Healthcare Claude Skills

Skills for clinical and revenue-cycle work — eligibility, prior authorization, denial management, and patient communication.

• Billing Compliance AuditorConduct internal billing and coding compliance audits to ensure accurate claims submission and prevent fraud/abuse. Provides audit methodology for E/M leveling, modifier use, medical necessity, and documentation. Use for monthly/quarterly chart audits, pre-billing reviews, or responding to payer audits.
• Breach Incident ResponderRespond to potential HIPAA breaches and security incidents following required procedures. Provides breach determination methodology, risk assessment framework, notification requirements, and documentation templates. Use when a potential breach is discovered or security incident reported.
• Clinical Trial ProtocolGenerate clinical trial protocols for medical devices or drugs. This skill should be used when users say "Create a clinical trial protocol", "Generate protocol for [device/drug]", "Help me design a clinical study", "Research similar trials for [intervention]", or when developing FDA submission documentation for investigational products.
• Coverage Verification CheckerVerify patient insurance coverage with deterministic yes/no checks. Validates active coverage, effective dates, provider network status, PCP assignment, referral requirements, and authorization needs. Use when confirming a patient can be seen for a service before the appointment.
• Denial Management PlaybookClassify healthcare claim denials by CARC/RARC codes and execute appropriate response workflows. Provides denial code lookups, action decisioning logic, appeal letter templates, and payer-specific rules. Use when processing denied claims, generating appeals, or analyzing denial patterns for RCM automation.
• Fhir Developer SkillFHIR API development guide for building healthcare endpoints. Use when: (1) Creating FHIR REST endpoints (Patient, Observation, Encounter, Condition, MedicationRequest), (2) Validating FHIR resources and returning proper HTTP status codes and error responses, (3) Implementing SMART on FHIR authorization and OAuth scopes, (4) Working with Bundles, transactions, batch operations, or search pagination. Covers FHIR R4 resource structures, required fields, value sets (status codes, gender, intent), coding systems (LOINC, SNOMED, RxNorm, ICD-10), and OperationOutcome error handling.
• Good Faith Estimate GeneratorGenerate compliant Good Faith Estimates (GFEs) for uninsured and self-pay patients as required by the No Surprises Act. Provides content requirements, timing rules, and templates for GFE creation. Use when scheduling self-pay patients or when patients request cost estimates.
• HIPAA Risk Analysis ConductorConduct HIPAA Security Rule risk analysis as required by 45 CFR 164.308(a)(1). Provides methodology for identifying ePHI assets, assessing threats and vulnerabilities, scoring risks, and developing risk management plans. Use when performing annual risk analysis, after significant changes, or preparing for OCR audit.
• Patient Responsibility EstimatorEstimate patient out-of-pocket costs for healthcare services based on insurance benefits. Calculates deductible, copay, and coinsurance with confidence levels based on data completeness. Use when providing cost estimates to patients before service or at time of scheduling.
• Prior Auth ReviewAutomate payer review of prior authorization (PA) requests. This skill should be used when users say "Review this PA request", "Process prior authorization for [procedure]", "Assess medical necessity", "Generate PA decision", or when processing clinical documentation for coverage policy validation and authorization decisions.