Susie is a Rev Cycle legend and a master of billing. She’s dealt with private sector and government payers for over 20 years. She gets denials overturned better than anyone. She outperforms everyone in the department. And she’s retiring next year.

More on Susie in a minute.

Healthcare faces a double whammy: an aging workforce and a shortage of workers to replace them when they retire. We hear a lot about labor issues on the clinical side of the business, but the challenges are just as pronounced in the back office.

  •  90% are experiencing a labor shortage in their RCM1
  • 50% of RCM roles are vacant2
  • 25% of workers will be over 55 by 2024, and ⅓ of these will be 65 or older3

With age comes experience. Health systems benefit from the experience of workers who have cracked the code for how to maximize revenue. Interruptions and delays will impact productivity and revenue when workers take their technical knowledge and expertise with them when they leave.

The challenge for RCM leaders is maintaining operational continuity and growth, even as workers retire and replacements are slow to onboard. To do this, they need a working model of how top performers do what they do. And one that others can replicate.

Now, back to Susie.

She is happy to lean into her legendary status, make herself available to peers, and pass along what she knows. There’s only one problem: she can’t explain how she does it. Sure, there are tips and tricks, but a full explanation of how she gets appeals overturned at such a high rate is a more complicated blend of knowledge, experience, timing, and action.

Susie’s manager will use process mining to get a detailed view of how she works. There’s no need for consultants to observe workers; this is a discreet, programmatic method to capture data that shows the steps, systems, and timings surrounding her work. In reviewing the data, Susie and the leadership will define a new process model and performance baseline so the team can work their own Susie magic.

With ongoing process mining and quality review, managers will monitor adherence to Susie’s process–and continue to improve it–long after she leaves. With a continuous flow of data and operational intelligence, other areas of improvement may be identified, such as:

  •  Bypass bottlenecks with a new workflow
  • Avoid errors by addressing them upstream before they happen
  • Automated rote tasks like payer portal navigation or document requests
  • Focus workers on high-priority work that leads to better outcomes

Process mining is more than preserving knowledge; it’s a window into the workflows and processes across the rev cycle. It reveals how to build continuous improvement into the DNA of the organization.
Health systems rely on experienced medical coders, billing specialists, and revenue cycle analysts. Their departure could lead to errors, delays, and financial losses if their successors don’t benefit from their knowledge and expertise. Process mining is an essential tool to ensure continuity and growth. Workforce transitions are inevitable; disruptions don’t have to be.

R1 RCM, October 6, 2022

2 R1 RCM, October 6, 2022

3 FORTUNE, September 20, 2022