Insights into healthcare finance

Healthcare providers are under pressure to improve financial outcomes while navigating shrinking margins, workforce shortages and rising patient expectations. To stay financially resilient, provider organizations must rethink how they manage payments — from claims submission to reimbursement.

At the HFMA Annual Conference, Zelis experts shared actionable strategies to help providers optimize their revenue cycle, reduce denial rates and accelerate payments using automation, analytics and interoperable systems.


Let’s break down the answers from Zelis experts at the HFMA Annual Conference.

What are the top revenue cycle metrics providers should prioritize?


Providers should focus on first-pass claim resolution rate, collections at time of service, denial rate trends and days in accounts receivable (A/R). These metrics reveal front-end efficiency, reimbursement speed and areas for improvement.

  • First-pass claim rate: Measures claims paid without rework. High rates mean clean claims and efficient coding.
  • Collections at time of service: Indicates front office efficiency and builds patient trust.
  • Denial rate trends: Uncovers root causes for payment delays.
  • Days in A/R: Tracks how quickly claims are paid.

How can providers create efficiency while maintaining quality financial outcomes?


Providers can drive efficiency by removing departmental silos, standardizing workflows, automating repetitive tasks and balancing operational goals with patient experience.

  • Break down silos: Foster teamwork across front office, back office and clinical staff.
  • Standardize workflows: Reduce variation and training gaps; automate where possible.
  • Prioritize high-value opportunities: Focus on areas with the greatest financial impact.
  • Balance goals: Ensure clear bills and faster resolution for patients.

What tools and technologies make the biggest impact on payments?


Automation, analytics dashboards and interoperable systems are game changers for payment efficiency. These tools reduce manual work, surface actionable insights and streamline processes.

  • Automation: Handles repetitive tasks like eligibility checks and payment posting.
  • Analytics dashboards: Provide real-time denial trends and A/R aging outliers.
  • Interoperable systems: Eliminate paper-based processes and manual data entry.
  • Staff enablement tools: Reduce cognitive load and let teams focus on value-added work.

What advice helps provider teams build momentum and early wins?

Start with data to identify bottlenecks, fix one area first for measurable impact and align KPIs to both financial health and team performance.

  • Begin with analytics: Use data to uncover revenue leaks and bottlenecks.
  • Tackle one issue at a time: Show results, then build a case for broader change.
  • Leverage senior staff: Assign complex claims to experienced team members; let new staff handle simpler tasks.
  • Align KPIs:Measure both financial outcomes and team performance.

Why should providers invest in revenue cycle optimization now?


With shrinking margins and rising costs, optimizing the revenue cycle is essential for financial sustainability and better patient experiences. Early wins build momentum for lasting change.

  • Financial health: Protect margins and reduce revenue leakage.
  • Operational efficiency: Streamline workflows and reduce waste.
  • Patient experience: Deliver transparency and faster resolution.

What are the next steps for provider teams?

Watch the full interview above with Zelis experts, Ceciley McNair and Shanta Horton, strategic engagement managers, for proven strategies and practical tips.

Ready to transform your revenue cycle?

Visit Zelis Provider Solutions to learn more.