A not-for-profit health system with nine hospitals, including a dedicated pediatric facility, and more than 480 care locations, enjoyed strong operational performance and national recognition as a top employer. The organization was well-positioned for continued growth, however, the convergence of major events—including the acquisition of
two hospitals and a system-wide Epic upgrade—created an urgent need to modernize long-standing workflows, reduce variation across facilities, and strengthen financial resilience.
Impact Advisors partnered with the health system’s leadership to design and execute a comprehensive revenue cycle optimization program, focusing on six high-opportunity areas: Authorization Throughput, AR Management, Charge Reconciliation, Denial Prevention, Point-of-Service (POS) Collections, and Payment Variance. Working collaboratively with client leadership and staff, teams conducted deep-dive assessments, mapped end-to-end workflows, identified root causes of inefficiency, and implemented sustainable solutions grounded in best practice, transparency, and accountability.
Enhancing Authorization Throughput and Reducing Denials
The organization faced inconsistent authorization processes, limited standardization, and a general underutilization of Epic functionality within its Surgical and Radiology departments. As authorization delays mounted in these areas, downstream impacts were felt across financial clearance, scheduling, and denial management.
Impact Advisors partnered with cross-functional teams to unify authorization operations under a centralized model, establishing common workflows, reporting tools, and a governance structure capable of sustaining long-term operational discipline. The team’s work expanded to include supporting OR scheduling technology modernization, increasing visibility into denial trends, and improving communication pathways across departments. By project end, authorization turnaround time improved significantly, pending volumes decreased, and 25 staff were successfully transitioned into the new centralized model.
Improving AR Management and Driving Accountability
The health system’s AR follow-up process suffered from staffing misalignment, inconsistent quality expectations, and limited insight into vendor performance. Teams managed
numerous workqueues with little standardization, and productivity varied widely.
Impact Advisors analyzed staff assignments, introduced targeted training for follow-up and denial management, and implemented a consistent quality audit program. Workqueues were restructured, scoring models were implemented, and account activities were standardized. These changes gave leaders clearer visibility into performance and enabled teams to prioritize high-risk accounts more effectively. The result was a meaningful improvement in follow-up productivity—rising approximately 25% over the course of the engagement.
Establishing a System-wide Charge Reconciliation Function
The health system previously lacked a formal charge reconciliation structure, resulting in missing charges, charge lag, and inconsistent capture practices across departments.
Impact Advisors was tasked with designing and implementing a fully decentralized reconciliation model that emphasized department-level accountability supported by system-wide governance.
A structured approach guided the complex rollout across the many facility locations, each with its own unique workflows—from policy development and staff training to pilot testing and full deployment. Departments learned to perform daily reconciliation, utilize monitoring dashboards, escalate issues effectively, and understand the financial
impact of timely, accurate charge capture. By the end of the engagement, the organization realized approximately $3.9M in revenue, increased the percentage of charges submitted on time to 96.9%, and reduced average charge lag by more than half—from 1.12 days to 0.54 days. Equally important, charge reconciliation became a routine operational discipline, embedded within every department’s daily workflow.
Reducing Avoidable Denials Through Governance and Transparency
Prior to the engagement, the health system lacked centralized oversight of denials, and variability in Epic configuration prevented staff from prioritizing high-risk
accounts. Departments had limited visibility into trends and avoidable write-offs, and collaboration between payers, case management, and managed care was inconsistent.
Impact Advisors introduced a formal denial governance structure, implemented routine root-cause analysis practices, and improved Epic-based reporting to support real-time tracking. Operational and system changes—particularly within registration, credentialing, and authorization processes— reduced preventable issues upstream. By project end, the organization projected a 0.6% reduction in avoidable write-offs as a percent of net revenue for hospital billing and a 1.0% reduction for professional billing.
Transforming Point-of-Service Collections and Improving Patient Financial Transparency
Point-of-service (POS) collections were significantly below target due to stigma around payment conversations, inconsistent use of newly implemented prepayment tools,
and a high Medicaid population with frequent affordability challenges. Staff lacked standardized scripting, training, and reporting.
Impact Advisors and the client’s internal teams deployed a comprehensive training program reaching 1,500 registration staff and implemented a unified collections policy emphasizing transparency and compassionate communication. Epic reporting for POS performance was created to increase visibility at the facility level. Financial assistance workflows were redesigned to station counselors at locations with the greatest patient need.
These efforts produced a 10% increase in pre-service collections, equating to an $11M improvement compared to prior year performance, while simultaneously elevating the patient financial experience.
Standardizing Payment Variance Management
The organization previously lacked a defined function for managing payment variance, particularly related to DRG downgrades, payer disallowed charges, and contract inconsistency. Impact Advisors developed a standardized approach to payment variance, introduced monitoring tools, and improved transparency into contract build status. This laid a foundation for long-term financial integrity and payer accountability.
Positive Impact
Across all six workstreams, the health system achieved measurable improvements in performance, cultural alignment, and operational consistency:
- Authorization functions for 16 service lines were centralized, improving throughput and reducing pending volumes.
- AR productivity increased by approximately 25% following training, workqueue redesign, and improved monitoring.
- Charge reconciliation improvements generated approximately $3.9M in revenue and dramatically reduced charge lag.
- Avoidable write-offs decreased through improved governance, analytics, and upstream workflow refinement.
- Point-of-service collections increased by $11M compared to the prior year.
- Payment variance workflows became standardized, with clearer visibility into contract build and payer performance.
A Partnership Focused on People, Process, and Long-Term Sustainability
This engagement demonstrates Impact Advisors’ ability to deliver measurable results by bridging technology optimization with operational redesign and cultural transformation. Rather than offering high-level recommendations, consultants partnered directly with client leaders and frontline teams to design, implement, and sustain meaningful change.
The change-management-driven approach ensured strong executive sponsorship, staff engagement, and consistent performance monitoring—providing the client organization with a durable, enterprise-wide revenue cycle foundation equipped for future growth and ongoing operational excellence.