From Carle Health to NYC Health + Hospitals and Cleveland Clinic, three revenue cycle leaders at Becker’s 11th Annual Health IT + Digital Health + RCM Conference shared stories of their biggest wins and what they plan to tackle next.
A warning on payer-provider dynamics
One of the sharpest notes discussed was on the payer retention side. Marji Karlin, chief revenue officer, New York City-based NYC Health + Hospitals, said escalating friction over payer policy changes won’t be resolved with technology alone. She used an analogy of automated systems clashing without solution.
“I always have had this rock ’em, sock ’em robot thought in the back of my head,” she said. “We’ll put our bots in, they’ll put their bots in and the bots are fighting with the bots. Either they’re going to implode, we’re going to implode, but nobody’s going to win there.”
Reorganizing around regions, not silos
At Urbana, Ill.-based Carle Health, senior vice president of finance operations Aaron Klein said his biggest recent success came from reorganizing a back-end revenue cycle team at the beginning of 2025 that had been sectioned by region rather than function.
“When you move who reports to who and what people are doing, et cetera, there’s a lot of cultural upheaval with that population,” Mr. Klein said. “We saw tremendous improvement as 2025 wore on. Our overall write off rate for denials was about 2.5% of net patient service revenue. As we moved into this year we’ve really stabilized around 1.1% net patient service revenue denials as a percentage of net patient service revenue.”
Mr. Klein said the strong performance comes before he and his team have even fully executed the rest of their strategic plan, because they have been focused on culture alignment and placing employees with work that they are supposed to be doing.
Ms. Karlin detailed a similar situation.
Facing a decentralized system where each hospital and post acute care federally qualified health centers had their own revenue cycle department, Ms. Karlin suggested centralizing key functions. The move, even without full buy-in, got system facilities communicating to each other in new ways.
“By just proposing centralization, we were able to get the facilities to talk to each other in ways that they didn’t,” Ms. Carlin said. ” By the end of 2027, 2028, we should be in best practice according to the EPIC benchmarks. In our first year, we improved the insurance net collection rate by 5%, which contributed $50 million to the organization. That was the big one.”
Ahmad Kilani, MD, associate medical director revenue cycle management and medical director hospital throughput West submarket, Cleveland Clinic, touched on a broader operating-model shift that meshed physician advisors into the revenue cycle. This connection helped connect clinicians to denial data.
“Once you tell them what you’re doing, [like this is] what’s creating the denial… their practice could change,” Dr. Kilani said. He noted that the framing helped shift clinicians from blaming payers to asking “what do we need to do” and how they can “work together.”
The next challenge: people, not technology
The leaders said what keeps them up at night is workforce readiness.
“The technical environment is changing faster than we can upskill our staff,” Ms. Karlin said. She pointed to a heavily unionized workforce and jobs that are “very transactional” even as expectations elevate.
Mr. Klein concurred, and noted that his 350 full time employees on the back end – 90% remote across 30 states – always have 30 FTE open positions. The fix? Not less employees, but using them in a way to ensure their skills can involve critical thinking about problems and how to resolve them in the revenue cycle process.
“I don’t think we’re going to have a need for less people,” he said. “I think those people are going to have to do more at the end of the day and leverage technology to the best of its ability. And we need to upskill them to help them support that work going forward.”
Ms. Carlin said analytical and critical thinking are among the most important skills.
“If you fix something once, great. If you have to fix it a third or fourth time, think about it,” she said. “What can we do to stop the problem from happening?”
Dr. Kilani added a fourth trait: flexibility. “Because everyone needs to know that the work they sign up for is not going to be the same as next year and the year after.”
