Historically, revenue cycle leaders were not considered part of the executive team. Revenue Cycle Management (RCM) has been considered a tactical, back-office function operating in the peripheral, and for the most part, it’s worked. Until now. Market dynamics have changed, and the function has become increasingly complex and critical. As a result, RCM has moved into the spotlight, requiring strategic revenue cycle leaders to join the C-suite and drive business decisions.
Like other executive team roles, today’s RCM leaders call for a more advanced skillset. In the healthcare industry, we find that a successful RCM executive demonstrates four key attributes: team building, embraces technology, patient-focused mindset, and compliance conscious. We engaged with several highly regarded RCM healthcare executives who shared their perspectives on why these four attributes are critical for companies looking to make their next RCM executive hire.
The shift to remote and hybrid work environments is not new, but the prevalence increased significantly during the pandemic. For organizations with a traditional central billing office (CBO) model or similarly centralized hub, the adjustment has been challenging.
To pivot the RCM team successfully, healthcare organizations need a leader who understands what it takes to build culture and nurture employee engagement in a remote environment. It is important to have a leader that knows how to build company culture and personal relationships both in the office and remotely.
Jenny O’Pry, VP of Revenue Cycle Management at Mindpath Health, underlines the importance of nurturing team relationships. By way of example, she has implemented “coffee talks” with her team on a regular basis to encourage virtual “water cooler” interactions and build trust. She also ensures that each person on the team understands the impact of their role on the end-to-end revenue cycle.
Team building is particularly critical because the RCM function in healthcare has traditionally struggled with higher turnover than other fields. Without an RCM leader who can successfully lead in the remote environment, this challenge multiplies. Jeff Noonan, Managing Director at Alvarez and Marsal, is the leader of A&M’s revenue cycle service line. He is seeing client turnover rates spike to the 30% range from historical mid-teens. Noonan highlights that not all turnover is created equal. He shared that organizations should focus on retaining top performers, and it all comes back to culture. Culture and team building in the remote environment is critical to retention.
These challenges are not solved by simply returning to the office. Noonan observes that organizations demanding full-time in-person work are seeing as much as a 50% reduction in their talent pool. Remote is here to stay, and the most successful RCM leader will recognize that and respond accordingly.
Beyond remote work considerations, there are other employee engagement tactics that are critical: flexibility, rewards and recognition, transparent communication, and career development opportunities. Keeping employees engaged and nurturing the overall team dynamic are key to developing a great culture. A strong RCM executive should have a good sense for what is important for the day-to-day support of the team, as well as how to continue to incentivize and motivate the top performers for the long-term.
Technology in healthcare RCM has evolved rapidly over the last few years, and an effective RCM leader must seek to understand the big picture of technology’s role and impact within the function. It is possible to be overzealous in the pursuit of digitizing the revenue cycle. There are countless examples of failed artificial intelligence (AI) and robotic process automation (RPA) pilots within organizations that simply were not ready to hand over their processes to the faceless arms of technology.
As technology advances it will evolve, but most RCM experts agree that the area to focus on in the current landscape is efficient configuration of existing tools and technologies. Automating for the sake of automation is not an effective strategy. Instead, RCM leaders should look to assess high impact areas like “rinse-and-repeat” tasks within the revenue cycle where current technology can have a greater impact on optimization. Some good examples include cash posting, claims submissions, and other historically offshore functions. Insurance payors have traditionally run a paper-heavy business, but automation is changing that.
Leading healthcare RCM executives know that only after a robust foundation is built can an organization look to integrate more sophisticated technology into the revenue cycle. AI and machine learning may be tremendously helpful in leveraging predictive analytics in areas like denial avoidance. Cutting-edge, multifaceted technologies that could play a substantial role in RCM may emerge as technology continues to advance.
The No Surprise Act is top of mind right now, compelling organizations to strengthen their RCM processes to protect against billing violations and ensure consumers receive medical bill transparency. Regardless of industry sector, consumers now have a great deal of control over buying options and decisions. The consumer experience and expectations in B2C industries have extended to healthcare, and organizations that are in-tune with the market have responded to this shift in meaningful ways.
Top leaders in RCM should be keenly aware of these changes because the revenue cycle doesn’t operate in a vacuum. Jeff Noonan brings a valuable perspective on the cross-functional nature of patient care. He points out that organizations know they need an expanded patient contact center, but the question of where it lives is a challenging one to answer. Does it belong to the clinical side of the organization, where scheduling is the life blood of the office, or operations or revenue cycle? Many healthcare organizations are in fact choosing to move the patient contact center into the revenue cycle function instead of sitting outside of it. This requires a high-touch, empathetic approach to collections.
No matter where the patient contact center ends up, RCM is no longer just a back-office function with minimal patient interaction. It is bigger than that, expanding into improved patient engagement and requiring a more vigilant approach to billing. The new RCM leader must be aligned with these changes to run a successful and patient-focused RCM team.
RCM leaders in today’s healthcare market must be tuned in to the increasingly complex world of compliance. This is particularly true for businesses that are heavily reliant on government payors. Padma Nemani, Sr. VP of Revenue Cycle at AccentCare, has observed a significant uptick in the cadence and intensity of Medicare and Medicaid compliance audits and recoupments over the last six months and doesn’t expect this trend to change. This trend results in a faster pace of work for the RCM team, requiring greater vigilance and further burdening a team that is often already stretched thin. In some cases, there are automations in place that make it exceptionally difficult to get answers from real people, making the job that much harder.
As Jeff Noonan points out, “There is an influx of private equity (PE) investment in Medicare in the current market. This is a stark contrast to seven or eight years ago, and it’s because in areas like in-home health especially, the patients and care in this space create a more predictable and more profitable revenue stream. It’s also an area where the compliance measures are better understood and compliance with Medicare is absolutely critical.”
With increased audits and intense PE interest, organizations must be incredibly vigilant when it comes to compliance. The RCM executive should be leading the charge in mitigating risk in this area. Furthermore, there are frequent state specific changes and other challenges sparked by staffing shortages and automation that necessitate leaders to stay hyper-aware of how well their processes, documentation, and policies are aligned with compliance requirements.
In today’s healthcare landscape, the revenue cycle function has evolved. It is critical to have the right RCM leader in place. If your organization is looking for a Chief Revenue Officer or similar RCM executive, the team at JM Search is here to help. Reach out to us today to get started.
Special thank you to Jenny O’Pry, Jeff Noonan, and Padma Nemani for their insights and contributions.