RCM, Healthcare Technology and AI

Insights from a healthcare revenue cycle leader

As part of an interview series with healthcare Leaders across the country, the Olive team had the chance to interview industry leader James McCurley about the biggest challenges facing healthcare today. Previous to his current role as Vice President, Revenue Cycle, James worked in a number of finance positions at Community Medical Centers. He received a Bachelor’s degree in biomedical physics and an MBA from California State University, Fresno.

RCM, healthcare technology & AI

Q: To begin, tell us about your background in healthcare and what brought you to Community Medical Centers?

I’ve been with Community Medical Centers (CMC) for almost 8 years now but I started my career in science – I was a physics major at California State University, Fresno. When I graduated, I was very interested in finance because it was during the peak of the financial crisis in 2009/10. I thought I wanted to work in investment banking, so I enrolled in an MBA program as a bridge between science and business. Once I graduated from the MBA program, I realized that Wall Street wasn’t for me, and I started working at CMC as a financial analyst. I was lucky to work under the C-Suite and got involved in a lot of really cool projects with fantastic mentors. I’ve been fortunate enough to be put in a series of progressively challenging jobs at CMC, eventually leading to being the VP of Revenue Cycle.


Q: What advice do you have for someone trying to build a strong revenue cycle team? 

Aside from the obvious answers like hiring the right people and having the right management and training in place, the revenue cycle inherently is built around analytics and data, and I really want people in leadership positions who understand and embrace that – it should be a very quantitatively heavy profession. So, I really try to push that idea through our team and make it part of our culture. 

Second, the revenue cycle is a perfect example of when leaders really need to see the forest through the trees – in the revenue cycle that’s really important because, for example, many of the day to day functions within the revenue cycle are repetitive and time consuming, so it’s easy to get tied up in the day to day. But as a leader of this team, you need to tie those tasks and everything we do back to supporting our organization’s goals and our mission to provide a greater patient experience, all while still receiving correct reimbursement.


Q:  If you could eliminate one of the healthcare industry’s challenges overnight, which one would it be? 

That’s a difficult question; I think I’m going to start asking that in my own interviews! (laughs) But to answer your question, you really see in my position how big the administrative burden is – especially around prior authorizations, eligibility, etc. – and if you take that entire section of work and look at the value of those tasks, the inputs are greater than the outputs on a macro level. This is one of the big reasons why healthcare costs so much – an entire conference room full of smart people trying to figure out why a claim was denied and spending so much of their resources to do so. Those people could be better utilized doing more valuable work, and utilizing technology to offload those burdensome processes frees up time for healthcare employees to focus on tasks that require a human touch. 


Q: How do you see artificial intelligence and machine learning impacting your revenue cycle over the next five years? 

I think the current status on a lot of AI in revenue cycle today is heavily focusing on eligibility, claim status, and prior authorization using RPA, but the next step is for AI to take over tasks on the billing side where machine learning is utilized to make more meaningful impact to the entire billing cycle – that would be a game changer. 

For instance, the idea of how you can build machine learning models to analyze your denials data – this claim has a high probability of denial based on x,y,z, for example –  where that knowledge came from the historical data of all of your past denials. Because of opportunities like this, I think the next step for AI is going to be continued adoption on the billing side. 


Q: In your opinion, what are some of the untapped opportunities to improve patient experience today?

My particular view into patient experience is largely on the financial side of things. There is a tremendous amount of work currently being done around sending appointment reminders, enabling transportation services, and much more. But an area of opportunity I see is not having to remind patients multiple times of how much they owe or are paying for their services. Minimizing the amount of times patients are touched by the financial aspect of receiving care would tremendously improve the patient experience. 

I think it’s easy to lose sight of the basic premises of being a consumer of services, such as knowing your liability and having the ability to resolve that liability in an easy manner. Additionally, maximizing our patients’ knowledge and use of financial assistance and counseling, prior to receiving services, is essential.

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