Revenue cycle leaders across the country are rethinking how their organizations capture, protect and collect revenue, and the initiatives paying off look different from one health system to the next.
Some leaders point to centralizing fragmented operations while others to bringing outsourced functions back in-house, and still others to investing in their people rather than new technology. A common thread runs through nearly every response: sustainable financial performance depends less on any single tool and more on alignment across departments that once worked in silos.
Becker’s asked revenue cycle executives, directors and managers one question: What project or initiative has had the biggest positive impact on your revenue cycle? What did you do, and what were the results? Their answers span health systems, ambulatory surgery centers, behavioral health organizations and international care networks.
Editor’s note: Responses have been lightly edited for clarity and length.
Elizabeth Ward. Vice President of Revenue Cycle Management, Aletheia Health Partners (Watkinsville, Ga.): The most impactful initiative has been implementing a disciplined revenue cycle operating model that integrates daily performance management, data-driven work queue prioritization, and clear accountability across patient access, coding, billing, denials and accounts receivable. Rather than treating these functions independently, we focused on root-cause identification, standardized workflows and using analytics to drive operational decisions. This approach has resulted in measurable improvements in cash acceleration, reduced A/R days, lower denial rates and sustainable financial performance across both large health systems and rural hospitals.
Angela Confoey. Senior Vice President, Revenue Cycle and CRO, UMass Memorial Health (Worcester, Mass.): Use of artificial intelligence to identify missed clinical documentation. We have an excellent clinical documentation Improvement team that does outstanding work in our highest-priority focus areas, but it would not be financially feasible to hire enough nurses to review every potential opportunity. AI has allowed us to extend that reach by analyzing a broader universe of cases and identify additional documentation opportunities that support accurate capture of patient acuity and appropriate reimbursement.
Shifting utilization review into revenue cycle. This step has allowed us to standardize work across the health system, create more consistent processes, and better align clinical review, documentation, authorization and reimbursement workflows.
Lindsay Bennett. Vice President, Revenue Cycle and HIM, Chapters Health System (Tampa, Fla.): Revenue cycle functions as a sequential, interdependent workflow. When claims pile up behind a constraint — for example, when there are documentation delays — everything downstream is impacted. Staffing models are not designed for pile-ups and periodic releases. At Chapters Health System, the projects that have increased real-time visibility and quantified the dollars in bottlenecks have helped us focus our process improvement efforts where they have the biggest impact. Developing real time throughput metrics has helped us identify and contain issues quickly — not months later when they are impacting the aging. That has helped us consistently keep our days in A/R low.
Nydia Valle. Financial Analyst, Oschner Health (New Orleans): The initiatives that have had the greatest impact in my experience haven’t been focused on a single denial or payer issue, but on building stronger partnerships between clinical operations and revenue cycle. By embedding a revenue cycle partner within clinical operations, we’re able to proactively review payer policies, evaluate workflows and standardize processes to prevent revenue leakage before it occurs. Denials are often a symptom rather than a root cause. Collaborating early and building strong cross-functional relationships allows us to expand reimbursement opportunities, reduce avoidable denials, and improve financial performance across multiple service lines. Revenue cycle is at its best when it’s preventing problems, not just collecting on them.
Jeff Mincher. Senior Vice President and Chief Revenue Cycle Officer, Texas Health Resources (Arlington): The most impactful current initiative has been our One Revenue Cycle transformation, which aligns revenue cycle functions across the enterprise under a common strategy, governance structure, and operating model. By focusing on standardization, automation, and shared accountability, we are improving decision-making, reducing variation and creating a stronger foundation for scalable growth and innovation.
Sal Brown. System Vice President, Mount Sinai Health System (New York City): One of the most impactful initiatives we’ve undertaken at Mount Sinai has been transitioning from a decentralized revenue cycle structure to a centralized enterprise operating model. Historically, many functions were managed independently across hospitals, physician groups and even departments, which created variation in workflows, productivity, payer strategies, performance and ultimately accountability. While local ownership has its advantages, it often limits our ability to scale best practices and respond consistently to industry challenges.
By centralizing our revenue cycle, we standardized processes, governance, and performance metrics across the system while leveraging enterprise expertise. The result is improved financial performance, greater operational resilience, a more consistent patient financial experience, and an organization that’s better positioned to adapt to the rapidly changing healthcare reimbursement landscape. Centralization wasn’t simply an organizational redesign — it became the strategic enabler for sustainable transformation across the entire health system. That foundation also positioned us to accelerate innovation and enable an exception-based operating model.
Stephanie Wells. System Vice President, Revenue Cycle, Ochsner Health (New Orleans): While we have launched a number of impactful initiatives — ranging from a robust financial clearance process to multiple automation efforts — the investment that has had the greatest long-term impact on our revenue cycle has been our investment in people.
We have made a deliberate effort to strengthen our team through succession planning, talent development, skill-gap assessment, and employee engagement. Our goal has been to build a deep bench of capable leaders and subject matter experts who are prepared to step into new roles as the organization evolves.
This focus has created a more resilient and high-performing revenue cycle organization. It has allowed us to maintain momentum during periods of growth, adapt to industry changes, and navigate retirements or turnover without significant disruption. By prioritizing the development and retention of our talent, we have built a team that is both highly competent and highly engaged.
The result is an organization that continues to improve performance, embrace new opportunities, and sustain operational excellence because we have the right people in the right roles, ready for what comes next.
Heather Dunn. Senior Vice President and Chief Revenue Officer, Novant Health (Winston-Salem, N.C.): The single biggest impact has been moving away from siloed departments and redesigning our revenue cycle into an integrated operating model with clear accountability across the entire patient financial journey. We aligned functions into centers of excellence, created a single business office across hospital and professional billing, strengthened payer relationships and invested in AI where it could remove manual work, where appropriate, rather than simply shift it.
The results have been significant. We’ve reduced AR days by nearly 6%, reduced our aging by 16%, exceeded our goals, improved operational efficiency and lowered costs through a thoughtful sourcing strategy. We’ve also reinforced our internal relationships, particularly partnerships with both our IT and managed care teams. More importantly, we’ve created a foundation that allows us to scale innovation while improving the patient experience. Sustainable revenue cycle transformation isn’t about one technology — it’s about aligning people, processes and technology around a common strategy.
Ruchi Tomar. Director Revenue Cycle of Northwell Health (New York City): Our partnership with physician practices upstream has been a key initiative positively impacting our revenue cycle team. We identified that coding issues, particularly those related to lab charges, are frequently exploited by payers, often leading to denied claims. Physicians, coders and their clinical justifications are indispensable for providing the necessary information to validate claim charges and ensure they convert into revenue.
Furthermore, we recognized that data interface challenges, particularly unclear information translated from external EMR systems, could also hinder our revenue cycle.
To address these areas, we have been actively strengthening our partnerships and alignment with external physician offices, as well as our internal clinical integration team. By focusing on these collaborative efforts, we aim to enhance claim accuracy, streamline data flow and ultimately improve our revenue cycle performance and drive results.
Paul LePage. Vice President of Revenue Cycle, UC Davis Health (Sacramento): The single most impactful initiative has been shifting our organization from a reactive revenue cycle to a proactive one through an enterprise revenue integrity and denial prevention strategy.
Historically, we spent significant resources appealing denials after they occurred. We changed the focus to preventing denials upstream by creating cross-functional governance that included patient access, HIM, coding, clinical operations, case management, finance and managed care. We used analytics to identify the highest-value root causes, standardized workflows, implemented real-time work queues, and established executive accountability for performance.
The results included:
– A double-digit reduction in preventable denials.
– Improved clean claim rates and first-pass payment rates.
– Reduced accounts receivable days.
– Faster cash acceleration and improved operating margin.
Better collaboration between clinical and revenue cycle teams because everyone was aligned around shared performance metrics instead of departmental silos.
Shawn McCardell. AVP Revenue Cycle, Mercy Health Services (Baltimore): Recently we worked with a partner in the complex appeals area to not only take over the complex claims appeals from the billing and follow-up staff, but also to provide the appeals previously performed by our clinical staff post discharge. Concurrent appeals are still performed by internal clinical staff but once the patient discharges our partner is not the one to submit the appeal for any denials during their stay. This has allowed us to redeploy our clinical staff to continue to work on concurrent appeals but also broaden their work into a more CDI focus. We have also freed up billing and follow-up staff to work on the more administrative appeals, which are less clinical in nature. We have seen an immediate increase in our overturned appeals rate and within two short months have over $200,000 in recoupments.
Monica Richey. Interim Vice President of Revenue Cycle, Vice President, Grady Health System (Atlanta): One Revenue Cycle. One Patient Experience. One Grady.
Over the past five years, Grady Health System has undergone one of the most transformative professional revenue cycle initiatives in its history by bringing together our employed providers, Morehouse School of Medicine and Emory University School of Medicine onto a single professional billing platform.
While technology enabled the work, the true transformation came from aligning people, processes, and a shared vision. Consolidating multiple physician enterprises into one revenue cycle operation eliminated unnecessary complexity, standardized workflows, and created operational efficiencies that continue to benefit our providers, staff, and patients every day.
Most importantly, the integration improved the patient financial experience. Patients now interact with a more consistent billing process, creating greater transparency and reducing confusion across our academic physician practices.
A unified operation also positioned us to accelerate innovation. Standardized workflows created the foundation to deploy robotic process automation and artificial intelligence across key revenue cycle functions, allowing our teams to automate repetitive tasks, improve accuracy, and focus on higher value work that directly supports patients and providers.
The financial impact has been equally meaningful. Through stronger operational alignment, technology enabled efficiencies, and an unwavering commitment from an exceptional team, Grady has achieved sustained double digit revenue growth year over year while building a more scalable revenue cycle for the future.
Large scale transformation is never the result of technology alone. It requires committed leadership, trusted partnerships, and talented people willing to embrace change. I am incredibly proud of what our revenue cycle team, operational leaders, physicians, and academic partners have accomplished together. This work demonstrates that when organizations unite around a common purpose, they can simultaneously improve financial performance, operational excellence, and the patient experience.
The greatest success of this initiative is not simply that we integrated three organizations. It is that we created one revenue cycle that better serves the patients who depend on Grady every day.
Erin Hodson, MSN. Vice President, Revenue Cycle, Inova (Falls Church, Va.): One of the biggest shifts we’ve made in revenue cycle has been changing how we approach denials and revenue leakage. While automation remains critical, we recognized that simply automating broken processes wasn’t going to solve the problem. Too often, payer behavior dictates the pace of reimbursement.
Instead, we focused on using data to understand and address the root causes of payer denials and retractions. With a data-science partner, we’ve been able to identify payer-specific patterns, automate where it adds value, and challenge practices that create unnecessary administrative burden and revenue leakage.
The results have been meaningful. We’ve identified and challenged multimillion-dollar payment retractions, achieved some of our lowest professional and hospital denial rates, and worked with a national payer to eliminate an edit responsible for more than $1 million in denials. More importantly, we’ve shifted from reacting to payer behavior to proactively using data to improve financial performance and reduce friction for our managed care and revenue cycle teams.
Skyley McLain. Manager, Physician Revenue Integrity, Integris Health (Oklahoma City): One of the most impactful initiatives has been a Revenue Leakage Reduction PDSA (Plan-Do-Study-Act) focused on our operating room revenue cycle. We brought together stakeholders from IT teams, patient access, clinical operations, physician teams, supply chain, revenue integrity, coding, billing and authorization teams to identify where revenue leakage was occurring across the surgical workflow. Through a structured Plan-Do-Study-Act approach, we evaluated gaps related to charge capture, authorization accuracy, implant and supply documentation, registration workflows and claim readiness.
Rather than treating denials as isolated events, we focused on identifying and resolving upstream process failures. This work strengthened cross-functional accountability, improved workflow standardization, reduced avoidable rework, and increased visibility into opportunities that could impact reimbursement. Most importantly, it shifted the conversation from denial management to proactive revenue integrity.
Prajay Kotamreddy. Manager – Claims, Desert Valley Hospital (Victorville, Calif.): The most impactful initiative was shifting our mindset from revenue cycle management to revenue cycle intelligence.
For years, healthcare organizations have measured success through lagging indicators such as denials, collections, and days in A/R. While important, these metrics only tell us what has already happened.
Our focus was on building greater visibility into the operational decisions that ultimately drive financial outcomes. By improving workflow standardization, strengthening cross-functional accountability, and increasing transparency across departments involved such as claims, eligibility, provider offices and payer operations, we were able to identify revenue risk earlier and create more predictable reimbursement outcomes.
The greatest lesson was that the revenue cycle is not about processing faster. It is about creating predictability. Organizations that can consistently predict and protect future cash flows will always outperform organizations that spend their resources reacting to financial surprises.
Felicia Kimble. Director of Revenue Cycle, Memorial Hospital of Carbon County (Rawlins, Wyo.): One of the most impactful initiatives I led was bringing our outsourced accounts receivable operations back in-house. After a comprehensive assessment of costs, performance, and patient experience, I identified an opportunity to improve both financial outcomes and service quality by building and managing an internal AR team.
Using Lean Six Sigma principles, we mapped existing workflows, identified inefficiencies and waste, analyzed root causes of performance gaps, and redesigned processes to improve productivity and accountability. The project required careful planning and execution, including workflow redesign, staff recruitment and training, development of key performance indicators, and a structured transition plan to ensure continuity of operations and cash flow throughout the conversion.
The financial impact was significant. The initiative generated approximately $700,000 in savings during the first year alone and was projected to deliver more than $3.4 million in cumulative savings over a five-year period. In addition to the cost savings, collections’ performance improved through greater operational visibility, stronger oversight, and more effective management of accounts receivable.
Perhaps the most meaningful outcome was the improvement in the patient experience. Patients appreciated speaking with local representatives who understood the community and could provide personalized, compassionate assistance with billing questions and payment options. This increased trust, improved patient satisfaction, and reinforced our commitment to delivering exceptional service throughout the revenue cycle.
This initiative demonstrated that revenue cycle transformation is most successful when operational excellence, financial stewardship, and patient-centered care are aligned. By applying Lean Six Sigma methodologies and empowering a dedicated internal team, we achieved measurable financial results while enhancing the experience of the patients we serve.
Ekbal Alnajar. President of Insight Revenue Cycle Management, Insight Health System (Chicago): The most impactful initiative has been the strategic realignment of our RCM and IT departments, specifically through the integration of AI tools for clinical documentation improvement and automated billing. We transitioned certain operational workflows to strategic vendor relationships while heavily utilizing AI for charting automation across our multistate system. By streamlining these processes, we significantly reduced administrative bottlenecks, improved the precision of our APC/DRG calculations, and accelerated our overall cash flow while reducing claim friction.
Heather Clinton. Director, Revenue Cycle, OrthoNebraska (Omaha): One of the most impactful initiatives has been focused physician education to support stronger documentation and coding accuracy. We partnered closely with providers to deliver targeted education, practical documentation tips, and specialty-specific coding pearls that ensure accurate, compliant documentation, helping physicians stay protected amid ever-changing requirements and clearly tell the full patient story. As a result, we’ve seen improvements in coding accuracy, reduced variability, and more complete capture of the complexity of care being delivered.
Robert Jacobs. Chief Revenue Officer, South Shore Hospital (Chicago): Addressing the self-pay portion of every hospital bill. You must have experience up front staff and have financial counselors in place to talk with the patients and either collect some of the money or make payment arrangements. Once the patient leaves the facility, the percentage of collecting a debt falls 75%. Each hospital should determine the cost of collections.
Erika Whitney. AVP – Revenue Cycle Operations, Synchrony Health Services (Louisville, Ky.): The biggest positive impact I’ve seen on a revenue cycle did not come from a new technology platform or a major process redesign. It came from investing in workforce stability.
Early in my career, I assumed operational performance was primarily driven by systems and workflows. What years of leadership have taught me is that even the best processes struggle when organizations are constantly replacing and retraining staff. Sustainable improvement requires experienced people who understand the work, can identify issues before they become problems, and have the confidence to continuously improve operations.
In one of the most impactful initiatives I’ve led, we focused on strengthening hiring, onboarding, training and retention while creating clearer expectations, accountability and operational visibility for the team. As turnover stabilized and tenure improved, we were able to address longstanding inventory and claim backlogs, improve operational performance and create more consistent financial results.
The measurable outcomes were significant, but the most important lesson was that workforce stability is often an overlooked revenue cycle strategy. Strong teams create strong processes, and strong processes create sustainable results.
Ticia Selmon. Director of Coding Education, Baptist Health (Louisville, Ky.): The risk adjustment capture and reporting enhancements via implementation of new tools and new workflows for my team has had a positive impact on our medical group revenue cycle. We implemented Epic’s Pre-Visit CDI and Post-Visit CDI Coding tools. We’ve improved our diagnosis specificity capture through pre-visit nudges and reduced our post-visit specificity queries.
Ashley Foster. Vice President of Information Systems Applications, MemorialCare (Fountain Valley, Calif.): The project that had the biggest impact on the revenue cycle was automating the patient financial experience through Epic’s Gold Stars optimization program. Over the last two fiscal years, we upgraded our gateway vendor, integrated credit card payments into Epic, added online and mobile bill payment features and self-serve payment plans, implemented 100% paperless statements for patients who opted in, and amplified dashboards and reports for increased visibility and decision-making for operational leaders. As a result of these efforts, operating margins experienced an increase of automatic payment posting by 35% and point-of-service payment collection by 10% across all entities with some individual practices experiencing growth up to 15%.
Brett Mcmillan. Vice President of Revenue Cycle Operations, VCU Health (Richmond, Va.): The most impactful initiative to our overall revenue cycle performance over the past 36 months has been foundational and functional alignment of historically disparate front-end revenue cycle functions into a consolidated team of access professionals under common revenue cycle leadership.
Securing organizational buy-in for this change by clearly articulating the benefits in core efficiency and effectiveness metrics, and then demonstrating performance against those metrics after changes were made, have built significant credibility in the team.
This is a multi-year journey at a complex academic multi-hospital system, but just as Rome wasn’t built in a day we have found success in clearly articulating our vision for the revenue cycle operating model and maintaining milestone-level work plans and regularly tracking progress through data.
Here are some results: Our cash vs. cash-target performance over the past 3 years is 100%+, our AR Days are at 5+ year lows, and despite organizational CAGR of high single digits our revenue cycle cost to collect is falling and revenue cycle operations FTE count has not increased in the past 18 months.
Carol Siedsma, MS, Vice President, Revenue Cycle, Berkshire Health System (Pittsfield, Mass.): We recently implemented a patient payment platform system that has significantly improved our patient financial experience. Patients now have an opportunity to receive their bills digitally and the platform offers an easy payment plan for patients to accept. We have received positive feedback from our patients and accelerated cash flow.
Leticia Longoria. Patient Financial Services Director, Hemphill County Hospital (Canadian, Texas): The biggest positive impact on our revenue cycle was bringing our billing operations back in-house. While many rural hospitals have outsourced portions of their revenue cycle, we made the decision to bring billing back under our own roof. Having direct control over the billing process has allowed us to proactively follow up on claims instead of relying on a third party to identify and resolve issues.
As a result, our accounts receivable days decreased, collections increased, and we were able to quickly identify trends affecting reimbursement, such as registration errors, payer contracting issues, authorization problems and appeal opportunities. Because we’re a small rural hospital, our staff know each other, communicate regularly, and genuinely care about the success of the organization and our community. That level of collaboration has allowed us to resolve problems much faster than we could before and has had a significant positive impact on our overall revenue cycle performance.
Joe Bedwell. System Director, Revenue Cycle, DCH Health System (Tuscaloosa, Ala.): The creation and incorporation of a systemwide, cross-departmental, monthly RCM Governance Committee has been one of the most impactful initiatives we have implemented. The biggest mindset shift we’ve made is recognizing that the revenue cycle isn’t a finance function, but more of an operational function. Nearly every dollar our hospital collects is influenced by decisions made before the bill is ever generated. When patient access, nursing, physicians, ancillary departments, HIM and finance work together around common data and accountability, financial performance improves naturally. The largest positive impact for us has come from shifting our mindset from recovering revenue to preventing revenue leakage. A common saying we have adopted throughout the organization is that we are all members of the revenue cycle team, regardless of title.
Lisa R. Fox. CEO of The Bradley Center (Pittsburgh): Bradley’s biggest strategic bet is that the future of children’s behavioral healthcare will be built through strong partnerships, shared resources, and collaborative systems of care. As a mid-sized nonprofit, we recognize that we cannot, and should not, try to do everything alone. Our greatest impact will come from partnering across healthcare, education, families and community organizations to leverage expertise, share resources, expand access and create a more connected continuum of support.
By building meaningful collaborations, we can combine strengths, reduce duplication and better meet the increasingly complex needs of children and families, from prevention and early intervention to intensive treatment. We believe the organizations that embrace partnership and collective impact will be best positioned to create lasting change.
Brett Tracy. Principal with The Landry Group (Houston): The biggest improvements came when we stopped looking at the revenue cycle as just the billing department and treated it like an operational process that starts with the patient and ends with payment.
We brought registration, clinical teams, coding, billing, finance and IT together around shared metrics, standardized workflows and focused on fixing the root causes of denials instead of just appealing them. That led to millions of dollars in additional cash collections, faster reimbursement, fewer denials and a much more sustainable process.
Khalil El Atab, MD. Group RCM Director, Cambridge Health Group (United Arab Emirates and Saudi Arabia): One of the most impactful initiatives we implemented was the establishment of a centralized revenue cycle management structure across multiple rehabilitation and long-term care facilities (five hospitals) in both the UAE and Saudi Arabia. Managing revenue cycle operations across different countries meant navigating varying regulations, payer requirements, billing rules, and contractual frameworks.
To address these challenges, we standardized key revenue cycle processes, including authorization workflows, denial management, clinical documentation requirements, coding oversight and payer communication protocols. We also created unified governance and performance monitoring mechanisms across all facilities.
As a result, we achieved significant improvements in clean claim rates, reduced denial volumes, shortened accounts receivable days and enhanced cash collections. Equally important, the initiative strengthened collaboration between clinical, operational and financial teams, creating a more sustainable and scalable revenue cycle model that continues to support long-term financial performance.
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