As automation and artificial intelligence move from pilots into daily revenue cycle operations, a new leadership role is taking shape inside health systems. Revenue cycle executives are increasingly acting as AI governance leaders, responsible not only for efficiency and accuracy, but also for clinical integrity, regulatory compliance and ethical oversight.
Rather than delegating AI strategy solely to IT or digital teams, revenue cycle leaders are defining where automation is appropriate, where human judgment must remain in control and how systems should surface risk before it turns into denials, compliance issues or patient disruption.
Establishing the standard
At UC Davis Health in Sacramento, Calif., Paul LePage, vice president of revenue cycle, described an intentional division of labor between technology and people.
“Our system will employ automation to handle high-volume, rules-based tasks — such as eligibility checks, charge capture, and documentation prompts — while preserving human oversight for clinical judgment, exception management, and quality assurance,” said Paul LePage, vice president of revenue cycle at UC Davis Health in Sacramento. “In 2026, advanced analytics and AI-driven workflows will surface risk, variance and compliance issues in real time, enabling staff to intervene where expertise adds the most value.”
That balance is foundational to responsible AI use to avoid compromising clinical integrity and regulatory compliance. A similar governance mindset is taking shape at Johns Hopkins Medicine in Baltimore. Amber Imboden, director of revenue integrity, said automation is being positioned as an early warning system rather than an autonomous decision-maker.
“In 2026, we will use automation as the first line of defense, leveraging Epic and AI-enabled tools to proactively identify things like missing charges, documentation gaps and charge related compliance risks before billing,” she said. “Human oversight will focus on reviewing exceptions, applying clinical and regulatory judgment, and partnering with the system on workflow improvement.”
That structure allows the organization to scale consistency without relinquishing accountability. Feedback from the RCM team on the performance of AI-enabled tools ensures the technology stays on track and the system will continue to iterate over time.
Governance leadership
At Harvard Medical Faculty Physicians in Boston, the governance role of revenue cycle leaders is even more explicit. Shannon Cameron, chief operating officer of revenue cycle, said the organization has formalized a required human-in-the-loop model.
“In 2026, our approach to revenue cycle and clinical documentation is intentionally human-led, with automation serving as a support layer-not a replacement,” she said. “Automation is applied to high-volume, rules-based tasks such as data normalization, charge capture checks, eligibility verification, claim edits, and trend identification.”
Clinical accountability remains firmly with the human workforce, who are responsible for coding accuracy, compliance interpretation, provider query management and final financial accountability.
“We operate with a required human-in-the-loop model where experienced coding, compliance, and revenue cycle professionals review exceptions, validate automation outputs, and make final determinations, particularly for complex, high-risk, or high-dollar encounters,” she said.
At Beth Israel Lahey Health in Cambridge, Mass., governance structures are being built alongside the technology itself. Keisha Downes, vice president of mid-revenue cycle, said oversight and transparency are non-negotiable as AI adoption accelerates.
“We are establishing rigorous AI governance structures that require transparency in algorithmic decision-making and continuous monitoring of performance metrics to ensure accuracy, equity, and compliance,” she said. “The real opportunity in 2026 isn’t choosing between humans and machines, but in designing intelligent workflows that leverage both to their fullest potential.”
AI limits
Automation has great potential benefits, but there are limits and the risks of overreliance without human interpretation. Scott Schwab, CFO and COO of Hillsboro Medical Center in Portland, Ore., said revenue cycle and documentation demand a higher level of human involvement.
“For revenue cycle and clinical documentation, the human aspect is even more important,” he said. “Technology cannot replace clinical judgment, and many revenue cycle activities are driven by clinical documentation and require input from the care team.”
Governance is necessary at the root-cause level to mitigate risk and achieve the desired efficiencies.
“Most automation at this stage is not sophisticated enough to properly identify root causes, let alone craft solutions and communicate with the appropriate owner,” he said, adding that constantly changing payer policies further reinforce the need for human oversight.
Across organizations, leaders describe automation as a force multiplier rather than a decision-maker. Ashwin Singh, vice president of revenue cycle management at Jackson Health System in Alpharetta, Ga., said prioritization is where AI delivers value, but control remains with people.
“Advanced AI and rules-based engines will provide prioritization for high-value work while harnessing human skills and maximizing results,” he said. “While humans retain decision rights on exceptions, clinical nuance, and financial risk thresholds, designing systems with embedded human-in-the-loop controls will be the key.”
For many, the governance role also extends to workforce strategy. Beth Carlson, chief revenue cycle officer at WVU Health System in Morgantown, W.Va., said integrating technology and talent is central to the future revenue cycle.
“Our team is leading a workforce transformation initiative designed to intentionally integrate technology and talent into a single workforce optimization model,” she said. “The initiative builds a workforce equipped to drive the revenue cycle of the future where oversight, expertise and decision-making matter most.”
As AI becomes embedded in revenue cycle operations, governance is no longer a separate function; it is being absorbed into the day-to-day responsibilities of revenue cycle leaders.
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
