Ask a Revenue Cycle Leader is a new series featuring insights from health system and hospital revenue cycle executives nationwide. Becker’s poses questions on the most pressing issues in healthcare finance — from payer relations and automation to workforce and patient experience. We welcome responses from all revenue cycle, finance and reimbursement leaders.
Question: What is one leadership lesson you learned the hard way?
Stacey Bui. Middle Revenue Cycle Division Chair at Mayo Clinic (Rochester, Minn.): One leadership lesson I learned the hard way is that it takes real leadership to address difficult performance issues directly. It can feel easier in the moment to avoid the confrontation or hope things improve on their own, but they usually don’t. Having those hard conversations is uncomfortable, but it’s ultimately better for your high performers, the organization and, most importantly, the individual. Addressing issues honestly gives people the clarity and opportunity to improve, while also showing the rest of the team that accountability matters.
Joanna Caballero. Corporate Vice President of Revenue Cycle at Scripps Health (San Diego): A leadership lesson I learned the hard way is that clarity is kinder than delay. When a performance issue surfaced, I initially gave it more time than was helpful before having a direct conversation. The feedback was received well, and the individual appreciated knowing exactly what needed to change. It also reinforced for the team that leaders should address concerns fairly, consistently and in a timely way. Direct feedback, delivered respectfully and early, is an important part of effective leadership.
Mark Evard. Vice President of Revenue Cycle Operations at University of Texas Medical Branch (Galveston): Early in my career as a leader, I made the mistake of saying “I did this and I did that” when in reality it was my entire team that did it. I was very fortunate to have a team member who was not intimidated by my title and called me out. I felt horrible because I didn’t even realize I had been doing it. Since then, I make it a point to say “we” or “they” and I also make it a point to recognize them daily for the work they do.
MariaRita Genovese. Director of Revenue Cycle and Business Operations for MD Anderson Cancer Center at Cooper (Camden, N.J.): One leadership lesson I learned the hard way is that you can’t always be the person who steps in and fixes everything. Earlier in my career, when we had a significant revenue cycle problem, my instinct was to take ownership, work through the details myself and make sure the solution was right. I eventually realized that while I was solving the immediate problem, I wasn’t giving my team the opportunity to think through the issue, build confidence and develop their own solutions. Once I began giving people more ownership and creating space for them to lead, I saw a real difference, not only in their confidence and engagement, but also in the team’s ability to solve problems without always relying on me. That experience taught me that the lasting impact of leadership isn’t just fixing today’s problem; it’s developing people who are prepared to solve tomorrow’s challenges.
Joel Gentry. Vice President of Revenue Cycle at OU Health (Oklahoma City): One leadership lesson I learned the hard way is the importance of understanding what you don’t know. Early in my career, I led the rollout of a new operational process that I believed was thoroughly planned and supported. The implementation failed because I had unknowingly overlooked critical operational realities, and we ultimately had to reverse course. While it was a difficult experience at the time, it fundamentally changed how I lead. I learned that success is not determined by having all the answers. It comes from asking the right questions, seeking diverse perspectives and creating an environment where concerns and risks are surfaced before they become problems. To this day, one of the most valuable questions I ask before any major decision or initiative is, “What am I missing?”
James Hartman. Director of Revenue Cycle at Thorek Memorial Hospital (Chicago): At a prior hospital I worked at, the inpatient authorization denials were out of control. Our approval rate was around 40%. I had a team in place, but instead of leading them through it, I took the work on myself. I was working the denials daily while I built and tested the new process and training staff on the side.
It worked, but it cost more than it needed to. I became the bottleneck, and the team was learning the process secondhand instead of building it with me.
The lesson was that when I do the work, I fix the problem once. When I build the team to do the work, I fix it for good. So I shifted: I brought the team into designing and testing the process, trained them on it and stepped back to managing results. That became the dedicated denials team, and approval rates went from 40% to 95%.
I’ve led that way since. At Thorek, I set the direction and hold owners accountable, and my managers run the work.
Sandra Johnson. Vice President and Chief Revenue Officer at MedStar Health (Washington, D.C.): When I first became a leader, I always tried to be fair, transparent and inclusive. As I was putting on my first event for the staff, I tried to think of things that everyone would like and want to participate in. We had the event, and 98% were very satisfied. I met with some of the other 2%, and some of the reasons they were not happy didn’t make a lot of sense. It really bothered me. I talked to my mentor about it. She told me, “Sandra, you will not always make everyone happy. If I’m a person who is not happy about life, believe me, you are not going to make them happy. Stick to your foundation of fairness, transparency, and inclusiveness and do what you can but you can’t let the facts that 100% of people don’t think it was great bother you. If you start from your foundation and if even 50% feel it’s satisfying, you have won.”
Paul LePage. Vice President of Revenue Cycle at UC Davis Health (Sacramento, Calif.): One leadership lesson I learned the hard way is that not everyone is motivated by the same thing, or the same way. Early on, I assumed a clear goal and a strong team culture would bring everyone along at the same speed. Over time, I learned that some people want recognition, others want more ownership, and others need support or room to grow. As a VP of revenue cycle, I still hold everyone to the same standards, but I try to understand what helps each person do their best work. Finding that balance makes me a better leader and makes the team stronger.
Scott Smith. AVP of Revenue Cycle Back-End Operations at UT Southwestern Medical Center (Dallas): Early in my leadership career, I had an unhealthy habit of taking on too many projects simultaneously — and a difficult time telling executive leadership “no.” The result was inevitable: burnout, slower timelines and frustration for everyone involved.
Through mentorship, I learned that the answer isn’t simply saying “no” — it’s setting clear priorities and inviting my executive leaders to help ensure my prioritization aligns with theirs. This approach does two things: it keeps us strategically aligned, and it provides visibility into the true volume of active projects, so we can make better decisions together.
Geneva Stewart. Director of Revenue Cycle at Montage Health (Monterey, Calif.): One leadership lesson I learned the hard way is that delaying difficult conversations rarely makes the outcome better. Whether it’s addressing staffing needs, process gaps, payer challenges or technology limitations, waiting usually allows the issue to grow and impacts more people. I’ve learned that leaders create the most value when they identify risks early, bring the right people together and build a plan before a problem becomes a crisis. Prevention with proactive leadership and collaboration is almost always easier than recovery with a people-first driver.
Next question: What is one thing you look for in a revenue cycle hire that doesn’t show up on a resume? If you are interested in responding, please send responses to Andrew Cass at acass@beckershealthcare.com.
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