How AI Is Redefining Revenue Cycle Management: The Voice of the Customer

The excitement was palpable for Nextech EDGE 2025. This user conference held in March promised deep discussions, actionable insights, and a roadmap for the future of healthcare revenue cycle management (RCM). The Nextech team’s focus was simple yet transformative: listen to our customers, understand their challenges, and enhance their experience with artificial intelligence (AI)-driven revenue cycle solutions. 

Recognizing the rapid evolution of RCM, we structured our sessions to facilitate meaningful dialogue. We opened the revenue cycle program with two think tanks, each designed to uncover real-world struggles and solutions in workforce management, efficiency building with AI, and denial management. To set the stage, we introduced a word-cloud activity, asking participants what keeps them up at night regarding revenue cycle challenges. The most common responses? payer relations, lack of quality candidates, policy changes, denials, and audits. This set the foundation for roundtable discussions aimed at untangling these pressing issues. 

Addressing Workforce Limitations and Training with AI 

One of the most pressing concerns raised was workforce shortages and the challenge of training new hires efficiently. Traditionally, revenue cycle teams have relied on manual processes and outdated training methods, leading to high turnover and prolonged onboarding periods. Customers shared how AI-driven solutions – such as job description creation, performance management, intelligent workflow automation, and real-time coaching tools – are transforming staff training. 

Key Takeaways: 

• AI-Powered Training Simulations: By leveraging AI-driven interactive training modules, employees can experience real-time simulations of claim submissions, denial resolutions, and compliance checks, reducing training times significantly. 
• AI-Assisted Decision Support: AI helps newer employees by offering suggestions and real-time guidance when entering claims or managing account receivables, minimizing costly errors. 
• Workforce Augmentation: AI chatbots and virtual assistants handle routine queries, allowing human staff to focus on more complex problem-solving and patient interactions.

Enhancing Revenue Cycle Efficiency with AI 

Efficiency in RCM has long been hindered by fragmented workflows, redundant manual processes, and inconsistent payer interactions. Customers emphasized that AI-driven automation is breaking these inefficiencies and delivering measurable improvements. 

Key AI Innovations Driving Efficiency: 

• Automated Claim Processing: AI models predict errors before submission, reducing rejections and the need for manual intervention. One customer boasted they fully automated the coding and billing process with an industry standard clean-claim rate. 
• Predictive Analytics for Cash Flow Management: AI identifies cash flow bottlenecks by analyzing historical data, allowing finance teams to optimize revenue forecasting. 
• AI-Powered Data Extraction and Integration: AI automates the extraction of patient and payer data from various systems, eliminating redundancy and improving the accuracy of claim submissions

One practice administrator shared how their organization reduced claim processing time by 30% using an AI-driven claims reconciliation system that automatically identifies discrepancies and flags high-risk claims before submission. 

AI’s Role in Denial Management and Audits 

Denial management remains a significant challenge in revenue cycle operations. Customers expressed frustration over the labor-intensive processes required to track and appeal denied claims. AI is now shifting the paradigm by making denial management more proactive rather than reactive. 

Breakthrough AI Solutions in Denial Management: 

• Predictive Denial Analytics: AI identifies patterns in past denials, allowing organizations to adjust claim submissions before rejections occur. 
• Automated Appeals Generation: AI-generated appeal letters significantly cut down the manual workload, ensuring compliance with payer requirements and expediting the appeal process. 
• Real-Time Audit Readiness: AI-powered compliance monitoring ensures that documentation and coding practices align with evolving payer policies, minimizing audit risks.

Transforming Payer Relations with AI 

Payer relations remain a significant source of frustration, with frequent policy changes, shifting reimbursement models, and opaque communication. Customers highlighted that AI is proving invaluable in transforming payer negotiations and interactions. 

AI’s Impact on Payer Relations: 

• Contract Compliance Monitoring: AI continuously scans payer contracts and compares them to actual payments, flagging underpayments and discrepancies. 
• Automated Prior Authorization Assistance: AI reduces prior authorization delays by predicting necessary documentation and automatically retrieving missing information. 
• AI-Driven Payer Negotiation Insights: By analyzing claims data, AI provides insights that strengthen contract negotiations with payers, ensuring more favorable reimbursement terms.

The Future of AI in Revenue Cycle Management: A Customer-Centric Approach 

Nextech EDGE’s think tanks revealed a clear trend — AI is no longer an experimental tool but a necessity in RCM. As customers shared their success stories, a consensus emerged: AI is not replacing humans; it is empowering them. It allows revenue cycle teams to move beyond transactional tasks and focus on strategic growth and patient-centered financial care. 

The future of AI in RCM will be driven by continuous learning, real-time adaptability, and deeper integration across all touchpoints of the revenue cycle. Our customers are leading the way, proving that AI is not just redefining revenue cycle management — it is revolutionizing it. 

Final Thoughts 

Listening to our customers at Nextech EDGE reinforced the transformative impact AI is having on revenue cycle operations. From workforce enablement and efficiency gains to denial management and payer negotiations, AI is elevating every facet of RCM. The key takeaway? AI is not just about automation — it’s about intelligence, foresight, and empowerment. 

As we move forward, the organizations that embrace AI-driven RCM strategies will be the ones best positioned to navigate the complexities of healthcare finance, maximize revenue, and ultimately, improve patient financial experiences. The future is here, and AI is leading the charge. 

About the Author

Nio Querio, Nextech RCM Advisor, has 30+ years’ experience in Revenue Cycle Management for Manager Hospital Systems, PHOs, ASCs, Large Specialty Provider Groups and Primary Care Organizations. Nio was named as one of the Top 25 Innovators of 2021 by “Modern Healthcare.” She previously served as the SVP of Revenue Cycle at Tufts Medicine and currently serves as the Fractional Chief Strategy Officer at Nashville General Hospital.