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Healthcare Industry Workflows

Version: 1.0.0 Last Updated: December 12, 2025 Industry: Healthcare Total Workflows: 50

Workflow Overview​

This document provides 50 comprehensive healthcare H.P.006-WORKFLOWS designed for healthcare organizations to streamline operations from patient management through clinical operations, revenue cycle, compliance, and administrative tasks. Each workflow includes automated steps, dependencies, quality assurance integration, and execution guidance.

Key Features:

  • Automated healthcare H.P.006-WORKFLOWS for improved efficiency
  • Integration with healthcare H.P.001-AGENTS (healthcare-specialist, compliance-auditor, clinical-specialist)
  • Quality assurance checkpoints for validation and review
  • Comprehensive coverage across all healthcare operational areas

Workflow Checklist​

  • Prerequisites verified
  • Configuration applied
  • Process executed
  • Results validated
  • Documentation updated

Workflow Steps​

  1. Initialize - Set up the environment
  2. Configure - Apply settings
  3. Execute - Run the process
  4. Validate - Check results
  5. Complete - Finalize workflow

Table of Contents​

Phase 1: Discovery​

Before implementing healthcare H.P.006-WORKFLOWS, healthcare organizations should:

  1. Assess current processes - Review existing patient management and clinical H.P.006-WORKFLOWS
  2. Identify automation opportunities - Determine which H.P.006-WORKFLOWS will benefit from automation
  3. Map dependencies - Understand agent and system dependencies
  4. Plan implementation - Prioritize H.P.006-WORKFLOWS based on impact and complexity

Phase 2: Implementation​

Execute healthcare H.P.006-WORKFLOWS systematically:

  1. Configure H.P.001-AGENTS - Set up healthcare-specialist, clinical-specialist, and compliance-auditor H.P.001-AGENTS
  2. Establish integrations - Connect EHR systems, billing platforms, and regulatory databases
  3. Deploy H.P.006-WORKFLOWS - Implement H.P.006-WORKFLOWS incrementally by category
  4. Train staff - Ensure healthcare team understands automated H.P.006-WORKFLOWS

Phase 3: Optimization​

Continuously improve healthcare operations:

  1. Monitor performance - Track workflow execution metrics and outcomes
  2. Gather feedback - Collect input from clinicians, administrators, and patients
  3. Refine processes - Optimize H.P.006-WORKFLOWS based on performance data
  4. Scale adoption - Expand successful H.P.006-WORKFLOWS across the organization

Inputs​

InputSourceDescription
Patient dataEHR/EMR systemsDemographics, medical history, insurance information
Clinical ordersProvider systemsLab orders, prescriptions, referrals, imaging requests
Insurance dataPayer systemsEligibility, coverage, prior authorizations
Regulatory requirementsCMS, state agenciesHIPAA, HITECH, accreditation standards
Scheduling requestsPatient portal, staffAppointment and procedure scheduling needs

Outputs​

OutputDestinationDescription
Clinical documentationEHR/EMR systemsVisit notes, care plans, discharge summaries
Claims and billingPayer systemsCoded encounters, claims, payment records
Compliance reportsRegulatory agenciesQuality metrics, regulatory filings, audit responses
Patient communicationsPatientsCare instructions, appointment reminders, statements
Analytics dashboardsLeadershipKPIs, operational metrics, quality scores

Success Criteria​

MetricTargetMeasurement Method
Patient wait time< 15 minutesScheduling system analytics
Claims first-pass rate> 95%Billing system reports
Documentation compliance> 98%Audit sampling
Patient satisfaction> 90%Survey results (HCAHPS)
Workflow automation rate> 80%Process monitoring tools
Regulatory compliance100%Audit outcomes

1. Patient Management​

1.1. patient-intake​

  • Description: Streamlined patient registration with insurance verification and medical history collection
  • Trigger: New patient arrival or online registration
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: recommended
  • Dependencies:
    • Agents: healthcare-specialist, compliance-auditor
    • Commands: /patient-intake
  • Steps:
    1. Collect demographics - intake-coordinator - Gather patient information
    2. Verify insurance - revenue-specialist - Check coverage eligibility
    3. Collect medical history - clinical-specialist - Record conditions and medications
    4. Sign consent forms - compliance-auditor - Obtain required authorizations
    5. Create patient record - healthcare-specialist - Initialize EMR entry
    6. Schedule follow-up - scheduling-agent - Book next appointment
  • Tags: [patient, intake, registration, healthcare]

1.2. appointment-scheduling​

  • Description: Intelligent appointment scheduling with provider availability and patient preferences
  • Trigger: Patient request or referral
  • Complexity: simple
  • Duration: 5-15m
  • QA Integration:
    • validation: required
    • review: optional
  • Dependencies:
    • Agents: scheduling-agent, healthcare-specialist
    • Commands: /schedule-appointment
  • Steps:
    1. Check provider availability - scheduling-agent - Query calendar systems
    2. Match patient preferences - scheduling-agent - Consider time and location
    3. Verify insurance coverage - revenue-specialist - Confirm visit type covered
    4. Send confirmation - notification-specialist - Email/SMS patient
    5. Update EMR - healthcare-specialist - Record scheduled visit
  • Tags: [appointment, scheduling, calendar, healthcare]

1.3. patient-follow-up​

  • Description: Automated post-visit follow-up with care instructions and satisfaction survey
  • Trigger: Visit completion (24-48 hours post)
  • Complexity: simple
  • Duration: 5-15m
  • QA Integration:
    • validation: recommended
    • review: optional
  • Dependencies:
    • Agents: healthcare-specialist, notification-specialist
    • Commands: /patient-follow-up
  • Steps:
    1. Generate care summary - clinical-specialist - Compile visit notes
    2. Send care instructions - notification-specialist - Deliver patient education
    3. Schedule medication reminders - healthcare-specialist - Set up alerts
    4. Send satisfaction survey - feedback-analyst - Collect experience data
    5. Flag concerns - healthcare-specialist - Escalate issues if needed
  • Tags: [follow-up, patient-care, satisfaction, healthcare]

1.4. care-coordination​

  • Description: Multi-provider care coordination for complex patients with multiple conditions
  • Trigger: Complex patient identification or referral
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: healthcare-specialist, clinical-specialist, care-coordinator
    • Commands: /care-coordination
  • Steps:
    1. Identify care team - care-coordinator - List all providers involved
    2. Compile medical records - healthcare-specialist - Aggregate from all sources
    3. Create care plan - clinical-specialist - Develop unified treatment plan
    4. Schedule team meeting - scheduling-agent - Coordinate provider availability
    5. Document care plan - clinical-specialist - Update all EMR systems
    6. Assign care manager - care-coordinator - Single point of contact
    7. Monitor progress - healthcare-specialist - Track outcomes and adherence
  • Tags: [care-coordination, multi-provider, complex-care, healthcare]

1.5. patient-discharge​

  • Description: Comprehensive discharge planning with medication reconciliation and follow-up scheduling
  • Trigger: Physician discharge order
  • Complexity: moderate
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: clinical-specialist, discharge-planner, pharmacy-specialist
    • Commands: /patient-discharge
  • Steps:
    1. Reconcile medications - pharmacy-specialist - Compare admission and discharge meds
    2. Create discharge instructions - clinical-specialist - Document care requirements
    3. Arrange home services - discharge-planner - Coordinate home health if needed
    4. Schedule follow-up - scheduling-agent - Book post-discharge appointments
    5. Educate patient - clinical-specialist - Review instructions with patient
    6. Process discharge - healthcare-specialist - Complete administrative tasks
    7. Send to PCP - healthcare-specialist - Transfer care summary
  • Tags: [discharge, transition, medication-reconciliation, healthcare]

1.6. referral-management​

  • Description: Specialist referral processing with authorization and appointment coordination
  • Trigger: Provider referral order
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: recommended
  • Dependencies:
    • Agents: referral-coordinator, revenue-specialist
    • Commands: /referral-management
  • Steps:
    1. Receive referral - referral-coordinator - Process referral order
    2. Verify authorization - revenue-specialist - Check insurance requirements
    3. Find specialist - referral-coordinator - Match patient needs with providers
    4. Schedule appointment - scheduling-agent - Book with specialist
    5. Transfer records - healthcare-specialist - Send relevant documentation
    6. Notify patient - notification-specialist - Confirm appointment details
  • Tags: [referral, specialist, authorization, healthcare]

1.7. patient-satisfaction-survey​

  • Description: Automated patient experience survey with sentiment analysis and reporting
  • Trigger: Post-visit (H.P.009-CONFIGurable timing)
  • Complexity: simple
  • Duration: 5-15m
  • QA Integration:
    • validation: optional
    • review: optional
  • Dependencies:
    • Agents: feedback-analyst, notification-specialist
    • Commands: /patient-survey
  • Steps:
    1. Send survey invitation - notification-specialist - Email/SMS survey link
    2. Collect responses - feedback-analyst - Gather patient feedback
    3. Analyze sentiment - ai-specialist - Process open-ended responses
    4. Calculate scores - feedback-analyst - Compute satisfaction metrics
    5. Generate report - reporting-specialist - Create summary dashboard
    6. Alert on issues - notification-specialist - Escalate low scores
  • Tags: [satisfaction, survey, patient-experience, healthcare]

1.8. chronic-care-management​

  • Description: Ongoing management program for patients with chronic conditions
  • Trigger: Chronic condition diagnosis or enrollment
  • Complexity: complex
  • Duration: ongoing
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: care-coordinator, clinical-specialist, healthcare-specialist
    • Commands: /chronic-care
  • Steps:
    1. Enroll patient - care-coordinator - Register in CCM program
    2. Conduct assessment - clinical-specialist - Comprehensive health evaluation
    3. Create care plan - clinical-specialist - Develop management strategy
    4. Schedule check-ins - scheduling-agent - Regular monitoring appointments
    5. Track metrics - healthcare-specialist - Monitor vital signs and labs
    6. Coordinate specialists - care-coordinator - Manage multi-provider care
    7. Monthly review - clinical-specialist - Evaluate progress and adjust
    8. Document time - revenue-specialist - Track CCM billing minutes
  • Tags: [chronic-care, ccm, disease-management, healthcare]

1.9. patient-portal-onboarding​

  • Description: Patient portal activation with identity verification and feature education
  • Trigger: New patient registration
  • Complexity: simple
  • Duration: 5-15m
  • QA Integration:
    • validation: required
    • review: optional
  • Dependencies:
    • Agents: healthcare-specialist, security-specialist
    • Commands: /portal-onboarding
  • Steps:
    1. Verify identity - security-specialist - Confirm patient identity
    2. Create credentials - healthcare-specialist - Generate secure login
    3. Send activation - notification-specialist - Email portal invitation
    4. Guide setup - healthcare-specialist - Walk through initial login
    5. Demonstrate features - healthcare-specialist - Show key functionality
    6. Confirm access - healthcare-specialist - Verify successful activation
  • Tags: [portal, onboarding, patient-access, healthcare]

1.10. telehealth-visit​

  • Description: Virtual visit workflow from scheduling through documentation
  • Trigger: Telehealth appointment request
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: recommended
  • Dependencies:
    • Agents: clinical-specialist, healthcare-specialist, tech-support
    • Commands: /telehealth-visit
  • Steps:
    1. Schedule visit - scheduling-agent - Book virtual appointment
    2. Send instructions - notification-specialist - Provide connection details
    3. Test connectivity - tech-support - Pre-visit technology check
    4. Conduct visit - clinical-specialist - Provider-patient video consultation
    5. Document encounter - clinical-specialist - Record visit notes
    6. Process billing - revenue-specialist - Submit telehealth codes
    7. Send summary - healthcare-specialist - Deliver after-visit summary
  • Tags: [telehealth, virtual-visit, video-consultation, healthcare]

2. Clinical Operations​

2.1. lab-order-processing​

  • Description: Laboratory order entry, specimen collection, and result delivery workflow
  • Trigger: Provider lab order
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: recommended
  • Dependencies:
    • Agents: clinical-specialist, lab-technician, healthcare-specialist
    • Commands: /lab-order
  • Steps:
    1. Receive order - clinical-specialist - Process lab requisition
    2. Verify patient - lab-technician - Confirm patient identity
    3. Collect specimen - lab-technician - Obtain samples per protocol
    4. Process sample - lab-technician - Run ordered tests
    5. Review results - clinical-specialist - Validate findings
    6. Release results - healthcare-specialist - Post to EMR
    7. Notify provider - notification-specialist - Alert ordering physician
  • Tags: [laboratory, lab-order, specimen, healthcare]

2.2. prescription-management​

  • Description: Electronic prescribing with drug interaction checking and pharmacy transmission
  • Trigger: Provider prescription order
  • Complexity: moderate
  • Duration: 5-15m
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: pharmacy-specialist, clinical-specialist
    • Commands: /prescription
  • Steps:
    1. Create prescription - clinical-specialist - Enter medication order
    2. Check interactions - pharmacy-specialist - Screen for conflicts
    3. Verify formulary - revenue-specialist - Check insurance coverage
    4. Select pharmacy - pharmacy-specialist - Choose patient's pharmacy
    5. Transmit electronically - pharmacy-specialist - Send via EPCS
    6. Document in EMR - healthcare-specialist - Record prescription
    7. Notify patient - notification-specialist - Confirm pharmacy selection
  • Tags: [prescription, e-prescribing, medication, healthcare]

2.3. clinical-documentation​

  • Description: Structured clinical documentation with H.P.008-TEMPLATES and compliance validation
  • Trigger: Patient encounter
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: recommended
  • Dependencies:
    • Agents: clinical-specialist, compliance-auditor
    • Commands: /clinical-doc
  • Steps:
    1. Select template - clinical-specialist - Choose appropriate note type
    2. Document encounter - clinical-specialist - Record visit details
    3. Add diagnoses - clinical-specialist - Code conditions (ICD-10)
    4. Document procedures - clinical-specialist - Record services (CPT)
    5. Validate completeness - compliance-auditor - Check required elements
    6. Sign note - clinical-specialist - Authenticate documentation
    7. Route for review - compliance-auditor - Send if supervision required
  • Tags: [documentation, clinical-notes, emr, healthcare]

2.4. medical-imaging-workflow​

  • Description: Radiology order processing from scheduling through result interpretation
  • Trigger: Imaging order
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: radiology-specialist, clinical-specialist, scheduling-agent
    • Commands: /imaging-order
  • Steps:
    1. Receive order - radiology-specialist - Process imaging requisition
    2. Check authorization - revenue-specialist - Verify insurance approval
    3. Schedule exam - scheduling-agent - Book imaging appointment
    4. Prepare patient - radiology-specialist - Provide prep instructions
    5. Perform imaging - radiology-specialist - Conduct exam
    6. Interpret study - radiology-specialist - Radiologist reads images
    7. Deliver results - healthcare-specialist - Post to EMR and notify
    8. Archive images - radiology-specialist - Store in PACS
  • Tags: [imaging, radiology, diagnostic, healthcare]

2.5. surgical-scheduling​

  • Description: Surgical case scheduling with OR allocation and team coordination
  • Trigger: Surgical authorization
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: surgical-coordinator, clinical-specialist, scheduling-agent
    • Commands: /surgical-scheduling
  • Steps:
    1. Receive request - surgical-coordinator - Process surgery order
    2. Obtain authorization - revenue-specialist - Get insurance approval
    3. Schedule OR time - scheduling-agent - Reserve operating room
    4. Coordinate team - surgical-coordinator - Assign surgeon, anesthesia, staff
    5. Order supplies - surgical-coordinator - Request equipment and implants
    6. Pre-op workup - clinical-specialist - Ensure clearances obtained
    7. Confirm with patient - notification-specialist - Verify date and prep
    8. Final checklist - surgical-coordinator - Pre-surgery verification
  • Tags: [surgery, scheduling, operating-room, healthcare]

2.6. nursing-shift-handoff​

  • Description: Standardized nursing shift handoff with patient status communication
  • Trigger: Shift change
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: recommended
  • Dependencies:
    • Agents: nursing-specialist, clinical-specialist
    • Commands: /shift-handoff
  • Steps:
    1. Generate patient list - nursing-specialist - Compile assigned patients
    2. Update status - nursing-specialist - Document current conditions
    3. Flag priorities - clinical-specialist - Identify critical issues
    4. Conduct handoff - nursing-specialist - Verbal communication
    5. Transfer tasks - nursing-specialist - Hand over pending items
    6. Acknowledge receipt - nursing-specialist - Confirm understanding
    7. Document handoff - nursing-specialist - Record in EMR
  • Tags: [nursing, handoff, shift-change, healthcare]

2.7. clinical-trial-enrollment​

  • Description: Clinical trial patient screening, enrollment, and protocol management
  • Trigger: Trial referral or patient inquiry
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: research-coordinator, clinical-specialist, compliance-auditor
    • Commands: /trial-enrollment
  • Steps:
    1. Screen eligibility - research-coordinator - Check inclusion/exclusion criteria
    2. Informed consent - research-coordinator - Obtain patient consent
    3. Baseline assessment - clinical-specialist - Conduct initial evaluation
    4. Randomization - research-coordinator - Assign treatment arm
    5. Protocol training - research-coordinator - Educate patient on requirements
    6. Schedule visits - scheduling-agent - Set up protocol visits
    7. Document enrollment - research-coordinator - Update trial database
    8. Report to sponsor - research-coordinator - Notify of enrollment
  • Tags: [clinical-trial, research, enrollment, healthcare]

2.8. adverse-event-reporting​

  • Description: Adverse event identification, documentation, and regulatory reporting
  • Trigger: Adverse event identification
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: safety-officer, clinical-specialist, compliance-auditor
    • Commands: /adverse-event
  • Steps:
    1. Identify event - clinical-specialist - Recognize adverse event
    2. Document details - safety-officer - Record event specifics
    3. Assess severity - safety-officer - Grade event severity
    4. Determine causality - clinical-specialist - Evaluate relationship
    5. Notify stakeholders - safety-officer - Alert leadership and sponsors
    6. Submit reports - compliance-auditor - File with FDA/IRB as required
    7. Implement corrective action - safety-officer - Address root cause
    8. Follow-up - safety-officer - Monitor patient and process
  • Tags: [adverse-event, safety, pharmacovigilance, healthcare]

2.9. infection-control-monitoring​

  • Description: Healthcare-associated infection surveillance and prevention
  • Trigger: Daily surveillance schedule
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: infection-control-specialist, clinical-specialist
    • Commands: /infection-surveillance
  • Steps:
    1. Review lab results - infection-control-specialist - Screen for HAIs
    2. Identify cases - infection-control-specialist - Apply CDC definitions
    3. Investigate source - infection-control-specialist - Determine origin
    4. Implement precautions - clinical-specialist - Initiate isolation
    5. Report findings - infection-control-specialist - Document in system
    6. Track trends - infection-control-specialist - Monitor facility rates
    7. Report externally - compliance-auditor - NHSN submission
  • Tags: [infection-control, surveillance, hai, healthcare]

2.10. quality-metrics-reporting​

  • Description: Clinical quality measure calculation and reporting for value-based care
  • Trigger: Reporting period end
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: quality-analyst, clinical-specialist, reporting-specialist
    • Commands: /quality-reporting
  • Steps:
    1. Extract data - quality-analyst - Query EMR for measure data
    2. Validate accuracy - quality-analyst - Check data quality
    3. Calculate measures - quality-analyst - Apply CMS specifications
    4. Generate reports - reporting-specialist - Create dashboards
    5. Identify gaps - quality-analyst - Find improvement opportunities
    6. Submit data - compliance-auditor - Report to CMS/payers
    7. Distribute results - notification-specialist - Share with providers
  • Tags: [quality, metrics, value-based-care, healthcare]

3. Revenue Cycle​

3.1. insurance-verification​

  • Description: Real-time insurance eligibility and benefit verification
  • Trigger: Patient scheduling or check-in
  • Complexity: simple
  • Duration: 5-15m
  • QA Integration:
    • validation: required
    • review: optional
  • Dependencies:
    • Agents: revenue-specialist, healthcare-specialist
    • Commands: /insurance-verify
  • Steps:
    1. Collect insurance info - revenue-specialist - Gather policy details
    2. Query payer - revenue-specialist - Check eligibility electronically
    3. Verify benefits - revenue-specialist - Confirm coverage details
    4. Calculate responsibility - revenue-specialist - Determine patient portion
    5. Update registration - healthcare-specialist - Record in system
    6. Notify patient - notification-specialist - Communicate costs
  • Tags: [insurance, verification, eligibility, healthcare]

3.2. prior-authorization​

  • Description: Prior authorization request submission and tracking
  • Trigger: Service requiring authorization
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: recommended
  • Dependencies:
    • Agents: authorization-specialist, clinical-specialist
    • Commands: /prior-auth
  • Steps:
    1. Identify requirement - authorization-specialist - Determine auth needed
    2. Gather documentation - clinical-specialist - Compile supporting info
    3. Submit request - authorization-specialist - Send to payer
    4. Track status - authorization-specialist - Monitor for response
    5. Respond to queries - clinical-specialist - Provide additional info
    6. Record decision - authorization-specialist - Document approval/denial
    7. Appeal if needed - authorization-specialist - Process appeals
  • Tags: [prior-authorization, authorization, payer, healthcare]

3.3. medical-coding​

  • Description: Accurate diagnosis and procedure coding for billing
  • Trigger: Encounter documentation completion
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: coding-specialist, compliance-auditor
    • Commands: /medical-coding
  • Steps:
    1. Review documentation - coding-specialist - Analyze clinical notes
    2. Assign diagnosis codes - coding-specialist - Apply ICD-10-CM
    3. Assign procedure codes - coding-specialist - Apply CPT/HCPCS
    4. Verify specificity - coding-specialist - Ensure code accuracy
    5. Check compliance - compliance-auditor - Validate coding rules
    6. Query provider - coding-specialist - Clarify unclear documentation
    7. Submit for billing - coding-specialist - Send coded encounter
  • Tags: [coding, icd-10, cpt, healthcare]

3.4. claim-submission​

  • Description: Electronic claim submission with scrubbing and tracking
  • Trigger: Coded encounter ready
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: recommended
  • Dependencies:
    • Agents: billing-specialist, revenue-specialist
    • Commands: /claim-submission
  • Steps:
    1. Generate claim - billing-specialist - Create 837 transaction
    2. Scrub claim - billing-specialist - Check for errors
    3. Correct issues - billing-specialist - Fix identified problems
    4. Submit claim - billing-specialist - Transmit to clearinghouse
    5. Confirm receipt - billing-specialist - Verify payer received
    6. Track adjudication - billing-specialist - Monitor claim status
    7. Record outcome - revenue-specialist - Document payment/denial
  • Tags: [claim, billing, submission, healthcare]

3.5. denial-management​

  • Description: Claim denial analysis, appeal, and prevention
  • Trigger: Claim denial received
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: denial-specialist, billing-specialist, clinical-specialist
    • Commands: /denial-management
  • Steps:
    1. Receive denial - denial-specialist - Capture denial details
    2. Analyze reason - denial-specialist - Identify denial cause
    3. Determine action - denial-specialist - Decide appeal or correction
    4. Gather documentation - clinical-specialist - Compile supporting info
    5. Submit appeal - denial-specialist - Send appeal to payer
    6. Track outcome - denial-specialist - Monitor appeal status
    7. Analyze trends - denial-specialist - Identify prevention opportunities
  • Tags: [denial, appeal, revenue-recovery, healthcare]

3.6. patient-billing​

  • Description: Patient statement generation and self-pay collections
  • Trigger: Patient balance identified
  • Complexity: simple
  • Duration: 5-15m
  • QA Integration:
    • validation: required
    • review: optional
  • Dependencies:
    • Agents: billing-specialist, revenue-specialist
    • Commands: /patient-billing
  • Steps:
    1. Calculate balance - billing-specialist - Determine patient responsibility
    2. Generate statement - billing-specialist - Create itemized bill
    3. Send statement - notification-specialist - Mail/email to patient
    4. Offer payment options - billing-specialist - Present payment plans
    5. Process payments - revenue-specialist - Record receipts
    6. Follow-up - billing-specialist - Send reminders as needed
  • Tags: [billing, patient-pay, statement, healthcare]

3.7. payment-posting​

  • Description: Electronic remittance processing and payment posting
  • Trigger: Payment received
  • Complexity: simple
  • Duration: 5-15m
  • QA Integration:
    • validation: required
    • review: optional
  • Dependencies:
    • Agents: revenue-specialist, billing-specialist
    • Commands: /payment-posting
  • Steps:
    1. Receive remittance - revenue-specialist - Download 835 file
    2. Match to claims - revenue-specialist - Identify paid claims
    3. Post payments - revenue-specialist - Apply to patient accounts
    4. Record adjustments - revenue-specialist - Document write-offs
    5. Identify denials - revenue-specialist - Flag for denial workflow
    6. Balance accounts - billing-specialist - Verify accurate posting
  • Tags: [payment, posting, remittance, healthcare]

3.8. collections-workflow​

  • Description: Patient collections process with aging management
  • Trigger: Account aging threshold
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: recommended
  • Dependencies:
    • Agents: collections-specialist, billing-specialist
    • Commands: /collections
  • Steps:
    1. Identify aged accounts - collections-specialist - Pull aging report
    2. Segment by age - collections-specialist - Categorize by bucket
    3. Contact patients - collections-specialist - Make collection calls
    4. Negotiate payments - collections-specialist - Offer payment plans
    5. Document contacts - collections-specialist - Record all interactions
    6. Escalate if needed - collections-specialist - Send to agency
    7. Report outcomes - collections-specialist - Track collection rates
  • Tags: [collections, aging, accounts-receivable, healthcare]

3.9. revenue-integrity-audit​

  • Description: Charge capture and revenue integrity auditing
  • Trigger: Scheduled audit or variance identified
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: revenue-integrity-analyst, compliance-auditor
    • Commands: /revenue-audit
  • Steps:
    1. Select sample - revenue-integrity-analyst - Choose audit population
    2. Compare charges - revenue-integrity-analyst - Match charges to services
    3. Identify variances - revenue-integrity-analyst - Find discrepancies
    4. Research issues - revenue-integrity-analyst - Determine root cause
    5. Quantify impact - revenue-integrity-analyst - Calculate financial effect
    6. Report findings - compliance-auditor - Document audit results
    7. Implement corrections - revenue-integrity-analyst - Fix identified issues
  • Tags: [audit, revenue-integrity, charge-capture, healthcare]

3.10. contract-negotiation​

  • Description: Payer contract negotiation and management
  • Trigger: Contract renewal or new payer
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: contracting-specialist, revenue-specialist
    • Commands: /contract-negotiation
  • Steps:
    1. Analyze current terms - contracting-specialist - Review existing contract
    2. Benchmark rates - contracting-specialist - Compare to market
    3. Prepare proposal - contracting-specialist - Draft negotiation position
    4. Conduct negotiations - contracting-specialist - Meet with payer
    5. Model scenarios - revenue-specialist - Calculate financial impact
    6. Finalize terms - contracting-specialist - Agree on final language
    7. Implement contract - contracting-specialist - Load into billing system
    8. Monitor performance - revenue-specialist - Track against targets
  • Tags: [contract, negotiation, payer-relations, healthcare]

4. Compliance & Regulatory​

4.1. hipaa-compliance-audit​

  • Description: HIPAA privacy and security compliance assessment
  • Trigger: Annual schedule or incident
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: compliance-auditor, security-specialist, privacy-officer
    • Commands: /hipaa-audit
  • Steps:
    1. Define scope - compliance-auditor - Determine audit coverage
    2. Review policies - privacy-officer - Assess documentation
    3. Test controls - security-specialist - Validate safeguards
    4. Interview staff - compliance-auditor - Assess awareness
    5. Identify gaps - compliance-auditor - Document deficiencies
    6. Create remediation plan - compliance-auditor - Develop corrections
    7. Report findings - compliance-auditor - Document audit results
    8. Monitor remediation - compliance-auditor - Track fixes
  • Tags: [hipaa, compliance, privacy, security, healthcare]

4.2. credentialing-verification​

  • Description: Provider credentialing and privileging verification
  • Trigger: New provider or recredentialing
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: credentialing-specialist, compliance-auditor
    • Commands: /credentialing
  • Steps:
    1. Collect application - credentialing-specialist - Gather provider info
    2. Verify education - credentialing-specialist - Confirm degrees
    3. Verify licenses - credentialing-specialist - Check state boards
    4. Check references - credentialing-specialist - Contact references
    5. Query NPDB - credentialing-specialist - Check national database
    6. Review malpractice - credentialing-specialist - Assess history
    7. Committee review - compliance-auditor - Present to credentials committee
    8. Grant privileges - credentialing-specialist - Issue approval
  • Tags: [credentialing, privileging, provider, healthcare]

4.3. license-renewal-tracking​

  • Description: Provider license and certification renewal monitoring
  • Trigger: Expiration approaching (90 days)
  • Complexity: simple
  • Duration: 5-15m
  • QA Integration:
    • validation: required
    • review: optional
  • Dependencies:
    • Agents: credentialing-specialist, notification-specialist
    • Commands: /license-tracking
  • Steps:
    1. Identify expiring - credentialing-specialist - Query license database
    2. Notify provider - notification-specialist - Send renewal reminders
    3. Track renewal - credentialing-specialist - Monitor submission
    4. Verify renewal - credentialing-specialist - Confirm new dates
    5. Update records - credentialing-specialist - Record in system
    6. Escalate if needed - notification-specialist - Alert leadership
  • Tags: [license, renewal, credentialing, healthcare]

4.4. accreditation-preparation​

  • Description: Healthcare accreditation survey preparation (Joint Commission, NCQA)
  • Trigger: Survey scheduled or annual prep
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: accreditation-coordinator, compliance-auditor, quality-analyst
    • Commands: /accreditation-prep
  • Steps:
    1. Review standards - accreditation-coordinator - Identify requirements
    2. Conduct mock survey - compliance-auditor - Simulate survey process
    3. Identify gaps - accreditation-coordinator - Document deficiencies
    4. Develop action plans - accreditation-coordinator - Create remediation
    5. Train staff - accreditation-coordinator - Educate on requirements
    6. Prepare documentation - accreditation-coordinator - Organize evidence
    7. Mock tracer - accreditation-coordinator - Practice survey scenarios
    8. Final readiness - accreditation-coordinator - Confirm preparation
  • Tags: [accreditation, joint-commission, survey, healthcare]

4.5. incident-reporting​

  • Description: Patient safety incident reporting and investigation
  • Trigger: Incident identification
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: safety-officer, clinical-specialist, compliance-auditor
    • Commands: /incident-report
  • Steps:
    1. Document incident - safety-officer - Capture event details
    2. Assess severity - safety-officer - Grade incident severity
    3. Notify stakeholders - safety-officer - Alert appropriate parties
    4. Investigate cause - safety-officer - Determine contributing factors
    5. Identify improvements - safety-officer - Develop action items
    6. Report externally - compliance-auditor - File required reports
    7. Track remediation - safety-officer - Monitor corrective actions
  • Tags: [incident, safety, patient-safety, healthcare]

4.6. root-cause-analysis​

  • Description: Structured root cause analysis for sentinel events
  • Trigger: Sentinel event or serious incident
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: safety-officer, quality-analyst, clinical-specialist
    • Commands: /root-cause-analysis
  • Steps:
    1. Assemble team - safety-officer - Identify RCA participants
    2. Gather facts - safety-officer - Collect event information
    3. Create timeline - safety-officer - Map sequence of events
    4. Identify causes - quality-analyst - Analyze contributing factors
    5. Determine root cause - quality-analyst - Drill to fundamental issue
    6. Develop action plan - safety-officer - Create corrective actions
    7. Present findings - safety-officer - Report to leadership
    8. Monitor effectiveness - quality-analyst - Track improvements
  • Tags: [rca, root-cause, sentinel-event, healthcare]

4.7. policy-review-cycle​

  • Description: Healthcare policy and procedure review and update cycle
  • Trigger: Annual schedule or regulation change
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: compliance-auditor, policy-administrator
    • Commands: /policy-review
  • Steps:
    1. Identify policies due - policy-administrator - Query review schedule
    2. Assign reviewers - policy-administrator - Route to subject experts
    3. Review content - compliance-auditor - Assess for current accuracy
    4. Update as needed - policy-administrator - Revise policy language
    5. Route for approval - policy-administrator - Send through approval chain
    6. Publish updates - policy-administrator - Release new version
    7. Communicate changes - notification-specialist - Notify affected staff
  • Tags: [policy, procedure, review, healthcare]

4.8. training-compliance​

  • Description: Required healthcare training tracking and completion monitoring
  • Trigger: New hire or annual requirement
  • Complexity: simple
  • Duration: 5-15m
  • QA Integration:
    • validation: required
    • review: optional
  • Dependencies:
    • Agents: training-coordinator, compliance-auditor
    • Commands: /training-compliance
  • Steps:
    1. Identify requirements - training-coordinator - Determine required courses
    2. Assign training - training-coordinator - Enroll staff in courses
    3. Track completion - training-coordinator - Monitor progress
    4. Send reminders - notification-specialist - Alert incomplete training
    5. Verify completion - training-coordinator - Confirm course completion
    6. Report compliance - compliance-auditor - Document training status
  • Tags: [training, compliance, education, healthcare]

4.9. audit-response​

  • Description: External audit response and documentation management
  • Trigger: Audit notification received
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: compliance-auditor, revenue-specialist, clinical-specialist
    • Commands: /audit-response
  • Steps:
    1. Receive notification - compliance-auditor - Log audit request
    2. Assign coordinator - compliance-auditor - Designate audit lead
    3. Gather documentation - compliance-auditor - Compile requested records
    4. Review for accuracy - compliance-auditor - Validate information
    5. Prepare response - compliance-auditor - Draft audit package
    6. Submit documentation - compliance-auditor - Send to auditor
    7. Track findings - compliance-auditor - Monitor audit progress
    8. Address findings - compliance-auditor - Respond to issues identified
  • Tags: [audit, response, compliance, healthcare]

4.10. regulatory-reporting​

  • Description: Mandatory healthcare regulatory reporting submission
  • Trigger: Reporting deadline
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: compliance-auditor, reporting-specialist
    • Commands: /regulatory-reporting
  • Steps:
    1. Identify requirements - compliance-auditor - Determine reporting needs
    2. Extract data - reporting-specialist - Pull required information
    3. Validate accuracy - compliance-auditor - Check data quality
    4. Format report - reporting-specialist - Prepare submission format
    5. Review report - compliance-auditor - Final validation
    6. Submit report - compliance-auditor - File with agency
    7. Confirm receipt - compliance-auditor - Verify submission
    8. Archive documentation - compliance-auditor - Retain evidence
  • Tags: [regulatory, reporting, compliance, healthcare]

5. Administrative​

5.1. staff-scheduling​

  • Description: Healthcare staff scheduling with coverage optimization
  • Trigger: Schedule period start
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: recommended
  • Dependencies:
    • Agents: scheduling-manager, workforce-analyst
    • Commands: /staff-scheduling
  • Steps:
    1. Forecast demand - workforce-analyst - Predict patient volume
    2. Determine staffing needs - scheduling-manager - Calculate requirements
    3. Collect preferences - scheduling-manager - Gather staff requests
    4. Build schedule - scheduling-manager - Create initial schedule
    5. Optimize coverage - workforce-analyst - Balance workload
    6. Publish schedule - scheduling-manager - Release to staff
    7. Manage changes - scheduling-manager - Handle swap requests
  • Tags: [scheduling, staffing, workforce, healthcare]

5.2. inventory-management​

  • Description: Medical supply and equipment inventory management
  • Trigger: Reorder point reached or schedule
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: recommended
  • Dependencies:
    • Agents: inventory-manager, procurement-specialist
    • Commands: /inventory-management
  • Steps:
    1. Monitor levels - inventory-manager - Track current inventory
    2. Identify needs - inventory-manager - Flag items below par
    3. Create orders - procurement-specialist - Generate purchase orders
    4. Submit to vendors - procurement-specialist - Send orders
    5. Receive shipments - inventory-manager - Process deliveries
    6. Update system - inventory-manager - Record receipt
    7. Stock locations - inventory-manager - Distribute to departments
  • Tags: [inventory, supplies, procurement, healthcare]

5.3. equipment-maintenance​

  • Description: Medical equipment preventive maintenance and repair tracking
  • Trigger: PM schedule or malfunction report
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: recommended
  • Dependencies:
    • Agents: biomed-technician, equipment-manager
    • Commands: /equipment-maintenance
  • Steps:
    1. Identify due equipment - equipment-manager - Query PM schedule
    2. Schedule maintenance - equipment-manager - Coordinate with departments
    3. Perform inspection - biomed-technician - Execute PM checklist
    4. Document findings - biomed-technician - Record results
    5. Repair if needed - biomed-technician - Fix identified issues
    6. Update records - equipment-manager - Record maintenance history
    7. Return to service - equipment-manager - Release equipment
  • Tags: [equipment, maintenance, biomed, healthcare]

5.4. vendor-management​

  • Description: Healthcare vendor contract and performance management
  • Trigger: Contract review or performance issue
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: recommended
  • Dependencies:
    • Agents: vendor-manager, procurement-specialist
    • Commands: /vendor-management
  • Steps:
    1. Review contracts - vendor-manager - Assess current agreements
    2. Monitor performance - vendor-manager - Track service levels
    3. Address issues - vendor-manager - Resolve problems
    4. Evaluate vendors - vendor-manager - Score performance
    5. Negotiate terms - procurement-specialist - Discuss improvements
    6. Update agreements - vendor-manager - Modify contracts
    7. Document outcomes - vendor-manager - Record changes
  • Tags: [vendor, contract, procurement, healthcare]

5.5. budget-planning​

  • Description: Healthcare department budget development and monitoring
  • Trigger: Budget cycle start
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: finance-analyst, department-manager
    • Commands: /budget-planning
  • Steps:
    1. Analyze history - finance-analyst - Review prior spending
    2. Forecast needs - department-manager - Project requirements
    3. Build budget - finance-analyst - Create detailed budget
    4. Review variances - finance-analyst - Compare to targets
    5. Submit for approval - department-manager - Present to leadership
    6. Monitor spending - finance-analyst - Track actual vs budget
    7. Report variances - finance-analyst - Document differences
  • Tags: [budget, finance, planning, healthcare]

5.6. department-performance-review​

  • Description: Healthcare department operational performance assessment
  • Trigger: Monthly or quarterly schedule
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: recommended
  • Dependencies:
    • Agents: operations-analyst, department-manager
    • Commands: /performance-review
  • Steps:
    1. Collect metrics - operations-analyst - Gather KPI data
    2. Calculate scores - operations-analyst - Compute performance measures
    3. Compare to targets - operations-analyst - Assess vs goals
    4. Identify trends - operations-analyst - Analyze patterns
    5. Generate report - operations-analyst - Create dashboard
    6. Review with leadership - department-manager - Present findings
    7. Create action plans - department-manager - Address gaps
  • Tags: [performance, operations, metrics, healthcare]

5.7. strategic-planning​

  • Description: Healthcare organization strategic planning process
  • Trigger: Annual planning cycle
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: strategy-analyst, executive-coordinator
    • Commands: /strategic-planning
  • Steps:
    1. Environmental scan - strategy-analyst - Analyze market and competition
    2. SWOT analysis - strategy-analyst - Assess strengths and weaknesses
    3. Define objectives - executive-coordinator - Set strategic goals
    4. Develop initiatives - strategy-analyst - Create action plans
    5. Allocate resources - executive-coordinator - Budget for initiatives
    6. Present to board - executive-coordinator - Obtain approval
    7. Communicate plan - executive-coordinator - Share with organization
    8. Monitor progress - strategy-analyst - Track implementation
  • Tags: [strategic-planning, strategy, leadership, healthcare]

5.8. community-outreach​

  • Description: Healthcare community outreach and health education programs
  • Trigger: Program schedule or community need
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: recommended
    • review: recommended
  • Dependencies:
    • Agents: outreach-coordinator, marketing-specialist
    • Commands: /community-outreach
  • Steps:
    1. Identify needs - outreach-coordinator - Assess community health needs
    2. Plan programs - outreach-coordinator - Design outreach activities
    3. Coordinate logistics - outreach-coordinator - Arrange venues and resources
    4. Promote events - marketing-specialist - Advertise programs
    5. Conduct programs - outreach-coordinator - Execute outreach
    6. Collect feedback - outreach-coordinator - Gather participant input
    7. Report outcomes - outreach-coordinator - Document impact
  • Tags: [outreach, community, education, healthcare]

5.9. emergency-preparedness​

  • Description: Healthcare emergency preparedness planning and drill management
  • Trigger: Drill schedule or plan update
  • Complexity: complex
  • Duration: 30m+
  • QA Integration:
    • validation: required
    • review: required
  • Dependencies:
    • Agents: emergency-coordinator, safety-officer
    • Commands: /emergency-prep
  • Steps:
    1. Review plans - emergency-coordinator - Assess current preparedness
    2. Update procedures - emergency-coordinator - Revise as needed
    3. Schedule drill - emergency-coordinator - Plan exercise
    4. Notify participants - notification-specialist - Alert staff
    5. Conduct drill - emergency-coordinator - Execute exercise
    6. Evaluate performance - safety-officer - Assess response
    7. Document findings - emergency-coordinator - Record results
    8. Update plans - emergency-coordinator - Incorporate lessons learned
  • Tags: [emergency, preparedness, drill, healthcare]

5.10. facility-management​

  • Description: Healthcare facility operations and maintenance coordination
  • Trigger: Work order or scheduled maintenance
  • Complexity: moderate
  • Duration: 15-30m
  • QA Integration:
    • validation: required
    • review: recommended
  • Dependencies:
    • Agents: facility-manager, maintenance-technician
    • Commands: /facility-management
  • Steps:
    1. Receive requests - facility-manager - Log work orders
    2. Prioritize work - facility-manager - Assess urgency
    3. Assign technicians - facility-manager - Dispatch workers
    4. Complete repairs - maintenance-technician - Execute work
    5. Inspect work - facility-manager - Verify completion
    6. Update records - facility-manager - Document maintenance
    7. Report status - facility-manager - Communicate to requestors
  • Tags: [facility, maintenance, operations, healthcare]

Summary​

CategoryWorkflowsDescription
Patient Management10Patient intake, scheduling, care coordination
Clinical Operations10Lab, pharmacy, imaging, documentation
Revenue Cycle10Billing, coding, claims, collections
Compliance & Regulatory10HIPAA, credentialing, audits
Administrative10Staffing, inventory, facilities
Total50Complete healthcare operations coverage

Related Files: