discharge summary or op note are moved to a documentation-pending list with a reminder draft for the provider. After coders work the lists, it checks midday whether high-priority charts were opened; if not, it rebalances. The supervisor approves every reassignment. Edge case: a trauma chart with ten procedures goes only to coders credentialed for inpatient surgery, even if their list is already longer.

How it works

Follow the arrows from top to bottom. The orange dashed arrow is the loop: when a check fails, the agent goes back and tries again.

Start and resultWhat it doesA check on its own workWaits for your OKGoes back and retries
Yes, continueApprovedYes, continueNoNo 1 STARTS WHEN Morning backlog pull at 7 am 2 USES A TOOL Read unbilled encounters with charges and dischargedates 3 CHECKS THE RESULT Is the documentation complete enough to code? If not: move the chart to documentation pending anddraft a provider reminder. Back to step 2. 4 DOES Score each chart by age, charges, filing deadlineand complexity 5 DOES Match charts to coders by credential and skill 6 YOU APPROVE Supervisor approves the work lists and providerreminders 7 USES A TOOL Publish work lists to the coding queue 8 CHECKS THE RESULT At noon, are top-priority charts opened? If not: rebalance unopened charts to coders with freecapacity. Back to step 5. 9 RESULT Daily backlog report with aging by bucket
Read the steps as a list
  1. Morning backlog pull at 7 am
  2. Read unbilled encounters with charges and discharge dates
  3. Is the documentation complete enough to code?If not: move the chart to documentation pending and draft a provider reminder. Back to step 2.
  4. Score each chart by age, charges, filing deadline and complexity
  5. Match charts to coders by credential and skill
  6. Supervisor approves the work lists and provider remindersThe agent waits here for your OK.
  7. Publish work lists to the coding queue
  8. At noon, are top-priority charts opened?If not: rebalance unopened charts to coders with free capacity. Back to step 5.
  9. Daily backlog report with aging by bucket

How it decides

It scores each chart by days since discharge, estimated charge, filing deadline and complexity, then matches the score to coder skill.

  • Charts within 10 days of a filing limit go first
  • Inpatient surgical charts go only to credentialed coders
  • Charges over $50,000 are worked within 2 days of discharge
  • Charts with missing op notes wait in pending, not in a coder list

Make it yours

Every agent is a starting point. You choose these settings for your own situation.

  • Scoring weights for age, dollars and deadline
  • Days before filing limit that counts as urgent (default 10)
  • Rebalance time (default noon)
  • Coder capacity per day by chart type

What keeps you in control

It always asks you first

  • Supervisor approves work list assignments
  • Supervisor approves reminders sent to providers

Hard limits

  • Never sends provider reminders without approval
  • Never assigns charts outside a coder's credential
  • Does not change any codes

It stops when

  • Done: every chart assigned or pending
  • Stop: encounter feed failed to load

Set it up

We guide you through the set-up, step by step

Members get the full set-up guide for this agent. No technical skills needed: you copy, paste and upload.

10 minto set it up in your AI
5 AIsChatGPT, Claude, Copilot, Gemini, Grok
  • One set of instructions to paste into your AI, with the clicks for ChatGPT, Claude, Microsoft 365 Copilot, Gemini and Grok
  • The agent then walks you through connecting your own data, one source at a time
  • A downloadable copy with the flow chart, the rules and the full guide
Get access to this agent

An example run

What happensOn 3 April the backlog had 412 charts. The agent moved 37 to documentation pending, including 9 missing op notes, and drafted reminders. It put a $96,000 cardiac case at the top of Maria's list. At noon the check showed 6 top charts unopened because Maria was in training. The agent shifted them to Sam, and supervisor Jo Reyes approved.

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