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Becker’s Healthcare Podcast
Leading Revenue Cycle Transformation at UNC Health with Stephen Rinaldi
00:19:25
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- [00:02]
Claritif Narrator
When it comes to negotiating fair prices for healthcare services, guessing is no way to go. That's why there's Claritif. With over 40 years of experience partnering with healthcare providers and the latest data driven insights built on 500 billion public records, Claritif is helping revolutionize the approach to healthcare services pricing, helping create more predictability for providers, more affordability for payers and employers, and more quality for patients. With Claritif, healthcare isn't left to chance. Claritif. More clarity, less guesswork.
- [00:38]
Andrew Kass
This is Andrew Kass with the Beckers Healthcare Podcast. I'm thrilled to be joined today by Stephen Rinaldi, Senior Vice President and Chief Revenue Officer at UNC Health. Stephen, it's a pleasure to have you on the podcast.
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Stephen Rinaldi
Well, thank you so much. I appreciate the opportunity.
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Andrew Kass
Of course. Before we begin, why don't you tell us a little bit about your background?
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Stephen Rinaldi
Sure. So you know, as you mentioned, I'm the Chief revenue officer for UNC Health. You know, we're a $12 billion healthcare system spanning North Carolina, we like to say from the mountains to the coast, headquartered in Chapel Hill. So in my role, I'm responsible for managed care reimbursement and end to end revenue cycle for professional and hospital operations. Been with UNC since 2014. Joined as the CFO at one of our entities. Later moved into our corporate financ division. I'm an accountant by trade and so tend to look at things from, from those lens, lenses if you will, and been at it for, for a while. Started out the earlier part of my career in banking actually with Fleet Boston and M and A and, and, and corporate finance there. So come at healthcare operations from, from the perspective of those experiences.
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Andrew Kass
Yeah, and you have a little bit of an SEFO background as you said. And so how has that, you know, kind of influenced you as a revenue a leader?
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Stephen Rinaldi
Yeah, definitely. I think I bring a CFO lens to it for sure. So more concerned with communicating from a forecast perspective, where we're going and setting strategy around the headwinds that we face and, and pivoting our operation, if you will, to where we need to be. I think it's a little easier or more commonplace for a lot of revenue cycle leaders similar to my friends that are controllers to sort of look at things from the rear view perspective. This is how we perform. These are our core KPIs, things of that nature. And I think that those things are important because they serve foundationally to measure performance. But the real lens that I bring is really that forward looking Strategic financial plan around how we operate from a revenue perspective.
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Andrew Kass
And speaking of those headwinds, what would you say is the biggest headwind you're facing right now as a revenue cycle leader?
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Stephen Rinaldi
Oh, gosh, there are no shortage of, of headwinds right now in health care, that's for sure. I think that in as much as these are forces against operating performance, I think it's more productive to face sort of these challenges as opportunities. So I tend to come at it from that perspective. Some of those challenges we face include Medicare and Medicaid reimbursement and policy program changes. Those remain significant and certainly not unique to UNC Health, but affecting everyone in health care, labor challenges continue to be something that we face organizationally, certainly competition for both remote and hybrid positions. We used to compete within our market and against competitors, but now the marketplace, as you well know, is national and even international. Since COVID which has really changed the dynamic, we have increased payer administrative burdens. All of the information that we see all the time in the news, whether that's increased authorizations, peer to peer expectations for our providers, which are particularly frustrating whenever we have to take a provider away from the bedside, post visit audits and things of that nature. And then the pace of technological adoptions, while that's both a headwind and a tailwind, it still remains something that provides a need for us to become more educated about and to support from an implementation perspective.
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Andrew Kass
On the labor front, how are you working to develop the next generation of revenue cycle leaders? That's something I hear that is a challenge for a lot of revenue cycle leaders that I speak with.
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Stephen Rinaldi
Yeah, for sure. Right. All leaders in general. But yeah, I think you have to begin with your hiring strategy and that begins at the senior level for us. And my perspective is we need to really identify successful leaders whom have both succeeded and failed. Because I think it's important for us to recognize that we generally learn from our failures and we also need to be nimble. By that I mean being able to hire talent when it's available, even when we don't have a role. If we see someone and think, gosh, they're a star and I would really love to have them on the team, but you don't have a role. I think you need to think about making one because it's important to secure that talent for the organization when it's available. And that can be somewhat infectious, I think in terms of both driving execution but also inspiring the talent that you have within, within the division. So around that I like to Coach our leaders around asking questions that focus on execution. That's a really important differentiator for me. A lot of times someone will say, you know, a project will come up or an implementation or something and they'll say, well, I think I can get to that and we should be able to get it done in three weeks. I like to have leaders that ask key questions around that challenge the timeline, say, you know, what is it that you also have going on that's preventing you from being able to get to this as your highest priority? So that our leaders can then reprioritize and say, well, you know, let's move this ahead of project A or B because it's a higher priority or has a higher yield or greater importance to the organization and then to push them a little bit and say, you know, could you possibly get this done next week or today if you had this additional resource? So I think that that's a leadership development skill that, that I like to help coach our team and our leaders.
- [06:52]
Andrew Kass
Around along those lines.
- [06:53]
Stephen Rinaldi
I think, you know, there's some red flags to me as well, right. If you hire a new leader into the organization, especially in a senior role, and they don't have a following, you know, if they're coming in, then they're not telling you about teammates that they'd like to bring along from the team that they led previously. I think that it's a red flag and you have to ask yourself the question, you know, what's. What's wrong with their leadership? Or why is it that people that have worked with them in the past don't want to follow them to the new role? So you need to be willing to make changes if you've made the wrong decision. And you know, sometimes that can be reallocation within the enterprise or even assistance and outplace placement, which is never a comfortable exercise but, but always remains an important one for leaders to keep front of mind. So as we look at that next generation of reven cycle leaders, you have to, I think, start by establishing what the expectation is and then throughout your group, and our group is large with, you know, several thousand teammates, I think you have to then identify the folks that are not on that path and help direct them through the right resources, whether it's education, coaching, training, shadowing, whatever it is that you can do to help identify their skill sets and then pull them along to be part of future leaders for the organization.
- [08:10]
Andrew Kass
Another thing that I hear a lot about from revenue cycle leaders, that's a challenge is the, and not just revenue Cycle leaders. But I think healthcare as a whole is the one big beautiful bill act. And as a revenue cycle leader, how are you preparing for the effects of that bill that are coming down the road?
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Stephen Rinaldi
Yeah, the one one big beautiful bill or OB3 is as @ least I being told that it's the buzzword today, definitely introduced a number of potential headwinds beginning with the reduction of supplemental programs such as HASP and upper payment limit. Organizations are really dependent upon those supplemental programs to make up the difference between the cost footprint and the reimbursement level of Medicare and Medicaid. From a general CFO perspective, we used to talk about trying to make a Medicare, excuse me, a 3% operating margin on a Medicare book of business. But post Covid with the inflation that we've seen in labor and supplies, that's a really difficult thing to achieve. When you add on top of that the headwinds with the impact of Medicaid enrollment and the likely, you know, reduction of covered beneficiaries, it becomes even more challenging. So for us and I think for most organizations, in order to survive this type of disruption, you really need to focus on both top line revenue integrity while working to control the cost footprint across your enterprise to the extent possible. Most organizations cannot reduce cost quickly enough to offset a loss of revenue. This creates what is commonly known as a financial structural weakness. So you really have to be excellent in converting clinical services into net revenue. From a revenue cycle perspective, that means strong front end processes and financial clearance, really connecting the scheduling process to making sure that the scheduled service will be covered from a reimbursement perspective and then also that the patient won't have any surprises from a liability perspective despite all those efforts if you don't. In addition have a strong denial management program and a focused strategy of holding payers accountable for what you've agreed to in your contracts. I think you'll still fail or will still have revenue leakage. There is no shortage of new rules and policies and challenges that are popping up that really are not even necessarily part of OB3 but become exploited as much larger issues because they are where you can lean your efforts to reducing the impact of OB3 and it takes us there in the conversation. Even in revenue cycle though, there's opportunities on the expense side. We used to look to cost to collect as being the key metric, but cost to collect is commonly calculated by taking the expense of your revenue operation and dividing it by net revenue. And Most of the CFOs and revenue cycle leaders out there will tell you that While that might be the industry standard, it's really transactional volume that defines the demand for revenue cycle. You could have net revenue stay completely flat, but one policy change or one payer change, increase the number of authorizations and all of a sudden you need more people or more technology, but your net revenue hasn't increased. So on the expense side, look at productivity, evaluating service lines that need revision, whether they're contracting or you're trying to exit that business and then really try to leverage technology where possible and appropriate into the organization is is really where we're.
- [11:36]
Andrew Kass
Focused. And as we're recording this, we are getting pretty close to the end of 2025 here. So I wanted to ask what your biggest accomplishment or win that you've had this.
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Stephen Rinaldi
Year? Yeah, thanks so much for asking me that. It's nice to be able to celebrate some of these things. I would say by far the strength of team in our transition of revenue cycle operations from a PBHB or professional hospital background using sort of the. The epic platform that we're on as the buzzword there to a front middle model has been our greatest win. And by that I mean we've been fortunate in recruiting excellent leaders with a depth of experience, humility and a sense of teamwork to drive success. These folks are really content experts with a track record of leading and innovating. Super critical with the headwinds we're facing. It's also an exciting time to be part of a university healthcare system where we have academics and research at our core that really helps foster a model of continuous learning which is important culturally and to drive our growth across our revenue cycle. The leaders that we have have helped put together excellent teams at all levels within our organization that are really focused on the patient, financial experience and teamwork. So culturally and from a motivational and alignment perspective, I feel we're really in a great place and the people are the most important part of that operation. And that's why I really feel like it's the biggest win we've had this.
- [13:11]
Andrew Kass
Year. Great. And what are you. What is your top priority heading into.
- [13:16]
Stephen Rinaldi
2026? So you know, as we look at 2026, really remain supporting and continue to support our clinical operation and executing strategies. You know, our mission at UNC is to improve the health and well being of North Carolinians. In order to do that, we really need to have operating performance and margin. Hate to be cliche, but the no margin omission remains really important into your ability to reinvest. So our team is really at the Elbow. With our care delivery model, both supporting and collaborating, I think that means as a top priority, we have to be really deliberate in understanding those service lines and providing the right resources to support them. Sometimes that means at the elbow, resources which we commonly receive requests for from our surgical teams, means being at the bedside in utilization management and clinical documentation, improvement and being part of planning where we're expanding and changing what we're doing from an operational perspective. In addition to that, going back to one of your previous questions, the continued development of the strength of team remain a top priority as we're implementing different AI technologies, including those with augmented technology, with human in the loop where they make sense. I think that that creates anxiety for the teammates. Am I going to be replaced by technology? So a lot of that is around setting a priority of continuing to elevate our team to operate at the top of their training, at the top of their license, if you will, and leveraging technology to make their life easier where we can pick up efficiency. So the buzzword I like to use is sort of deliberate revenue integrity, sort of to monitor and manage that conversion of clinical care into revenue. You know, focusing to the extent we can on being on being precise. That's easier said than done since you know, our payers are working to delay, dilute or otherwise reduce our ability to receive payment. But we all know that long term that's really unsustainable. And so unless we pivot and make sure that we are know, sort of firing on all cylinders to the extent that we have control over that aspect of our business, we need to, we need to take advantage of it to the best of our ability. So I think as we look into not just 2026, but really beyond that, will need to be a continued important focus of us from a revenue.
- [15:47]
Andrew Kass
Perspective. And the last question I wanted to ask you, and I think we touched a little bit on this earlier, but what is the key to being an effective revenue cycle.
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Stephen Rinaldi
Leader? Oh, that's a great, another great question. You know, I think being effective as a revenue cycle leader is similar and if not identical to the leadership traits that you need in general in any role. So the way I look at this is self awareness, integrity, humility, really foundational characteristics of inspiring leaders. And I think it's important to create that internal discipline for execution through inspiration. In order to do that, we need to have a strong self awareness and own our successes and failures. One of my favorite books is Extreme Ownership by Jocko Wilnick. He talks a lot about leaders needing to take responsibility for everything. In the world. And one of the quotes that he has in the book, both him and Leif Bab and his co author is there are no bad teams, there's only bad leaders. And I think that that's a really important lesson. They also talk about this thing called cover and move, which of course is a tactical skill used in hostile environments to move safely under fire. But in a business sense, it really means that teams must support each other independently through interconnected efforts versus isolation. So get rid of silos, encourage matrix cost, divisional partnerships and collaboration and things of that nature. I think that that's the critical piece that can make you effective as a leader, whether in revenue cycle or in other areas. But I think because revenue cycle touches all aspects of the business, it's really important for us to exercise those sorts of leadership qualities. You're not working with one department, you have to work across all of the departments. And in order to do that, you have to be humble and eager to learn and receptive and a good communicator. Again, just really grateful for the team that we have that they are so adept at doing this. But overall, I think if you focus on those things as a leader, you'll, you'll be successful. Lots of books and lots of material out there on that and I'm sure there's different perspectives and views on what makes a, a great leader. But to me, a lot of times we, we can see them and know who they are and, and they often have the characteristics and qualities that I've, that I've mentioned, whether or not they had them at the beginning. I think that, you know, some leaders are born that way, but I think many people learn to lead and you do that by making mistakes and learning from.
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Andrew Kass
Them. So great. Thank you so much for joining us today, Stephen, it's been a pleasure speaking with you and I look forward to talking with you again.
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Stephen Rinaldi
Soon. Yeah, thank you so much. I always appreciate the opportunity and grateful for the.
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Claritif Narrator
Invitation.
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For healthcare services, predicting and negotiating prices can feel like a guessing game. But with claritif, complexity becomes clarity. With claritif's technology, data and insights, payers are equipped with the information needed to help reduce claims, payment errors. Providers can get more insight into payments and fair pay pricing. And employers have the analytics to make more informed decisions on benefits design. With caretif, healthcare decisions can be made with confidence. Claritif, more clarity, less guesswork.