Some of the biggest delays in healthcare begin long after a physician has decided what a patient needs. A treatment may be recommended, an imaging study ordered, or a medication prescribed, yet the next step can still depend on whether someone has checked insurance requirements, submitted a prior authorization, followed up with a payer, corrected missing information, or appealed a denial. Those tasks are administrative, but the consequences are not. For patients, they can mean days or weeks spent waiting for care.
Startup Serene, is focused on that part of the healthcare system. The company works on revenue-cycle tasks including prior authorization, eligibility verification, claim-status checks, and appeals. Its technology is designed to operate across the electronic health records, payer portals, and internal systems healthcare organizations already use, reducing the amount of manual work required to move those processes forward.
Co-founder Stefano Rosa came to the problem by looking closely at what healthcare employees were spending their time doing. “Patients don’t experience healthcare as isolated appointments; they experience the entire system,” Rosa said. That system includes the administrative work that determines whether a treatment is approved, whether a claim is paid, and how much effort a patient must expend navigating everything surrounding the care itself.
The Administrative Work Behind a Patient’s Wait
Consider a patient whose physician recommends a medication or diagnostic test that requires prior authorization. Before the patient can move forward, someone at the practice may need to determine the insurer’s criteria, collect clinical documentation, log into a payer portal, submit the request, and continue checking for a response. If information is missing, staff may have to resubmit it. If the request is denied, they may need to prepare an appeal or send additional records.
A delay at any point can leave the patient waiting even when the physician, facility, and treatment plan are already in place. The clinic sees an unfinished administrative task. The patient sees a test that has not been scheduled or a medication they still cannot receive.
Serene was built around these kinds of workflows. A revenue-cycle employee might otherwise spend part of the day moving between an EHR and several insurer websites to verify eligibility or determine the status of claims. Serene is designed to complete many of those steps, record what happened, and return the results for staff review. Employees remain responsible for situations that require judgment, but they do not have to manually complete every routine step.
Rosa and his co-founder arrived at this problem by visiting more than 50 healthcare practices around the Bay Area before building the product. They spoke with staff about the work that consumed their time rather than starting with a predetermined technology.
“We didn’t write a line of code,” Rosa said. “We went door to door, fifty-some practices across the Bay Area.”
The recurring complaints involved forms, prior authorizations, and other repetitive processes. Those conversations helped shape Serene around the systems healthcare organizations already use instead of requiring staff to adopt an entirely separate operating environment.
A healthcare organization can give Serene access to the tools its staff already use and assign a task for completion. The system can then navigate the relevant applications and document the actions it takes. For organizations managing multiple payer portals and legacy systems, reducing the manual work involved in using those tools can be easier than replacing the infrastructure itself.
Claims denials create another example. One denial can trigger a long sequence of work. A staff member may need to determine the reason for the denial, identify missing documentation, locate the relevant records, submit an appeal, and continue tracking the claim until it is resolved.
A billing employee handling dozens of claims may spend significant time simply checking whether anything has changed. Each claim may require a separate search through a payer portal before the employee can identify which cases actually need intervention. Completing routine status checks automatically allows staff to spend more time on denials, exceptions, and cases that require human judgment.
When Administrative Problems Reach the Patient
Healthcare administration can become a patient problem very quickly. Imagine a patient waiting for an imaging study that requires insurer approval. The physician has made the recommendation, the imaging facility is available, and the patient is ready to proceed. The authorization is the only unfinished part of the process.
Nothing about the patient’s medical need has changed, but the appointment may still remain on hold.
Patients can face the same frustration after care has already been delivered. Someone undergoing treatment may also be trying to understand a denial, resolve an incorrect bill, determine whether a service is covered, or repeatedly contact an insurer for an update. A sick patient can end up managing a process that even experienced healthcare staff find difficult to navigate.
Rosa believes much of that work should happen without requiring the patient to manage every step personally. He has described systems that could eventually monitor coverage, follow authorization requests, identify billing mistakes, and help patients respond to denials.
A medication denial shows how that might work. A patient receives notice that coverage has been denied but may have no idea whether the problem involves missing clinical documentation, a coding issue, a formulary requirement, or another coverage rule. Resolving the issue can lead to calls among the patient, medical practice, pharmacy, and insurer. If the necessary records and status information can be gathered before a person gets involved, staff can begin with the actual problem instead of first spending time finding it.
Administrative speed can have direct effects on the patient experience. Completing an authorization sooner may shorten the time between a physician ordering treatment and the patient receiving it. Resolving a claim issue earlier may prevent the patient from receiving confusing bills or having to intervene in a dispute between a provider and payer.
The technology does not need to participate in medical decision-making to affect how patients experience healthcare. Removing delays around care can matter just as much to a patient who is waiting for the next step.
Reducing the Work Around Healthcare
Healthcare organizations already rely on a large number of software systems, and introducing another application can create additional work for employees. Serene was designed to operate inside the existing administrative environment, allowing organizations to delegate workflows while retaining a record of the actions taken and the outcome.
“Our goal is to take that chaos and turn it into something reliable,” Rosa said.
Reliability is especially important because healthcare administrative work rarely follows an identical path every time. Payer portals differ from one another. Websites change. Documentation may be incomplete. A claim may have an unusual circumstance that requires a person to intervene. Automation that only succeeds when every step follows a fixed sequence has limited value in that environment.
Serene focuses on predictable administrative work while leaving exceptions with staff. A nurse may no longer need to spend part of the afternoon checking whether an authorization has moved. A billing employee may not need to open several insurer websites simply to discover that a claim remains unchanged. Employees can spend more time on cases where their experience and judgment are actually needed.
Patients may benefit without ever knowing that any of this technology is operating in the background. They may simply receive an authorization sooner, encounter fewer billing problems, or spend less time trying to determine why their care has stalled.
“The future belongs to systems that quietly remove friction rather than add complexity,” Rosa said.
Serene is concentrating on the administrative work most patients rarely see until something goes wrong. If fewer people have to chase an authorization, track down a claim, or spend hours trying to understand why treatment has been delayed, much of the value will be visible through what no longer happens.
