Revenue cycle teams today are navigating a changing workforce landscape alongside a steady rise in claim denials. Even as staffing shortages begin to stabilize, many organizations are managing more distributed and remote teams—changing how work gets done and where inefficiencies can emerge.
Nationally, $262 billion in claims are denied each year, and denial rates have increased 16% since 2020.¹ Remote and hybrid work models have improved flexibility, but they’ve also introduced challenges around visibility, handoffs, and consistency across workflows.²
As denials grow in volume and complexity, these operational shifts matter more than ever. When work is spread across teams, systems, and locations, even small variations in process can lead to delays, missed follow-up, and preventable write-offs. Without clear insight into how work moves end to end, organizations risk compounding inefficiencies—regardless of where their teams are located.
A Changing Workforce, Expanding Workload
Healthcare’s workforce challenges extend beyond clinical roles and are deeply felt within revenue cycle and patient financial services teams. As billing, follow-up, and authorization teams become more distributed, higher volumes and rising denials have made revenue cycle work more complex to manage and standardize.
When experienced employees leave, institutional knowledge goes with them. New hires face steep learning curves, and managers must maintain consistency and productivity across remote and hybrid teams. Without clear visibility into workloads and process variation, managers can’t easily see where time is lost or which steps are driving delays.
Denials Only Amplify the Strain
Denials are rising in both frequency and complexity. Payer requirements, authorization rules, and documentation standards evolve constantly, creating new opportunities for breakdowns in the process.
The impact isn’t just financial. Chasing avoidable denials adds stress to overextended teams and diverts focus from higher-value work. And because 65% of denied claims are never resubmitted, even small process gaps can translate into significant lost revenue.³
Without automation, manual rework simply can’t keep pace. Each denial requires data gathering, validation, and submission—tasks that are time-consuming and repetitive, yet critical to revenue integrity. The more denials increase, the harder it becomes for health systems to respond effectively with the staff they have.
Automation as a Force Multiplier
This is where intelligent automation can help. Janus Health has automated the areas of the revenue cycle that create the largest bottlenecks and require the most manual touchpoints—reducing friction, improving accuracy, and accelerating the path to payment.
Prior Authorization helps prevent costly delays and denials before they happen. By automating the submission, status tracking, and follow-up process, teams can manage authorizations more efficiently, reduce turnaround times, and ensure patients receive timely care without administrative bottlenecks.
Referral Management automates referral intake workflows—for consults and imaging—to ensure timely care, reduce referral-related denials, and retain patients within their own provider network. It leverages AI-based conversion of faxed referrals into the EHR with high accuracy, reducing manual data entry and downstream registration issues.
Notice of Admission (NOA) automation addresses another major source of preventable denials. By automating submissions, staff can reduce manual tasks, improving productivity and job satisfaction.
Claim Intelligence creates a 100% exception-based workflow, meaning staff only work the claims that require attention—those not automatically routed to the next step. This nearly eliminates the need for manual intervention at every stage of the claims cycle, allowing teams to focus on resolving true exceptions instead of repetitive status checks or updates. The result is faster turnaround, fewer touchpoints, and a more efficient path to payment.
Together, these solutions expand capacity and reduce manual burden, giving teams the time and clarity to focus on higher-value work like payer communication and complex case management.
Working More Efficiently Across the Revenue Cycle
Technology can’t solve burnout on its own, but it can give teams the visibility and insight to work smarter. The changing workforce and rising denials health systems face today demand a new approach—one built on data, automation, and intelligent operations. That’s where Operational Intelligence makes the difference.
Janus Health’s Operational Intelligence platform provides this holistic visibility to transform workforce productivity and process efficiency. It combines behavioral data, operational workflows, and payer insights to help health systems manage both performance and process, giving leaders the tools to make smarter, faster decisions that improve efficiency across the revenue cycle.
Operational Intelligence surfaces these insights across three critical dimensions of performance:
- Process Improvement: Identify workflow gaps and streamline inefficient handoffs.
- Performance Management: Benchmark productivity and quality across teams, systems, and roles.
- Payer-Driven Changes: Detect shifts in payer behavior or rule changes that affect throughput or denial trends.
By turning visibility into action, Operational Intelligence helps revenue cycle teams work smarter, adapt faster, and achieve measurable results—without adding headcount.
The Path Forward
The changes reshaping healthcare’s workforce and denial landscape are accelerating. Automation and AI are redefining the future of the revenue cycle—and the systems that move first will be the ones that lead.
Short Term (1–2 Years):
Revenue cycle teams will focus on automating high-volume, high-touch workflows that slow throughput and drive denials. The priority will be removing manual effort, accelerating claim progression, and giving teams immediate relief by focusing work only where human intervention is needed. Janus Health helps organizations take action quickly by automating the most friction-heavy points in the revenue cycle and delivering clear operational visibility.
Medium Term (3–5 Years):
As automation becomes embedded across RCM operations, leaders will shift from reactive issue management to proactive performance optimization. Operational Intelligence will be essential for understanding how work moves across teams, systems, and payers—and for making informed decisions about staffing, process changes, and denial prevention. Janus Health enables this shift by unifying data and insights into a single view of operational performance.
Long Term (5+ Years):
The revenue cycle will increasingly run on intelligent, connected workflows. Routine transactions will move forward with minimal manual intervention, while teams focus on strategic oversight, payer alignment, and continuous improvement. Organizations that invested early in automation and operational insight will be best positioned to scale efficiently and adapt to ongoing change.
The path forward is clear: invest in automation that amplifies performance and operational insight. With Janus Health, organizations can unify data, streamline processes, and empower teams to do more with less—building a more resilient, efficient, and future-ready revenue cycle.
Sources
- Change Healthcare, Kodiak Solutions, Premier Inc. surveys (2024).
- HFMA/AKASA Revenue Cycle Workforce Report (2021); Experian Health (2024).
- American Hospital Association, American Medical Association, MD Clarity Revenue Intelligence.