Becker’s Healthcare Podcast: How AI Can Drive Meaningful Results in RCM
Date: February 3, 2026
Host: Scott Becker
Guest: Dr. Josh Galeras, Co-founder & Head of Product Development, Smarter Technologies
Overview
This episode of Becker’s Healthcare Podcast explores how artificial intelligence (AI) is transforming Revenue Cycle Management (RCM) in healthcare. Dr. Josh Galeras discusses his journey from practicing physician to AI innovator, how Smarter Technologies is using AI to drive financial impact in health systems, real-world use cases, the critical balance between automation and human oversight, and the future outlook for AI in RCM.
Key Discussion Points & Insights
Dr. Galeras' Background and the Problem with RCM
- Dr. Galeras trained at Cornell and Columbia, blending clinical experience with a background in software development and data science.
- The complexity and manual nature of hospital revenue cycles stem from historical practices:
"Every hospital is a little bit different and it's not something that physicians know basically anything about. I mean to be blunt, 99% of physicians probably know basically nothing about how hospitals actually get paid." — Dr. Galeras [02:25]
- Personal anecdotes showcase his early exposure to healthcare documentation and the inefficiencies that have persisted despite digitization.
The Smarter Technologies Platform
- Smarter Technologies, formed by merging Access Healthcare, Smarter DX, Thoughtful AI, and Pieces Technologies, aims to "reduce the cost of healthcare in this country by using AI to augment all of these manual processes.” [08:52]
- Its pre-bill solution leverages AI to identify missed diagnoses and billing opportunities, resulting in significant recovered revenue:
"The impact of that is something like $2.5 million per 10,000 discharges in new revenue that the hospital would otherwise have forgone for care that they are already provided and are completely justified in in billing the payers for." — Dr. Galeras [03:15]
- Integration with Access Healthcare allows for BPO services enhanced by AI, while Thoughtful AI and Pieces Technologies focus on improving efficiency and embedding revenue cycle intelligence earlier in the physician workflow.
AI ROI in RCM: What Works and What Doesn’t
- Pilots for AI often fail when they focus only on marginal time savings:
"Every time they've tried to do an AI initiative with a goal of just saving time as the value proposition, it's fair every time." — Dr. Galeras [10:36]
- AI solutions yield the greatest ROI by expanding the scope of what is possible (e.g., uncovering missed revenue), not just automating existing processes:
"If we would have gone after a sort of time savings approach, even if we fully automated all of CDI and all of coding, we wouldn't have been able to generate as much value for the health system as we are today..." — Dr. Galeras [13:45]
- Key lesson: AI should augment and empower humans, making possible what was previously out of reach, not merely substitute for existing manual tasks.
Human-in-the-Loop & AI Governance
- Effective deployment of AI in RCM requires robust guardrails:
"The smarter strategy really is to make sure that you, you're carefully attuned to what AI is and isn't capable of and that you have humans in the loop..." — Dr. Galeras [15:38]
- Systems must be designed so it's hard to "skip over the important or risky details that the AI is suggesting," preventing blind acceptance of AI output.
AI for Denials & Appeals: The New Arms Race
- Both providers and payers are rapidly deploying AI, leading to an “arms race”:
"Arms race is a very good way to describe exactly what's happening, I think between providers and payers right now." — Dr. Galeras [18:01]
- Generative AI's current strength is in data abstraction and rapid, accurate understanding of clinical documentation, crucial for:
- Appeal letter generation: AI pulls out relevant data so nurses can focus on substance.
- Preventing denials by matching documentation to payer criteria before claims are submitted.
"AI can understand [payer criteria] and very quickly translate it and make suggestions to the physician that help describe that." — Dr. Galeras [20:22]
CMS Electronic Prior Authorization & Future AI Investment
- Faster, more transparent electronic prior authorizations shift the value of AI toward deep clinical understanding:
"The core task that we need AI to do is get better at understanding complex clinical data... because I think it shows up in so many of the different parts of revenue cycle." — Dr. Galeras [23:20]
- Unified clinical understanding is seen as foundational for AI to add value throughout the revenue cycle.
Optimism for the Future
- Despite risks and challenges, Dr. Galeras is optimistic that ongoing advances will reallocate resources from administration to patient care:
"Even though we've been thinking about them and working on them as a system for decades now, I do sort of see a light at the end of the tunnel here..." — Dr. Galeras [25:00]
Notable Quotes & Memorable Moments
On the scale of the RCM problem:
"Every year in this country we spend a hundred billion dollars on the administration of revenue cycle in healthcare, which is just insane." — Dr. Galeras [04:58]
On failed time-savings pilots:
"Every time they've tried to do an AI initiative with a goal of just saving time as the value proposition, it's fair every time." — Dr. Galeras [10:36]
On AI’s core opportunity in RCM:
"It's really about expanding what's possible within the health system and capturing more or doing a better job that is going to result in value. And I think that is where AI paired with humans actually makes the most impact..." — Dr. Galeras [14:25]
On the human-in-the-loop guardrail:
"What you want to do is present information in a way that makes it hard to skip over the important or risky details that the AI is suggesting and not just give an easy button..." — Dr. Galeras [16:10]
On future optimism:
"AI is not a panacea. It will not solve all of our problems. And being really critical and thoughtful about how you use AI is very important, but it is a meaningful advance on how we do things." — Dr. Galeras [24:33]
Important Timestamps
- 00:32-03:55 — Dr. Galeras background, Smarter DX’s AI-powered Pre Bill product
- 04:56-09:36 — The $100B RCM problem, historical context, and the Smarter Technologies platform
- 10:25-14:40 — Why many AI-for-time-saving pilots fail & what solutions deliver ROI
- 15:28-17:15 — Guardrails and governance: keeping humans in the loop
- 17:59-22:06 — AI reducing denials, appeal letters, and the arms race with payers
- 22:42-24:07 — CMS electronic prior-auth and where AI investments are best placed
- 24:25-26:08 — Dr. Galeras’ hope and optimism for the impact of AI in healthcare
Tone and Takeaways
The conversation is frank, practical, and cautiously optimistic. Dr. Galeras blends technical depth with relatable anecdotes and a strategic vision, emphasizing the necessity of combining AI with human expertise. Both the host and guest share the hope that, with careful implementation, AI can shift health system resources away from costly administration toward patient-centric improvements and innovation.