Revenue cycle teams should sort work before adding staff

When a single resignation can tip an understaffed revenue cycle department into crisis, the instinct is to post a job opening. Two practice consultants used an MGMA Summit session to argue that hiring is usually the wrong first move. Before adding a single position, they said, leaders should take the work apart: sort it by complexity, match each task to staff by skill and risk and repair broken processes before automating any of them. That discipline, they argued, is what separates revenue cycle teams that absorb payer churn, documentation gaps and constant turnover from those that lurch from one cash-flow scare to the next. The stakes are higher in 2026, as Medicare trims physician payment on the assumption that practices are already working more efficiently.

The advice came from Kem Tolliver, BS, FACMPE, CPC, CMOM, chief executive officer of Medical Revenue Cycle Specialists, and Taya Gordon, MBA, FACMPE, CMOM, chief executive officer of Atlas & Perpetua Healthcare Consulting, during a Medical Group Management Association Summit session June 3.

A reality check on five stressors

Tolliver and Gordon opened with what they called a reality check: the five stressors that grind down revenue cycle teams. Small teams carry heavy workloads, so one departure leaves an operational hole. Payers vary widely and change policies constantly, driving rework. Provider documentation gaps degrade claim quality. Thin analytics and limited IT bandwidth leave leaders deciding without clear data. And patient financial friction, from collections to demographic updates to high-deductible balances, can wear on a practice’s reputation in its community. “Working with small teams that have a big workload means your risk is higher if somebody leaves,” Gordon said.

Sort the work, then assign it

Before assigning anyone to anything, the speakers said, leaders should sort work into three buckets: transactional tasks, exceptions and complex work that demands critical thinking. Entry-level staff can absorb the transactional volume while experienced team members take the complex and exception cases, with assignments following skill and risk so the toughest scenarios stay away from new hires. Warm handoffs, each step defined from intake through resolution and close, cut the chaos when someone is out. Whatever procedures a practice writes, Gordon said, they belong in a single source of truth, whether a shared drive or an intranet.

Pick a staffing model, then cross-train anyway

The pair reviewed five models: centralized, decentralized, hybrid, offshore and cross-trained. Cross-training, they argued, is less a model than a constant discipline that lets staff cover one another. The blend Gordon sees succeed most often pairs clinical pods with an administrative core, with each provider working alongside a consistent set of medical assistants and front-desk staff while billing and other back-office functions stay centralized across the practice. Pods work especially well when providers document differently, she said, but every pod needs a backup coverage plan and a transition plan for vacations.

Automate, but fix the workflow first

On automation, the message was blunt: do not automate a broken workflow. The fastest returns come from verifying eligibility and benefits, scrubbing claims with rule edits and validating place-of-service codes, all of which head off denials and rework downstream. Practices should begin with assistive tools such as templates, routing and reminders, build quality assurance checkpoints and measure rework reduction rather than speed alone. The stakes are highest for small groups, the speakers noted, because a single misconfigured provider profile can choke cash flow.

What to keep and what to send out

Tolliver and Gordon drew a clear line between work to keep in house and work to outsource. Patient-facing financial conversations and provider-specific nuance work should stay internal. Overflow accounts receivable, low-complexity claims and after-hours tasks are fair to send out. Even then, leaders should hold strategic control over denial strategy, payer contract priorities and compliance. “Use outsourcing to stabilize, not to set it and forget it,” Gordon said.

For practices that do outsource, she offered five vendor management practices: set simple, enforceable expectations and turnaround times; demand transparency about what a vendor touched and what stalled; hold a regular governance cadence; clearly divide internal and outsourced duties; and document an exit plan, including data access, before signing. She likened that last step to planning for divorce while getting married.

Setting the tone for the team

Gordon handed the leadership segment to Tolliver, who described revenue cycle staff as constantly under pressure, switching context among phones, portals, patients and providers, carrying the emotional labor of money conversations and rarely earning credit because the work is invisible when it goes well. Leaders can ease burnout by bringing staff into decisions, being transparent about financial and operational goals, coaching instead of commanding and protecting uninterrupted focus time for work like payment posting and credit balances. Recognition should track to outcomes such as falling accounts receivable aging and fewer denials.

Retention also depends on giving people somewhere to go, Tolliver said. She pointed to skill tiers that move staff from associate to specialist to lead, certification support, flexible scheduling and more equitable workloads. Most people leave because of burnout, unclear expectations, thin training or no path upward, she said, not because of pay alone.

Let the data point the way

To see what teams actually do, the speakers recommended a “my job, my point of view” exercise, asking staff to document their daily, weekly, monthly and quarterly responsibilities, then comparing those answers against job descriptions to surface gaps, overstaffing or skills mismatches. They favored “one problem, one week, one fix” improvement sprints chosen by frontline staff, with before-and-after metrics made visible. For denials, they suggested grouping claim adjustment reason codes into eligibility, authorization and claims-prep categories to expose the workflow breakdowns behind them, and loading allowable amounts into the practice management system so teams can gauge the true value of a denied claim and work the high-value ones first.

On metrics, the advice was to stay lean, roughly six to 10 key performance indicators, or KPIs, to start, sorted into outcomes such as cash collected, days in accounts receivable, denial rate and write-offs; process measures such as charge lag, clean claim rate, authorization turnaround and payment posting lag; and patient measures such as the share of pre-visit estimates delivered, balance aging and collections rate.

A regulatory nudge toward efficiency

The speakers tied the urgency to a payment change taking effect this year. The 2026 Medicare Physician Fee Schedule applies a negative 2.5 percent efficiency adjustment to the work relative value units and intraservice time for most non-time-based services, a cut CMS has said reflects expected productivity gains from workflow improvements and technology adoption. Tolliver put it plainly: CMS is assuming practices are already optimizing the technology available to them, including AI, and is trimming RVUs to match, which leaves teams little choice but to adapt.

They closed with a 30-day plan: pick a staffing model; choose one automation target that cuts rework; identify two denial trends and tie them back to people and processes; put two burnout fixes in place, such as a daily priority order and protected focus time; and reset KPIs around a vital few, with a weekly cadence and clear action triggers.