Readers Write: A Revenue Cycle Disruptor Perspective and the Future of Healthcare Finance

A Revenue Cycle Disruptor Perspective and the Future of Healthcare Finance
By Heather Dunn

Heather Dunn, MBA is chief revenue officer of Novant Health.

I recently moderated a panel discussion at the HFMA Western Symposium with an amazing group of healthcare leaders and “disruptors” in the revenue cycle industry. We talked about what it takes to innovate in a very regulated environment, how to break out of the mold in revenue cycle, and how to succeed while facing great internal constraints. The lessons that we shared from this conversation have shaped my thinking of what it means to be a disruptor in any setting.

The healthcare finance landscape is evolving rapidly, and innovation is at the heart of this transformation. From the introduction of AI-driven tools to the resurgence of RPA (robotic process automation) and the focus on predictive analytics that help reduce costs and make revenue cycles more efficient, we are witnessing a fundamental shift in how healthcare finance operates.

But innovation isn’t just about adopting new technologies; it’s about rethinking our challenges and reimagining what’s possible. We’ve seen industry disruptors challenge the status quo and bring forward new solutions that fundamentally change how we manage claims processing, denial prevention, and payment integrity.

Game-Changing Innovations

Healthcare finance has long been weighed down by inefficiencies, whether it’s cumbersome claims processes, endless back-and-forth with payers, or the sheer administrative burden of staying compliant. But recent innovations are flipping the script:

• AI-powered claims analysis. Custom machine-learning technology is helping hospitals and providers analyze medical claims and remittance data to pinpoint the root causes of denials and underpayments. Instead of playing defense, healthcare organizations can now predict and prevent revenue loss before it happens.
• Rethinking cybersecurity preparedness. With cybersecurity threats on the rise, new solutions are stepping in to ensure that financial operations remain uninterrupted even during an outage. Given how interconnected revenue cycle management is with IT infrastructure, having a fail-safe plan in place is no longer optional, it’s essential.
• National payer scorecard. Transparency has always been a challenge in healthcare finance. With the creation of a national payer scorecard, organizations can now access critical insights into payer performance, helping them make more informed financial decisions.
• Business partner relationships. These relationships can help health systems keep up with how the industry is changing. Health systems should challenge their business partners to bring them solutions that will make them more efficient and effective.

Lessons from the Trenches

As exciting as these innovations are, they don’t come without challenges. Healthcare is notoriously slow to adopt new technology, often for good reason. The complexity of regulations, interoperability hurdles, and the ever-present concern over cybersecurity risks mean that even the best ideas can face roadblocks.

• Regulatory hurdles. States are introducing laws to regulate AI in healthcare. For example, California recently passed landmark legislation prohibiting health insurance companies from using AI to deny coverage. While AI holds immense promise, organizations must tread carefully and ensure compliance with emerging state and federal policies.
• Cross-industry inspiration. Unlike industries such as retail or finance, healthcare has been slow to embrace automation. But we don’t have to reinvent the wheel. Looking at how other sectors have successfully leveraged AI and automation can provide valuable lessons in accelerating our adoption curve.
• Balancing AI’s promise with reality. AI isn’t a magic wand. It requires the right data, ongoing monitoring, and a human-in-the-loop approach to be truly effective. The real question isn’t can we use AI, but how should we use it in a way that’s ethical, effective, and sustainable?

Actionable Takeaways

What can healthcare finance professionals do today to future-proof their revenue cycle strategies?

• Start small, scale smart. If AI or automation seems overwhelming, begin with pilot projects that address your most pressing pain points, whether it’s reducing denials, improving payment integrity, or streamlining workflows.
• Stay informed on legislation. The AI regulatory landscape is shifting quickly. Keeping up with state and federal guidelines will be critical in ensuring compliance and mitigating risk.
• Invest in cybersecurity resilience. Cyber threats aren’t a matter of if, but when. Having a solid financial continuity plan in place is just as important as preventing breaches in the first place.
• Look beyond healthcare for inspiration. Retail, banking, and even logistics have mastered AI-driven efficiencies. What lessons can healthcare borrow to accelerate adoption without falling into common pitfalls?

The Future is Now

The revenue cycle is no longer just about processing claims and getting paid. It’s about leveraging technology to create a smarter, more resilient, and ultimately more efficient system. Health systems rarely challenge the status quo. There is just a lot happening in their world every day. They need help to think about how tech and the future can change their revenue cycles work. The disruptors in this space are showing us that innovation isn’t just about new tech; it’s about new ways of thinking.

The real question isn’t whether the revenue cycle will evolve. It’s whether we will lead that change or struggle to keep up.

In every organization I’ve served, I’ve taken the approach of being a disruptor who is willing to embrace change. As I make my own career transition back to a patient care delivery organization, I am energized by the opportunities to be a disruptor yet again, to innovate, and to make a difference in the lives of patients and employees.