Why you need a dedicated RCM leader (even if you outsource everything)

Many multi-site healthcare providers evaluate whether to build or buy their revenue cycle management (RCM) infrastructure, asking: “should we keep RCM in-house or outsource it entirely?”

In the end, this is a false dilemma and might be the wrong question entirely. A more important question, especially in a private equity-backed, growth-oriented environment, is this: “who is accountable for the RCM function, regardless of who’s executing it?”

RCM accountability can’t be outsourced

Regulatory compliance, insurance considerations and overall revenue capture make RCM a unique challenge, and most organizations will elect to outsource parts of the revenue cycle, like credentialing, claims processing, denial management, etc. Some may even choose an end-to-end solution. But vendor management is different from functional leadership.

Without an in-house owner of revenue cycle strategy, outsourced partners become siloed, decisions get delayed and metrics like collections, denials and days in A/R slip without anyone accountable for the outcome.

The importance of RCM during periods of rapid change

We often hear CFOs and private equity sponsors say: “our organization is pursuing aggressive growth / transformation, and we expect to add multiple acquisitions and De Novo practices in the next 12-18 months.”

But when we dive deeper into where the elements of RCM accountability live, we hear: “our billing vendor handles that” or “our controller’s been managing it.”

And what we see after additional practices are added is that each comes with a different EMR and billing vendor, with some still using off-the-shelf legacy systems. Suddenly, you’re juggling multiple sets of payor contracts, billing rules and denial management protocols.

Without a strong in-house RCM leader, this patchwork of systems becomes a daily fire drill and leadership lacks a single source of truth, and when performance dips, no one can answer the most critical questions:

– Why are denial rates up this quarter?

– Why is net revenue underperforming relative to volume?

– What parts of the billing stack need to be consolidated post-acquisition?

Additionally, organizations looking to transform their systems with innovative solutions like AI or interoperability need a leader at the helm. Changes to the revenue cycle process start when a patient walks through the door at a facility, not with a reportable boardroom KPI, and without a leader who can manage these changes and liaison between billing vendors and senior leadership, organizations gamble with patient trust and revenue capture.

When an RCM leader becomes a must-have

Through many successful searches in RCM, we’ve found a clear pattern: companies hit a leadership breaking point when they face one or more of the following:

– Aggressive growth: acquiring multiple platforms in a year creates a billing Frankenstein, with different EMRs, different clearinghouses and different payor rules. A dedicated RCM leader is the only person who can rationalize that complexity into a coherent playbook.

– Transformation initiatives: Thinking about AI automation, predictive analytics or a new patient payment model? You’ll need someone who can translate tech into measurable revenue outcomes while keeping the trains running.

– Sponsor pressure: Private equity demands clean metrics and quarterly insight into collections, net revenue and denial trends. You need someone who can speak fluently at both the billing system and boardroom levels.

What this leader looks like

This isn’t just a billing manager in disguise. Strong RCM leaders typically bring:

– Multi-site healthcare experience

– Cross-platform EMR and clearinghouse exposure

– A track record of vendor transitions or integrations

– Board-level communication skills

– And increasingly, private equity seasoning

The title might vary between vice president, senior vice president or even chief revenue officer, but the mandate is the same: own the outcomes, not just the inputs.

The takeaway

If you’re on the fence about outsourcing your RCM process or keeping it in-house, or you’re seeing gaps in performance, you may need just one leader to oversee this function and evaluate the people, process and systems. Simply put, you need the right leader at the helm of the process.

To learn more about RCM talent, contact Jacob Sattler at (336) 217-9112 or jacob.sattler@charlesaris.com.