Models and agents for healthcare back-office work
Oakmont trains domain-specific models and deploys agents into complex healthcare back-office workflows.
Automation run
WF-2419-0114
Approved to submit
- Work item
- Payer records request
- Function
- Documentation operations
- Assigned agents
- Document + Policy + Payer Ops
- Systems accessed
- EHR · document repository · fax / portal
- Human gate
- Records release approval
- Window
- 10 business days · 6 remain
Evidence required
Actions
- ✓Request classified
- ✓Records located
- ✓Packet assembled
- ✓Records release approved — M. Alvarez
- ●Submission ready
- ○Follow-up scheduled
Next action: submit packet through required channel
18 actions logged
What We Automate
Oakmont deploys models and agents into the operational tasks healthcare teams repeat every day: calls, letters, portal work, records requests, submissions, follow-up, payment review, and patient outreach.
Payer Calls & Follow-Up
Outbound payer calls, status checks, reference numbers, commitments, next-touch scheduling, and escalation when payer responses stall.
Patient Outreach
Patient calls, secure messages, COB requests, accident questionnaires, insurance updates, and compliant contact workflows with verification steps.
Letter & Appeal Generation
Medical necessity appeals, reconsideration letters, documentation cover letters, underpayment disputes, and payer-specific submission packets.
Records & Evidence Assembly
Medical records retrieval, missing-document checklists, itemized bills, operative notes, authorization records, policy citations, and evidence packets.
Payer Portal & Submission Workflows
Portal submissions, claim status checks, attachment uploads, corrected claim routing, confirmation capture, and payer reference tracking.
Contract & Payment Review
Expected reimbursement calculations, contract variance checks, underpayment validation, fee schedule review, and dispute packet preparation.
Work execution
From intake to resolution
Oakmont works administrative items through the required steps: finding the issue, gathering evidence, preparing the work product, routing exceptions for review, submitting through the right channel, following up, and logging every action.
Work queue
| Claim | Payer | Amount | Deadline | Issue | Oakmont action | Review owner | Status |
|---|---|---|---|---|---|---|---|
| CLM-2418-0093 | National PPO | $41,820 | Sep 12 · 39d | CO-50 · Medical necessity | Appeal drafted with clinical evidence packet | RN | Review required |
| CLM-2417-4406 | Regional HMO | $9,412 | Nov 18 | Contractual underpayment | Variance worksheet built against expected reimbursement | Managed Care | Ready to submit |
| CLM-2416-8821 | Medicare Advantage | $6,842 | Aug 22 | Records requested | Required records located and packet assembled | HIM | Approved to submit |
| CLM-2414-9917 | Commercial EPO | $18,206 | Sep 03 | Prior authorization mismatch | Auth timeline reconstructed; payer conflict found | Operator | ▲Escalated |
| CLM-2413-5540 | Regional HMO | $1,904 | Sep 05 | Coding edit · modifier conflict | Correction proposed with supporting documentation | Coder | Coder review |
| CLM-2412-7195 | National PPO | $11,220 | Sep 30 | Payer follow-up · no response 45d | Portal checked; prior references attached | None | Follow-up due |
| CLM-2411-2064 | Commercial PPO | $2,460 | — | COB / patient responsibility | Patient outreach sequence prepared | None | Outreach scheduled |
Each work item shows what Oakmont completed, what is pending review, and where the item stands on the path to resolution.
Selected work item
CLM-2418-0093
- Payer
- National PPO
- Amount
- $41,820
- Issue
- CO-50 · Medical necessity denial
- Appeal deadline
- Sep 12 · 39 days remain
Oakmont finding
Clinical documentation mapped to payer medical-necessity criteria
Evidence attached
- ✓Discharge summary
- ✓Progress notes d1–d4
- ✓ED record
- ✓Imaging report
- ✓Payer medical policy excerpt
- Review owner
- RN
- Status
- Review required
- Submission route
- Payer-required appeal channel
Next step
RN review before submission
Audit trail · CLM-2418-0093
Every action is logged: what Oakmont did, what source it used, what changed, and whether a human approved it
- Jul 22 09:41Denial received; CO-50 classified as medical necessity
- Jul 22 09:44Recoverability assessed; appeal deadline detected
- Jul 22 10:02Discharge summary, progress notes, ED record, and imaging report located
- Jul 23 08:15Payer medical policy mapped to clinical documentation
- Jul 23 08:16Appeal draft created with evidence packet attached
- Jul 23 08:22Routed to RN for clinical sign-off
- Jul 24 14:30RN approved with edit; strengthening note appended
- Jul 24 15:01Ready for payer-required appeal channel
- Aug 06 11:12Follow-up scheduled if no payer response is received
Methodology
How Oakmont builds back-office automation systems
Oakmont starts with the work as it actually runs: the queue, the documents, the systems, the decisions, the exceptions, and the people responsible for review. From there, we build the models, agents, controls, and feedback loops around the workflow.
Map the workflow
Identify the operational queue, inputs, decisions, systems, exceptions, and human gates.
Structure the data
Bring together documents, transactions, policies, history, work notes, outcomes, and system context.
Train and evaluate models
Build domain-specific evaluations for classification, extraction, reasoning, work product quality, and escalation accuracy.
Deploy agents
Connect agents to the tools, systems, and channels required to execute the workflow.
Add safeguards
Approval thresholds, human review, role-based permissions, PHI controls, and audit logging are built into the workflow.
Monitor and improve
Outcomes, exceptions, payer responses, and operator edits feed back into playbooks and model evaluation.
Oakmont acts where the work is well-defined, routes exceptions to the right reviewer, and records what happened at every step.
Models
Models built for healthcare administrative work
Oakmont’s models are trained and evaluated against domain-specific examples from healthcare operations — the documents, policies, work notes, and outcomes that determine what happens next.
Trained and evaluated on
Designed to interpret the letter, remit, or policy in front of it — including the unstructured parts that never reach a structured feed.
Grounded in payer medical policies, contract terms, and plan rules, so the reading reflects how this payer actually adjudicates.
Trained and evaluated on gap detection: the record, citation, or attachment a submission needs before it can succeed.
Built around operational paths — appeal, correction, documentation, follow-up, outreach — and the channel each one runs through.
Determines whether the work should move to appeal, correction, documentation, follow-up, outreach, submission, or resolution based on the available evidence and workflow rules.
Reads responses and results back into structured outcomes, so every workflow closes the loop it started.
Agents
Agents built to automate tasks
Oakmont agents execute the repetitive, rules-heavy work that surrounds every claim: reading requests, gathering records, drafting letters, submitting packets, checking status, calling payers, contacting patients, and logging outcomes.
01
Documentation Agent
Finds and assembles the records a workflow requires: discharge summaries, progress notes, operative notes, itemized bills, authorization records, payer letters, and missing-document checklists.
02
Policy Agent
Maps work items against payer policies, plan rules, contract language, and submission requirements so the next step is grounded in the right standard.
03
Payer Operations Agent
Works payer-facing tasks: portal checks, appeal submissions, attachment uploads, fax workflows, reference numbers, status calls, and next-touch scheduling.
04
Letter Agent
Generates the written work product: medical-necessity appeals, reconsideration letters, documentation cover letters, underpayment disputes, and patient-facing correspondence.
05
Patient Outreach Agent
Runs approved outreach workflows for COB, accident information, insurance updates, and patient-dependent claim blockers with verification steps before PHI is discussed.
06
Authorization Agent
Reconstructs authorization timelines, matches auth numbers to payer records, identifies mismatches, and prepares supporting documentation for correction or appeal.
07
Follow-Up Agent
Tracks payer commitments, schedules next touches, checks status, logs reference numbers, and escalates stalled work instead of letting it age silently.
08
Orchestration Agent
Coordinates the workflow across agents, systems, review steps, submissions, follow-ups, and final resolution.
Each agent handles a specific part of the workflow. Together, they move work from request to resolution while keeping the record of what happened intact.
Integrations
Connected to the systems already in place
Oakmont connects to the operational systems, files, portals, and queues that already carry the work — without requiring teams to replace the revenue cycle stack they run on.
Epic & EHR / PM systems
Claims, encounters, account history, documentation, and existing work queues.
835 / 837 feeds
Claims, remits, status, adjustments, and transaction history.
ERAs & EOBs
Denial codes, payer notes, adjustments, reason codes, and unstructured remittance detail.
Clearinghouses
Submission, status, remittance, attachments, and payer transaction workflows.
Payer portals
Appeal status, authorization detail, attachments, requests, and payer-specific actions.
Contract systems
Rates, terms, fee schedules, expected reimbursement, and variance support.
Document repositories
Medical records, itemized bills, correspondence, policies, and evidence packets.
Prior authorization records
Auth numbers, timelines, submissions, approvals, denials, and mismatches.
Internal work queues
Assignments, approvals, exceptions, escalations, and operator handoffs.
Trust & controls
Secured for controlled healthcare operations
Oakmont is designed for HIPAA-regulated workflows where every action needs ownership, reviewability, and clear operating rules. Approval thresholds, access controls, PHI handling, audit logs, deployment monitoring, and HITRUST-readiness are built into the way each workflow is deployed.
Review gates & approval thresholds
Clinical, coding, HIM, managed care, and operator review steps are configured by workflow, payer, dollar amount, exception type, and customer policy.
PHI-aware workflows
Role-based access, HIPAA verification, channel rules, and PHI handling are built into the workflow before any patient or payer interaction occurs.
Audit logs
Agent actions, source documents, submissions, call attempts, approvals, and escalations are timestamped and tied to the work item.
Escalation policies
Exceptions route to the right owner instead of aging silently, with rules for when agents act, ask, or stop.
Deployment controls, monitoring & HITRUST readiness
Workflows can be staged by payer, workflow type, queue, or threshold, with live monitoring and the ability to pause. Oakmont is being built with HITRUST-readiness in mind for enterprise healthcare deployment.
Security, compliance, and HITRUST-readiness details are available on request.
Team
Built by engineers and operators from AI, healthcare, and enterprise systems
Oakmont is built by people who have worked on production systems, healthcare operations, and the financial infrastructure behind large organizations. The team brings together engineering discipline with direct experience in the workflows healthcare teams run every day.
Prior team experience
Sachs
Get started
Bring Oakmont into your back office
See how Oakmont would work against the queues, documents, systems, and review steps your team already manages.
