Sean has been an active force in the revenue cycle management domain for over three decades. He has been responsible for developing and executing complex strategic growth and change management initiatives.

In this in-depth interview with me, Sean talks about the innovative strategies he has implemented and the changes he has observed in this domain. He also speaks about his valuable journey from a skip tracer in high school to the renowned thought leader he is today.

A Young Entrant in the Revenue Cycle Management Domain

Sean began his journey in the collections and revenue cycle management industry in 1985 when he started working for one of the largest debt collection agencies in Southern California right out of high school. He began as a skip tracer followed by a special project collection job for telecommunication collections from an index card box at a time when there were no computers.

He worked on the project for two years before shifting gears to work as a paralegal at the collection agency’s law firm.  Sean then moved his focus to entrepreneurship and started his collection agency.  Recalling his account, Sean had a partner who was on good terms with an existing client. This allowed them to start their journey as entrepreneurs instantly. From there on, the partners networked diligently and leveraged that relationship for introductions to other prominent clients in the industry.

‘We made it a top priority to maintain a good reputation.  It takes forever to build a good reputation, but it can take only seconds to destroy it.’

After several partnerships and roughly 18 years of operation, Sean sold his company.  In 2009, he took a position with USCB America-a healthcare revenue cycle management service company, and worked for them for 10 years in various leadership roles, from Vice President of Operations to Senior Vice President of Compliance.

During the last 6 years of his time with USCB, Sean served as Chief Administrator Officer. Having operated his collection agency provided him with experience in all aspects of operations and business administration.

Current Business Scope

Recently, Sean has been involved primarily in providing consultancy services to hospitals and practices. His background in operations makes it easier to communicate about the various tools and technologies that he is representing to hospital providers.

Currently, Sean is involved largely with the technology aspect. He brings in AI applications, software solutions, and “plug-n-play” RPA technology that helps achieve significant tangible results in a short time following implementation, without the displacement of staff.

‘Artificial intelligence tools, repetitive process automation, intelligent automation-these are the type of technologies out there that I’m working with, and that I think offer the greatest potential to have a positive influence and impact on revenue cycle results.’

Currently, Sean is working as a consultant and is connected closely with 10 people who through networking and reciprocity, are assisting him with his outreach efforts. He has about eight major clients currently, one of the major ones being a SaaS platform he represented having a number of high-profile health care implementations of their software with great success.  The company is called AmplifAI Solutions and they have developed a powerful, cloud-based workforce optimization platform to help call centers improve agent productivity

Most of the companies Sean represents are technology-oriented.  In addition to OMNI Healthcare that buys Medical Liens, he is also working with Omega Healthcare, one of the largest offshore BPO resource companies. Another company he is working with is APS who are experts in the field of customizing and developing project-specific AI tools designed to address a customer’s very specific needs.

Repetitive Tasks and Automation in Revenue Cycle Management

Sean believes that there are too many moving parts throughout the entire revenue cycle continuum to isolate any task as being the most repetitive. However, the single most repetitive task that has the greatest opportunity to benefit from automation would be insurance follow-up.  This is because it is a task that providers require a human touch to track, monitor, and inquire from payers about the status of unpaid claims.

However, there are many effective automation solutions available that can automate a good percentage of the repetitive task of obtaining status from payer websites.  Implementing a bot or other RPA software can handle the routine follow-up tasks, leaving the staff to attend to the exceptions.  That’s a big area of concern because from a revenue perspective whether it is a public payer or commercial payer that is where the major majority of revenue is generated.

‘Automation starts with proper coding and proper billing.  The more accurate your coders and charge management capture protocols are, the less errors upfront which helps streamline the insurance follow-up process, reducing overall number of days claims spend in A/R and minimizing the volume of claim denials.’

Standout Moments as a Business Leader in RCM

For Sean, the exposure to the different phases and layers of the revenue cycle as it relates to patient engagement was extremely valuable. He also observed that there were opportunities to improve operational efficiencies through the use of technology that was very readily available, and yet hospitals were reluctant to adopt.

Another great takeaway is the accumulation of knowledge.  Sean learned a tremendous amount about revenue cycle management from working with some of the most knowledgeable people, as well as from working so closely with provider clients.

Talking about a proud accomplishment in this journey, Sean holds the results from networking that he accomplished to be high on the list.  Leveraging his reputation and the relationship with his friends and colleagues helped put him in touch with some exceptional companies, offering amazing technologies.

He discovered that there are numerous solutions out in the marketplace to help hospitals, and health care providers, especially during this unprecedented and challenging time.

‘I believe that hospitals, physician groups, and any healthcare provider, could benefit tremendously through leveraging technologies such as intelligent automation, artificial intelligence, repetitive process automation, computer bots, etc.’ 

Sean also believes that organizations need to focus on productivity rather than staff numbers. It is important to ensure that people have the best tools and training available to maximize their productivity.

Business Challenges in the Revenue Cycle Management Industry

One of the biggest challenges the industry is dealing with is the huge financial gap caused by the COVID-19 pandemic. It caused an exponential taxing on the hospital’s ER rooms mandating care for COVID patients and at the same time, social distancing and community health precautions required the cancellation of non-emergency elective procedures.

Hospitals were required to commit all their human capital and financial capital resources to deal with the COVID-19 patient care cannot yet accommodate elective procedures which is the more profitable segment of patient care. Hospital CFO’s and financial leadership in the industry are grappling with finding ways to bridge the financial gap.

Talking about one of the companies he is working with-OMNI-Healthcare, Sean says they have a unique and strong value proposition.  They buy Medical Liens and Letters of Protection relating to motor vehicle accidents and other personal injury claims. Third-Party Liability (TPL) claims can be burdensome on hospitals and physician groups, because that segment of a hospital’s portfolio of accounts typically remains unpaid until the conclusion of the patient’s lawsuit against the party that caused the injury.

This means that the hospital will have to wait 18 months to 24 months before they get reimbursed.  Given the present state of the industry financially, that can be a hard pill to swallow. OMNI will come in and buy that TPL portfolio straight away and pay the Hospital within five days.  This program has proved very helpful, especially for those rural hospitals with level I or level II trauma care units where they shoulder the burden of these patients for the community. OMNI has purchased well in excess of $300 million in receivables so it has helped quite a few hospitals.

Future Business Plans

Looking at the future, Sean does not plan on having a huge staff or expanding his business multi-fold. He believes he has achieved that in his previous roles and enjoyed the experience and learnings they brought him. Presently, he prefers staying nimble and having the ability to select which clients he works with.  His focus is on consulting and making introductions for hospitals to particular services, software platforms, and technology solutions that ultimately help them address issues or gaps in the process.

Talking about the marketing methods that have helped him grow, Sean lists networking as the prime benefit.  Additionally, he credits leveraging his reputation in the industry and the years of experience he has gained. He also mentions LinkedIn as a great tool to promote his consulting business.

‘A balanced approach combining networking, personal relationships, LinkedIn, and my website and e-mail campaigns seem to work the best for me.’

Top Philosophies and Core Values in Business

One of Sean’s top philosophies in RCM is the adoption of technology.  Intentionally, he has aligned himself with companies that can help hospitals and healthcare providers with the adoption of technology to assist with improving their processes and increase staff productivity and efficiencies through innovation.

‘You can’t grow, and you can’t improve unless you’re willing to innovate and take risks, and accept that technology is your friend, not your foe.’ 

A core value he believes in is patient engagement.  The industry, especially within the last 8 to 10 years, has been shifting where everything hospitals do is very patient-centric.  This is a critical shift in the industry because it’s crucial to consider the patient experience from beginning to end.  Hospitals are no longer just looking at the quality of care, but also, pre-procedure engagement, post-procedure, and post-discharge engagement.

Advice for Individuals Entering the RCM Domain

When it comes to advise for newcomers looking to enter the world of RCM, Sean lists learning about every angle of the industry as number one. He says it is important to learn from one’s peers, vendors, clients, and competitors.  Another area to focus on is learning about medical coding. It is important to become familiar with the entire continuum of services and revenue cycle process.

He believes it is important to understand what the patient’s experience is of their engagement with the service providers, when it starts, and why consent forms are needed, etc..  Additionally, it is important to learn about compliance and HIPAA, and why PHI needs to be protected along with the ramifications of failure to secure patient’s health information. Finally, it is important to understand the engagement and the interactions between physicians and the back office, and between nurses and administration.

‘My best advice would be to pay attention and try to learn all the steps beyond and outside the scope of your particular task or responsibility.  You will be more successful if you have a strong fundamental understanding of the entire revenue cycle continuum.’

Two Learnings over the Years

1. Understand the patient’s engagement throughout the whole process and how your involvement influences that journey.
2. Embrace the latest technology available to aid and improve operational efficiencies and help improve workforce optimization.

Best Practices Implemented in Processes

Utilizing AI tools, software solutions, and RPA to help streamline and improve processes-these are what Sean considers to be his best practices.

Effective change management is a crucial element of establishing best practices.  Mapping out the process, identifying who does what, when, and how.  Documenting the chronology of events, policies, and procedures, understanding objectives, and then reverse engineering to make sure that those objectives are being met.  These are important processes as they help one learn about the organization or that unit’s principle purpose, and discover what is working and what is not.

The final aspect of change or establishing best practices, is gaining buy-in. Change is always difficult, and it is important to understand the human factor associated with bringing in either technology or a new process.  Managing all that is critical for the success of whatever objective you’re looking to accomplish.

‘When I was with USCB I successfully introduced a number of best practices initiatives that ultimately saved the company FTE time, improved the efficacy of the process, minimizing and mitigating errors, which resulted in an increase in agent productivity.’ 

Key Benefits of Products or Services

There are three key benefits-improve the patient’s experience, reduce overhead and operations cost, and increase revenue.

‘I always try to make sure that what I’m doing can help you make money or save money while also improving the overall patient engagement.’ 

Future Vision for the RCM Domain

The pandemic has drastically impacted the hospital and RCM industry. Many hospitals and health system leaders are looking at what was a 5-year target for them, as an end-of-year target.  They are looking for ways to be more cost-effective, increase and accelerate revenue, while mitigating costs along the way and reducing overall operations expenditure.

Sean sees technology, AI, and RPA solutions taking a more prominent role in the RCM industry. He also believes artificial intelligence, intelligent automation, robotic process automation, and software bots gaining prominence. Additionally, tools and applications will become increasingly mainstream, and leveraged more to assist hospitals improve their ROI and their revenue operations.

Emerging Trends in RCM

Hospitals are trying to be more innovative and realigning their patient financial services (PFS) efforts to achieve higher scores in terms of their patient engagements.  Faster adoption of tools that can help optimize the patient’s overall experience, such as speech analytics will be utilized to help improve communication of agents with patients.  A trend that is currently underway is the utilization of tools that will ultimately make for a more productive patient financial services group, and also elevate the overall patient experience.

Patients are demanding a better overall experience with their healthcare providers and not just in terms of quality of care, but also with regards to pre and post-procedure experience.  Another trend is the adoption of omni-channel communications to help communicate with patients in a method that the patient prefers.  Everything is about electronic communication and incorporating it into the entire patient engagement ecosystem.

Leadership Lessons Learned on this Journey

For Sean, the biggest lesson has been leadership through servitude. He states that whether it has been from people that worked for him or those he worked for,  one thing he learned is that people don’t care how much you know until they know how much you care.

‘You have to have integrity, and strong morals.  You have to exercise compassion and understand that you don’t command respect; you have to earn it.  I believe many of these attributes are innate and develop over time if you genuinely live and breathe and exercise leadership through servitude.’ 

According to Sean, the goal of any leader is not to advance themselves, but to advance and elevate people to help them become as successful as possible.  In the end, the more successful they are, the more successful your group and ultimately, the more successful your organization.  Those are some of the mantras and some of the lessons that Sean believes he has learned and benefited from along the way.

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