Sheila Augustine has spent nearly her entire career in revenue cycle. Twenty-one years at Omaha-based Nebraska Medicine, the last stretch of them as executive director of revenue cycle for a roughly $3 billion net patient revenue organization. In that time, she has watched the role change from a largely operational function to something that now sits at the intersection of AI implementation, workforce strategy and financial risk management.
That shift has sharpened her thinking about succession. As health systems work to build the next tier of revenue cycle leadership — a challenge that Geisinger’s chief revenue officer recently called his No. 1 priority for 2026 —Ms. Augustine’s criteria have evolved alongside the role itself.
“When I look for leaders, they don’t have to know everything, but they have to be able to guide people,” she said during a “Becker’s Healthcare Podcast” interview. “People want to work for them.”
The qualities she names track closely with what the broader industry is demanding. A positive outlook. Openness to change. Strategic thinking. The ability to build team morale in an environment where remote work has made culture harder to sustain and where the definition of revenue cycle expertise is being rewritten by AI.
“If you’re very set in your ways and this didn’t work twenty years ago, you’re probably not in the right role,” she said.
The AI dimension is not incidental. Ms. Augustine has spent the past year implementing AI use cases across Nebraska Medicine’s revenue cycle focused on missing charge identification, mismatched charge detection and AI-assisted appeals writing among them. That experience has reinforced her view that the leaders best positioned for what comes next are the ones who have already been handed something new and run with it.
“You want somebody to be here, do a great job, have results, and be focused on building team morale,” she said. “Giving somebody that’s a high performer a project that they can do, and you get to see them bring that to light — and will they have an opportunity to grow and be successful in a leadership role?”
That project-based approach to succession development is intentional. Rather than relying on tenure or title proximity to identify future leaders, Ms. Augustine has used AI implementation work as a proving ground. The employees she designated as super users and subject matter experts for new tools became the internal champions who trained their own teams and demonstrated what leadership looks like in practice.
The approach also addresses the cultural challenge that comes with any major technology change. When staff hear that AI is coming to their department, Ms. Augustine said the first instinct is often fear about job displacement. Putting frontline employees at the center of implementation — as experts rather than subjects — changes that dynamic and surfaces the next generation of leaders at the same time.
She is also thinking about succession at the role level, not just the organizational chart. A coding leader, she noted, requires a different profile than someone running denials. The qualities that make a strong manager in one area of revenue cycle do not automatically transfer.
“If you’re looking across the revenue cycle, a coding leader, somebody who’s doing coding, might be different in some aspects than somebody that’s over denials,” she said. “Complementing that [you select] who would be the right leader for each role.”
The skills that matter most are also changing at the individual level. Data literacy, cross-functional collaboration and adaptability have emerged as the core competencies revenue cycle leaders point to as AI reshapes what the function requires day to day.
Ms. Augustine’s own evolution offers a case study. Working with her organization’s vice president of finance — a leader who came to healthcare from outside the industry and looked to her for revenue cycle expertise rather than assuming it — forced her to think more strategically about the business of healthcare, not just the mechanics of the revenue cycle.
“It gave me a different mindset to start thinking more strategically and realizing that while healthcare is healthcare, it’s a business as well,” she said.
The combination of Medicaid disruption, AI acceleration and mounting payer pressure means the revenue cycle leaders health systems develop today will inherit a function that looks materially different from the one that exists now. Augustine’s argument is that the organizations that identify and grow those leaders deliberately through project ownership to accelerate those transitions.
“Succession planning — that’s such a great opportunity for any organization, and revenue cycle is no different within the healthcare arena,” she said. “Make sure that you have identified leaders who can take that next step.”
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