Amid mounting financial and operational pressures, healthcare leaders are turning to AI not only to optimize revenue cycle performance but to reimagine it entirely.
During a recent discussion at Becker’s Health IT + Digital Health + RCM Meeting in Chicago, leaders from Optum and Microsoft discussed how AI is helping health systems tackle deep-rooted inefficiencies, reduce administrative burdens and pave the way for real-time, collaborative payer-provider engagement.
Here are four key takeaways from the discussion
1. Bridging the payer-provider divide
AI is transforming how health systems interact with payers, offering tools that minimize the costly back-and-forth of revenue cycle processes.
Madhu Pawar, chief product officer at Optum, highlighted two major focus areas: building real-time data bridges between payers and providers, and using AI to streamline core workflows.
“The entire industry of revenue cycle management is trying to, simply put, effectively predict what is going to be paid,” said Pawar. “We want to eliminate the guesswork via real-time interactions between payors and providers and the related friction”
Optum Real-time APIs, currently being piloted with UnitedHealthcare and a large health system, allow providers to verify reimbursement details, documentation requirements and patient responsibility at the point of care. According to Optum’s team, early adopters have already seen denial reductions and up to 40 percent fewer call center inquiries.
2. Clean data is the foundation for trustworthy AI
To scale AI, healthcare organizations need to first invest in unlocking silos of unstructured data around benefits, contracts and guidelines. Next, healthcare organizations need to adopt AI, and Optum Real is supporting organizations with this in real-time.
Pawar highlighted Optum’s high stakes in this conversation. With roughly 14.4 billion clinical transactions processed, “Getting it wrong is not an option.”
Microsoft’s Mary Varghese Presti, corporate vice president of Health & Life Sciences, echoed this point, noting that modern AI tools now make it easier to extract and structure data from fragmented sources, and that clean, well-organized data remains essential for safe implementation.
“We now have tools to create that common data platform on which to do work,” said Varghese Presti. “Getting to that clean data as the foundation is important because otherwise we run the risk of garbage in, garbage out.”
3. The ‘frontier firm’
Microsoft’s latest “Work Trend Index” report, “2025: The Year the Frontier Firm Is Born”, outlines a model for future-ready healthcare organizations. According to Varghese Presti, frontier firms don’t just deploy AI, they reimagine workflows and jobs to be done, reskilling and building trust for a hybrid workforce of humans and digital agents. This includes viewing workflows as human-agent partnerships, evolving org charts, and redefining job roles.
Becoming “frontier” includes three phases: using AI to assist human tasks, deploying agents to handle tasks autonomously, and, eventually, humans managing fleets of agents. Varghese Presti noted that leading organizations, such as Moderna, are already reorganizing leadership to align technology and workforce strategy.
“The pace of change is non-linear,” Varghese Presti said. “I would say get comfortable with AI assistants and agentic services, think about how it might reduce toil and give you operational leverage for your work.”
4. Generative AI is the future
While AI is still evolving and growing, it is available to us now and, in fact, many tools are already in place. Optum’s agentic systems, including those for real-time coding and documentation are being deployed across care settings. Ms. Pawar said the company aims to empower much of the healthcare ecosystem to these new platforms by the end of 2026.
Varghese Presti added that Microsoft has seen tangible impact from AI-powered agents in oncology, citing a pilot with Stanford Medicine that used AI to expediate medical review coordination and reduced review times from weeks to days.
While AI capabilities continue to grow, trust in the data and alignment between stakeholders remains a limiting factor. However, Varghese Presti and Pawar were optimistic that AI, when paired with foundational investments and cross-sector collaboration, could move the industry past these growing pains.
“There can be limitations and constraints to the data that we can see,” Varghese Presti said. “I do think this is the era of AI and we are going to have to see if our ambition and the technology allows us to push through so that the data can flow.”
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.
