2026
2026
To navigate an increasingly volatile healthcare landscape, revenue cycle executives are establishing new AI governance structures, embedding clinical expertise into billing and coding workflows, rethinking payer data exchange, and intentionally developing a resilient workforce.
To navigate an increasingly volatile healthcare landscape, revenue cycle executives are establishing new AI governance structures, embedding clinical expertise into billing and coding workflows, rethinking payer data exchange, and intentionally developing a resilient workforce.
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In an uncertain landscape defined by tightening margins, frequent regulatory shifts, and a saturated technology market, revenue cycle leaders can no longer rely on outdated playbooks.
During our Spring 2026 HealthLeaders Revenue Cycle Mastermind, participants agreed that sustained success requires bridging the historical divides between IT, clinical care, and the business office. By moving away from siloed operations and bringing everyone to the table, health systems can turn everyday headaches into scalable efficiency.
This report details the core insights from Mastermind discussions, focusing on AI governance, clinical collaboration, payer data exchange, and workforce evolution.
TAKEAWAYS
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Establish cross-functional committees to evaluate AI tools and ensure that new solutions deliver value before finalizing vendor contracts.
- Integrating clinicians, including nurses, pharmacists, and physician advisors, into the revenue cycle reduces medical necessity denials and drives reimbursement yields higher.
- As automation handles routine administrative tasks, health systems must cross-train staff for complex analytical work and cultivate leaders based on strategic vision, not just technical expertise.
Structuring AI Oversight
The rapid proliferation of AI has created an overwhelming number of vendor choices, forcing health systems to rethink how they evaluate and procure technology.
Mastermind participants emphasized that an AI label does not mean a tool offers genuine autonomous capabilities. To help ensure that new tools are effective, health systems are establishing governance structures to guide technology investments. For instance, Baptist Health Jacksonville has created the AI Institute that requires vendors to hit specific metrics during pilot programs before final contracts are signed, boosting potential for positive ROI.
Beth Israel Lahey Health
An integrated Massachusetts health system with 14 hospitals, 4,700+ physicians, and about 39,000 employees across academic and community care sites.
SOURCE: About Beth Israel Lahey Health
UF Health (University of Florida Health)
An academic health system affiliated with the University of Florida that includes 11 hospitals and hundreds of outpatient clinics across North and Central Florida.
Baptist Health – Jacksonville
Northeast Florida’s largest health system with six hospitals, more than 1,400 beds, and over 200 care sites across the region.
UNC Health
A state-owned integrated academic system serving all 100 counties in North Carolina through 11 hospitals and more than 33,000 employees.
SOURCE: UNC Health system overview
While many large health systems prioritize a native EHR strategy, executives warn against adopting unproven features simply because they are part of an existing platform. Keisha Downes, Vice President of Mid-Revenue Cycle at Beth Israel Lahey Health, notes that she puts native tools through the same vetting process as any outside startup.
"I can't be a beta for these technologies that they're coming out with rapid-fire," Downes says. "I need to do my due diligence".
From the vendor perspective, navigating the varying requirements of these internal committees can be challenging, but it goes even farther.
Tom Dougherty, SVP of Smarter Clinicals at Smarter Technologies, noted during the in-person gathering that many provider organizations need to better align technology strategy and financial goals for their AI.
“Leaders can better align these goals by finding an AI solution with attributable ROI that starts the day it goes live. Look for solutions that don’t require a big upfront investment to get started. You wouldn’t pay for a car without knowing if it can get you from point A to point B,” Dougherty says.
“The same should be true for AI: Look for contingency based or valuebased pricing if available, or a way to ensure you can see the return you need.”
Embedding Clinicians in the Rev Cycle
By integrating clinical roles such as nurses, pharmacists, and physician advisors directly into revenue cycle operations, health systems are successfully bridging the gap with patient care.
For decades, the revenue cycle operated in the background, disconnected from clinical care. Today, rising medical necessity denials and complex payer requirements have made that separation unsustainable. Administrative staff often lack the credentials and clinical vocabulary required to successfully overturn complex denials or challenge authorization policies.
To counter this, health systems are embedding clinical professionals directly into the revenue cycle. At Confluence Health, integrating a pharmacist to review drug reimbursements quickly uncovered a six-figure deficit caused by a payer reimbursing below acquisition costs. Similarly, utilizing registered nurses to write appeals has drastically improved overturn rates.
"These roles pay for themselves," says Kaci Ramsey, Vice President of Revenue Cycle at Confluence Health. "There's so much value and they'll reduce downstream work on our team, but also help get reimbursement in the door quicker"
Beyond handling backend appeals, this clinical integration allows revenue cycle teams to proactively educate providers. Mastermind participants shared strategies for deploying physician champions and clinical documentation educators to meet with doctors face-to-face, explaining how specific phrasing or missing elements directly impact the hospital's bottom line. By translating financial requirements into clinical language, revenue cycle leaders can build mutual respect and stop preventable errors at the point of service.
Data-Driven Payer Strategies
As payer mandates and administrative friction increase, revenue cycle executives are building structured feedback loops with managed care teams to leverage data during contract negotiations.
The relationship between providers and payers is possibly more adversarial than ever before. Mastermind participants voiced frustration with shifting payer policies, excessive medical record requests, and lower reimbursement rates hidden in self-funded and Medicare Advantage plans.
Piedmont Healthcare
A Georgia-based nonprofit health system delivering integrated care through a statewide network of hospitals, physicians, and outpatient locations.
SOURCE: About Piedmont Healthcare
UW Health
An academic health system affiliated with the University of Wisconsin–Madison that operates six hospitals, 105+ outpatient sites, and employs more than 26,500 staff.
SOURCE: UW Health About Us
Confluence Health
A physician-led healthcare network in Washington state anchored by Central Washington Hospital and Wenatchee Valley Hospital serving the region with integrated specialty and primary care.
While some health systems are exploring automated payer platforms to expedite data exchange, many executives feel that these portals primarily benefit the payer without reducing the provider's administrative burden.
To level the playing field, revenue cycle leaders are shifting from a reactive stance to a proactive, data-driven strategy. This requires partnership between revenue cycle operations and an organization's managed care or payer contracting teams. Through these partnerships, leaders can develop clear narratives on denial trends, policy updates, and delayed payments.
This aggregated data empowers contracting teams to negotiate SLAs and demand accountability when a payer's behavior violates the spirit of the contract. However, maintaining alignment among departments is critical to success, according to Mythli Mukundan, AVP of Revenue Integrity at WVU Medicine.
"I think it's a constant communication flow, and we as a revenue cycle team also trust the payer contracting team," Mukundan says.
Evolution in the Rev Cycle Workforce
With automation absorbing routine tasks, leaders must cross-train staff for complex analytical work, redefine productivity metrics, and rethink how they identify future management talent.
AI and automated workflows are fundamentally altering the daily reality of the revenue cycle workforce. Because bots now handle many mundane tasks like simple eligibility checks and status updates, human employees are left with more highly complex, exception-based responsibilities. This means traditional productivity metrics, such as the number of accounts touched per day, no longer accurately reflect an employee's value. Executives must actively rewrite these standards to focus on the overall yield and financial impact generated by their teams.
At the same time, leaders are navigating a structural lack of upward mobility, particularly in massive frontend departments like patient access. To retain top talent, health systems must map out clear career ladders.
WVU Medicine (West Virginia University Health System)
West Virginia’s largest health system with 25 hospitals, 3,260 beds, and more than 35,000 employees across multiple states.
United Health Services (UHS)
A nonprofit system based in Binghamton, New York with four hospitals, 60+ care locations, and about 6,300 employees serving the Southern Tier region.
SOURCE: United Health Services overview
Emplify Health
A regional health system formed from the integration of Gundersen Health System and Bellin Health, combining hospitals, clinics, and health plans across Wisconsin and neighboring states.
SOURCE: Emplify About Us
"We need to develop these people that want advancement," explained Ryan Klein, Senior Director of Patient Access and Financial Experience at UW Health. "We need to develop their skills outside of their silo".
However, as organizations cultivate this internal talent, they must be careful not to conflate technical excellence with leadership capability. Managing a modern, technology-enabled revenue cycle requires high-level change management, emotional intelligence, and the ability to foster multidisciplinary trust.
"Your subject matter experts are not necessarily going to be your best leaders," warned Michael Finley, Vice President of Revenue Cycle at Emplify Health. By defining specific leadership traits, such as adaptiveness and transparency, organizations can build a management bench equipped to guide staff through the ongoing technological revolution.
The Future State of the Revenue Cycle
The 2026 HealthLeaders Revenue Cycle Mastermind program illuminated a pivotal turning point for the industry. While AI and advanced automation offer incredible potential, they cannot fix fundamentally broken processes or disconnected teams.
The executives leading the charge are doing so by dismantling operational silos, demanding accountability from both vendors and payers, and redefining what it means to lead revenue cycle operations. By grounding financial and technological ambitions in strong clinical partnerships and rigorous governance, these leaders are constructing a revenue cycle capable of sustaining long-term financial health.
The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Revenue Cycle Technology Mastermind series features ideas, solutions, and insights into excelling your virtual nursing program. Please join the community at our LinkedIn page. Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at anorris@healthleadersmedia.com.
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Looking for even more on what our HealthLeaders Mastermind participants achieved?
