Re-engineered a fragmented pre-service financial counseling and prior-authorization model. By standardizing workflows, integrating real-time cost estimation tools, and optimizing Medicaid eligibility screening, this initiative successfully captured over $26M in net-new and recovered revenue while dramatically reducing insurance denials.

$26M Revenue Cycle & Financial Counseling Transformation

Situation: The health system was facing substantial front-end revenue leakage, driven by decentralized prior-authorization tracking and inconsistent financial counseling workflows. A lack of upfront cost transparency led to high write-offs, while a rising rate of insurance denials for avoidable, pre-service administrative errors was directly impacting the organization’s operating margin.
Task: Charged with auditing, restructuring, and leading the turnaround of the financial counseling, pre-registration, and prior-authorization teams to safeguard margins, capture leaked revenue, and improve patient financial clearance rate.
Action:
- Process Optimization (Lean Six Sigma): Mapped the entire front-end revenue cycle to eliminate departmental silos. Standardized the handoffs between scheduling, insurance verification, and financial counseling.
- Pre-Service Authorization & Medicaid Capture: Implemented a proactive prior-authorization clearance workflow and optimized Medicaid eligibility screening loops to capture coverage for uninsured patients prior to service delivery.
- Technology Integration: Deployed advanced point-of-service (POS) estimation software, enabling financial counselors to provide patients with accurate, transparent, and compliant out-of-pocket estimates.
- Performance Accountability & Training: Standardized training protocols for financial counselors, shifting the team's focus toward proactive advocacy, structured payment plan options, and point-of-service collections. Established performance dashboards to track daily clearance rates and denial trends.
Result:
- Successfully captured and recovered $26M+ in net-new revenue through optimized financial clearance, retroactive coverage capture, and pre-service authorization audits.
- Slashed administrative insurance denials by 20% system-wide, preserving baseline operating margins.
- Boosted point-of-service (POS) collections by $1M while significantly improving patient financial satisfaction and transparency ratings.
- Standardized a scalable revenue-cycle framework that remains a core operational pillar of the organization.