The line between the CFO’s office and the revenue cycle department is disappearing, four health system leaders said Sept. 15 during a panel discussion at Becker’s 11th Annual IT + Revenue Cycle Conference.
Beth Carlson, chief revenue officer at Columbus-based The Ohio State University Wexner Medical Center, described the shift directly.
“The lines between finance, revenue cycle, even the clinical operations, are becoming increasingly blurred,” she said. “CFOs are more focused on strategy more than ever. Chief revenue officers or revenue cycle teams are more embedded in clinical operations more than ever.”
Ms. Carlson said the metrics her team tracks have changed accordingly, moving past traditional accounts receivable waterfalls toward more actionable measures such as payer retraction activity and cash resurfacing from zero-balance accounts.
“You measure yourself not by how good you are explaining your performance but at influencing it,” she said.
Henry Stokman, a principal at ECG Management Consultants who leads the firm’s revenue cycle practice, said that blurring often creates friction rather than clarity. Revenue cycle teams are typically judged on operational activity, he said, while finance teams are judged on financial outcomes, and the two do not automatically translate. His fix is to convert operational metrics into financial language everyone in the room can act on.
“Instead of saying our denials rate is up 1%, [you can say], ‘Our denials rate is going to negatively impact our cash by $4.2 million this next quarter,'” he said. “‘These are the things that we need to do to try to drive that down.’ You get instant alignment between the group.”
That alignment starts with a shared obsession over cash, though panelists were careful to distinguish cash on hand from cash that is sustainable. Alex Miller, CFO of Lurie Children’s Hospital of Chicago, said his team tracks cash, write-offs and denials as its three core numbers, then pushes further into what that cash means for the organization’s future.
“Cash is king in my role,” he said. “We want to have predictability. So looking at our 12-month run rates, understanding what our historical trends have been, and then really being able to predict what our cash will be based off our current charges.”
From there, he said, the finance team decides how much of that cash supports working capital versus longer-term investment through the hospital’s endowment, sorting funds into liquidity, intermediate and long-term buckets.
Gregory Wiles, vice president of revenue cycle at Morristown, N.J.-based Atlantic Health, said the tools for spotting cash problems have changed as much as the underlying discipline. He described a recent incident in which a clearinghouse stopped transmitting the health system’s claims. In the past, he said, that kind of gap might have gone unnoticed for a week or two until a staffer manually followed up with a payer. With electronic claim status tools, Atlantic Health caught it within days.
The bigger shift, he said, is philosophical as much as technical. Atlantic Health is piloting agentic AI for scheduling calls and for drafting denial appeal letters that cite medical records and payer policy directly, but Mr. Wiles was clear about how leadership frames the investment.
“We’re very blessed at Atlantic,” he said. “Our CEO wants to invest in AI and wants to invest in our people. It is not a rip-and-replace technology for people. We’re going to grow, and this is one of the tools that we’re going to use.”
Not every panelist said they want to make big AI bets right away. Ms. Carlson said Ohio State Wexner is deliberately avoiding the highest-ROI, highest-risk AI projects in favor of smaller, low-risk deployments that build staff trust first.
“I don’t think that these tools are silver bullets that are going to eliminate the need for expertise or process design,” she said, arguing that a portfolio of small wins builds the internal buy-in needed before a system takes on a costlier, harder-to-reverse investment.
Underlying all three threads, the panelists said, is a workforce that needs reassurance as much as new dashboards. Ms. Carlson said she addresses staff fears about AI head-on rather than letting speculation take hold.
“Our jobs are going to change, but that’s nothing new,” she said she tells her team. “Our jobs have been changing for as long as we’ve been in them, and we’ve always been able to navigate that change.”
Mr. Miller made a similar point about templates and training: Staff need to understand why a metric matters, not just how to hit it, or organizations risk losing the underlying judgment that catches problems no template anticipated.
