Practical Applications for AI, Automation in Healthcare Finance

AI is reshaping healthcare finance and creating opportunities for providers to improve efficiency and financial performance. With government funding shortages, rising claim denials, and a competitive labor market, automation is becoming an essential tool. Third-party payors are already leveraging AI for claims processing, and providers may benefit from similar technologies. Consider just a few of the ways AI and robotic process automation (RPA) might be integrated into healthcare operations.

Provider Documentation and Coding. AI-powered speech recognition and note-taking technologies are helping providers streamline documentation and coding. These tools analyze verbal cues and leverage historical claims data to support accurate coding, improving efficiency and reimbursement. In time and as they integrate more payment and claims data, they can also help to reduce coding errors, ensuring greater accuracy and compliance.

Process Automation. Many providers are using AI and RPA to streamline routine administrative tasks. One common application is automating a single step in a workflow, such as logging into payor portals to retrieve and summarize data on eligibility, authorizations, referrals, claims status, and payments. By reducing the time invested in manual data entry and reporting, AI+RPA can accelerate payment posting, highlight key financial insights, improve prioritization, and help management make faster, more informed decisions.

Denial Management. AI and data analytics are transforming denial management by turning scattered data from multiple payors into clear, actionable insights. These tools can prioritize claims based on past outcomes, helping providers focus on those most likely to be recovered. As AI continuously learns from payor data and contract trends, it can improve claim submissions and rework denied claims more effectively over time.

Payors frequently update claims rules, introduce new codes, and adjust modifiers—changes that can lead to avoidable denials. AI can track these updates, integrate them into billing workflows, and alert teams to changes before they result in rejected claims, reducing delays and lost revenue.

Receivables and Reserves Analysis. AI can quickly organize and summarize large volumes of data, offering valuable support with accounts receivable analysis. One of the most significant financial risks for healthcare providers is accurately valuing receivables. CFOs and controllers often dedicate a considerable amount of time each month ensuring contractual allowances and other adjustments are properly accounted for.

By integrating AI into the revenue and receivables cycle, organizations can leverage years of claims and collections data to cross-check collection percentages, ensuring a more accurate and reliable patient accounts receivable balance. This enhances financial oversight and reduces the risk of misvalued receivables.

What we advise.

Assess your IT infrastructure. While there are numerous benefits, healthcare organizations should assess whether their electronic health record system and overall IT environment are equipped to support these technologies before implementing AI or RPA. A robust data warehouse capable of handling AI-driven analysis is essential. Without proper data centralization or with fragmented systems, the addition of AI or RPA may hinder, rather than enhance, operational efficiency. AAFCPAs advises that clients ensure their systems are not overly outdated before pursuing an AI or RPA initiative.

Prioritize due diligence. The market for AI vendors is growing rapidly, and many newcomers may overpromise results. As a result, it is important to evaluate potential vendors carefully. Request case studies or proofs of concept to verify their ability to improve collections or operational efficiency. When meeting with IT and AI vendors, be clear about the goals you intend to achieve—whether improving claim processing speed, reducing costs, enhancing collections, or increasing administrative capacity.

Change management and communication. Implementing AI, RPA, and data analytics technologies provides efficiencies and allows providers, business offices, and administrative staff to focus on higher-value tasks, such as patient care, strategic initiatives, and improving productivity and quality metrics. The benefits of AI—such as reducing physician administrative burdens, lowering training time for billing staff, improving retention, and enhancing work-life balance—should be clearly communicated to all stakeholders to alleviate the fear that AI will replace their jobs.

Update policies and procedures. Finally, establish a comprehensive AI policy prior to implementation. This policy should adhere to privacy protections, IT security standards, and internal controls over financial reporting, while also ensuring only authorized technologies are integrated into the organization’s environment, thus safeguarding against potential risks.

How We Help

At AAFCPAs, we understand the intricate challenges facing healthcare organizations, from regulatory compliance to financial management. With more than 50 years of experience in the healthcare sector, we provide comprehensive solutions tailored to your organization’s needs. Our approach combines extensive healthcare expertise with advanced technology solutions, such as Robotic Process Automation (RPA) and Artificial Intelligence (AI), to streamline operations, improve efficiency, and enhance patient care.

Our multidisciplinary team of financial statement auditors, CFOs, controllers, system and process analysts and implementation consultants as well as IT security specialists works collaboratively with clients to integrate emerging technologies into their financial and operational processes. These solutions can automate repetitive tasks such as claims processing, data entry, and reporting, allowing healthcare providers to focus on higher-value activities like strategic decision-making and patient care.

If you have questions, please contact Charles Webb, CPA, CHFP, Partner at 774.512.4046 or cwebb@nullaafcpa.com, Vassilis Kontoglis, Partner, Analytics, Automation & IT Security at 774.512.4069 or vkontoglis@nullaafcpa.com, Robyn Leet, Partner, Business Process Assessments & Attestations at 774.512.4010 or rleet@nullaafcpa.com—or your AAFCPAs Partner.