4 questions with Baylor Scott & White VP of revenue cycle Sarah Knodel

Sarah Knodel, system vice president of revenue cycle for Dallas-based Baylor Scott & White Health, is responsible for the strategic management and direction of the revenue cycle department for the nearly 50-hospital system, which includes responsibility for more than 1,700 employees spanning across access services, revenue integrity, utilization review, denial resource center and the central business office.

Ms. Knodel previously worked for Stockamp & Associates, now Huron Consulting Group in Chicago, where she focused on revenue cycle improvement initiatives for large, multifacility acute care hospital systems. She earned a Bachelor of Business Administration in finance from The University of Texas at Austin - Red McCombs School of Business.

Ms. Knodel recently answered questions from Becker's Hospital Review about her greatest challenges as a revenue cycle leader and how she would improve the revenue cycle process.

Note: Responses have been lightly edited for clarity.

Question: What's your favorite part about being a revenue cycle leader for a healthcare system?

Sarah Knodel: I love that no day is the same and the variety of the work we do and the challenges that come with it. It is exciting to lead a department that has a tangible impact on the patient's experience and the financial success of the organization. I enjoy getting to work with many talented individuals inside of the revenue cycle and across the numerous departments, facilities and clinics we interface with to help the organization achieve its strategic goals. As the saying goes, "care takes cash," and I enjoy serving in a role closely aligned with our clinical, operational and financial leaders so we can continue to deliver high-quality care to the patients and communities we serve.

Q: What is the biggest challenge you're facing as a revenue cycle leader?

SK: The biggest challenge is the sheer number of priorities we are trying to manage at any given time. People laugh at the whiteboard in my office that has a list of over 100 projects we are working on as a department. Since the merger of Baylor Scott & White Health, we've had challenges related to trying to standardize revenue cycle processes, systems and organizational structures between the two legacy healthcare systems. This integration work, coupled with work related to constantly improving our key performance indicators, increasing price transparency, improving the revenue cycle patient experience, reducing our cost-to-collect, integrating new business from organic growth and acquisitions and optimizing workflows in anticipation of future electronic health record conversions, leaves very little time to breathe. It's an exciting time but certainly challenging given the pace of change and the speed at which we need to get a number of important things completed in a relatively short amount of time.  

Q: What is one of your goals this year?

SK: Continuing to improve the revenue cycle patient experience. While we have made strides in different areas related to the financial experience, the key for us is being able to string everything together in a more cohesive manner from scheduling to post-discharge collections. So many industries have a simple yet robust way of engaging and interfacing with their consumers, but in healthcare we still have a lot of opportunities for improvement in this area. We have various revenue cycle bolt-on technologies and patient portals that have all provided improvements in our overall process and experience, but we need to continue to focus on making further improvements.

Q: What is one thing you'd do to improve the revenue cycle process?

SK: One thing I would do is improve collaboration with payers to reduce administrative costs for both sides. Driving out nonvalue added costs is critical for financial sustainability. Throughout the entire revenue cycle we have an opportunity to drive out costs associated with our third-party payers but unfortunately, we are faced with constantly changing pre-certification and medical necessity requirements that are unique to each payer, and a lengthy process on the back-end related to retrospective appeals for denials and underpayments. Despite more and more upfront requirements, it isn't translating to improved processing time on the back end. Although traditional methods for addressing some of these issues have been successful, those methods still require a significant amount of time and resources on both sides to arrive at the correct outcome. Ultimately, the member-patient is hurt by these delays and they can slow down our ability to provide timely care, to be paid timely and to timely bill the patient for their amount due. We want to explore what opportunities exist to pilot new strategies or models that could work on addressing some of these issues. 

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