Revenue cycle leaders have historically built expertise through repetition, spending years coding claims, working denials and reconciling charges before advancing into more complex roles. But As AI takes on more of that work, the traditional path to developing that experience is starting to disappear.
As automation absorbs more entry-level and repetitive work, health systems face a new workforce challenge: How will the next generation develop the judgment needed to lead if technology eliminates many of the “reps” that traditionally built that expertise?
Felix Segre, director of revenue integrity at Houston-based Memorial Hermann Health System, pushed back on the idea that organizations should try to recreate those 10,000 hours in the same way.
“We don’t,” Mr. Segre said during a panel at Becker’s 11th Annual Health IT + Digital Health + RCM Conference. “What we do is create that opportunity for AI to learn from those people.”
He argued that the mistake would be treating AI as a wholesale replacement for the expertise already embedded in revenue cycle teams.
“This is where some [health systems] are making a mistake: They see AI as the overall solution to our heartaches. It is not,” he said. “Our people [are] always going to be the heart of this and it is our responsibility as leaders to create that space for them to truly understand how AI is going to be.
“The good thing about AI is that it’s trainable. That’s really at the core of AI. What these people can contribute is helping train the AI to reach its maximum efficiency toward what we’re trying to achieve.”
For health systems, that creates some urgency around capturing the knowledge of experienced employees while they are still available to train, supervise and refine the technology being deployed around them.
Skyla McLean, physician revenue integrity manager at Oklahoma City-based Integris Health, described the moment as an opportunity to preserve knowledge that has historically lived largely in people’s heads.
“We have a privilege in this industry right now as we’re turning the cusp,” Ms. McLean said. “We have the opportunity to document that undocumented knowledge and gather it in a way that produces sustainable outcomes moving forward. Leaning into that education now is the best ticket right now.”
The next skill: Knowing when AI is wrong
The emerging career path may depend less on completing thousands of routine transactions and more on learning how to evaluate what technology produces.
Jamie Burke, a healthcare partner at Information Services Group, said health systems increasingly need people who can govern AI, determine whether its output makes sense and translate it into action.
“The real intelligence piece and the skill set shortage is those folks that can intelligently govern what’s happening and pull from what AI is giving you and actually make sense of it for you and your system and cash flow,” Mr. Burke said.
Rachel Papka, CIO at Las Vegas-based Steinberg Diagnostic Medical Imaging, said the revenue cycle role of the future could increasingly resemble that of an auditor.
“The role becomes a little bit more of an auditor,” she said. “It’s paired with your AI subject matter expert.”
Organizations will still need deep revenue cycle expertise, but that expertise will need to be paired with people who understand the technology.
“You can’t have just one, you have to have both,” Ms. Papka said.
Hari Balasubramanian, Solventum’s chief technology officer of health information systems, raised another reason those skills will matter: AI can deliver a bad answer with considerable certainty.
“AI can say things wrongly with great confidence,” mr. Balasubramanian said. “That means you need to have someone who can be at that helm challenging it.”
As automation frees employees from more manual work, he expects their responsibilities to move toward areas such as oversight, compliance and governance.
“The person who is sitting on the top should be able to challenge the AI’s output,” he said.
Revenue cycle needs a new apprenticeship
The bigger issue is succession.
If coding, authorization checks, appeal writing and other repetitive tasks become increasingly automated, some of the traditional entry points into revenue cycle careers could shrink even as health systems continue to need experienced directors and executives.
Sheila Augustine, executive director of revenue cycle at Omaha-based Nebraska Medicine, said she does not expect people to disappear from the revenue cycle. Instead, hospitals and health systems will need to deliberately expose employees to the implementation and oversight of new technology.
She pointed to opportunities for staff to become super users and subject matter experts as health systems deploy AI.
“Bringing in super users, SMEs to allow your staff members to actually see it be implemented and be part of that can help drive some of that succession planning,” Ms. Augustine said.
The skills future leaders need may also broaden.
Ms. Papka pointed to analytics as one capability that will become increasingly important as leaders move away from repetitive work and toward spotting trends, understanding workflows and identifying where technology is missing something.
“The repetitive items are AI, but the innovation and the next-level thinking still has to be a human interaction,” she said.
Deborah Greer, MD, system lead for advanced appeals and settlements at Chicago-based CommonSpirit Health, said experience and deep domain expertise will remain critical even as AI becomes more embedded in the work.
“AI isn’t going to replace people, but you’re going to get crowded out if you don’t use AI or you don’t understand AI,” Dr. Greer said.
The challenge for health systems is not simply deciding which tasks AI can perform. Leaders also have to consider what employees learned by performing those tasks and how that knowledge will be developed once the work changes.
The next generation may trade 10,000 hours of repetitive transactions for a different kind of apprenticeship: reviewing exceptions, auditing automated decisions, analyzing data, working across functions and learning when to challenge the technology.
As Mr. Burke put it, the transformation still comes back to “people, process, technology.”
“We all get bogged down in the technology and the process and we forget about the people,” he said. “Don’t forget about the people.”
