As AVP of Revenue Integrity at WVU Medicine, Mythli Mukundan is ensuring every dollar is captured accurately by embedding analysts directly into revenue cycle workflows, forging collaborative payer relationships, and redefining career paths for her staff.
WVU Medicine operates across a massive and incredibly diverse geographic footprint. Serving patients in West Virginia, Pennsylvania, Ohio, and Maryland, the health system encompasses everything from highly specialized acute care facilities to rural critical access hospitals.
For Mythli Mukundan, AVP of Revenue Integrity, this organizational complexity requires a revenue cycle that is highly adaptable. Managing billing rules for a critical access hospital looks entirely different than billing for a major academic transplant center.
To ensure that the health system captures all earned revenue without ballooning its administrative costs, Mukundan has focused her strategy on proactive technology adoption, internal workforce development and strategic payer collaboration.
Embedding Tech to Lower the Cost to Collect
WVU Medicine is navigating margin pressures, staffing challenges, rising patient financial responsibility, and a significant prior authorization burden. To manage these challenges, Mukundan’s department focuses on increasing efficiency and by being proactive.
In order to better partner with the IT department, the revenue cycle team at WVU Medicine has embedded tech-minded analysts directly within the revenue cycle team. These individuals act as liaisons, analyzing manual workflows, such as coverage discovery and clinical appeals, and partnering with IT to build automated tools. This allows WVU Medicine to remain agile and able to identify new ways to cut costs to collect.
Looking forward, Mukundan views advanced AI as the next major operational leap, particularly when it comes to catching errors upstream.
“If the denial pattern recognition fires before the claim is ever submitted, and we act on it, that'll be a game changer," Mukundan says.
Transforming Payer Friction into Collaboration
Instead of treating provider-payer relations as an adversarial process, Mukundan views it as an opportunity for strategic alignment. WVU Medicine is part-owner of Peak Health, a regional health insurance company. The health system actively leverages this unique relationship to see how new workflows can eliminate administrative friction on both the provider and the payer sides.
Mukundan takes a similar partnership-driven approach to the other payers. Rather than fighting payers in silos, her revenue integrity and payment validation teams track denial trends, coverage issues, and downgrade patterns. This data is then funneled directly to the system's payer contracting team. By arming the contracting team with the "big picture" of how specific policies are impacting the system's cash flow, they are better equipped to negotiate mutually beneficial agreements.
"I think it's a constant communication flow, and we as a revenue cycle team empower the payer contracting team with data and information," Mukundan notes.
Adapting the Workforce for AI
As technology adoption grows, the nature of revenue cycle work will fundamentally shift. Historically, large teams were required just to make coverage phone calls and check eligibility websites. Today, as automation handles much of that, the workforce is being redirected toward complex medical necessity reviews and clinical denials.
To maintain a resilient workforce, Mukundan believes leaders must stay ahead of these industry shifts by creating internal mobility for their staff. This requires robust change management so employees know when to trust an automated system and when to rely on their own expertise. It also requires leaders to actively cross-train their teams so that an employee with a charging background can easily transition into a payment validation role as the technology landscape evolves.
"You have to be one step ahead so that you know where you need to shift the focus because that's where the industry is headed," Mukundan says.
Luke Gale is the revenue cycle editor for HealthLeaders.
KEY TAKEAWAYS
Health systems can reduce the cost to collect by accelerating digital solutions. Revenue cycle leaders should embed dedicated technology analysts within their own teams to identify automation opportunities and strengthen partnerships with IT.
Revenue cycle teams can impact reimbursement by arming their payer contracting teams with granular denial data, and other payer metrics like average days to payment and average days to denial resolution to negotiate better terms.
As automation handles routine administrative tasks, executives must build structured career ladders to transition frontline staff into more analytical roles.