Podcast Summary: Becker’s Healthcare Podcast

Guest: Stephen Rinaldi, SVP and Chief Revenue Officer, UNC Health
Date: December 23, 2025
Host: Alan Condon

Episode Overview

This episode features a conversation with Stephen Rinaldi, Senior Vice President and Chief Revenue Officer at UNC Health, a major nonprofit healthcare system with 16 hospitals across 20 campuses in North Carolina. The discussion centers on the current financial landscape in healthcare, challenges from payer pressures and legislation, the evolving role of AI and technology in the revenue cycle, and UNC Health's strategic initiatives for future growth.

Key Discussion Points & Insights

1. Stephen Rinaldi’s Background and Role at UNC Health

• Stephen oversees managed care reimbursements, supplemental programs, net revenue recognition, cost reporting, and revenue cycle for both hospital and professional operations.
• 11 years at UNC Health, starting as a CFO, with a background in accounting and corporate finance.
  "I'm responsible for our managed care program reimbursements ... and then end to end revenue cycle for both professional and hospital operations." [00:32, Stephen Rinaldi]

2. Top Industry Trends Affecting UNC Health

A. Market & Payer Headwinds

• Heightened payer pressure, including increased denials, administrative burdens, and legislative changes like OB3.

• Financial uncertainty due to fluctuating Medicaid funding and ACA (Affordable Care Act) subsidies.

• Anticipated reduction in supplemental payments (especially Medicaid), which threatens critical patient services and investments.
  "The pressure from the Federal Government and OB3 that will reduce supplemental payments represents a particular concern." [04:30, Stephen Rinaldi]

• UNC Health is proactively working to maintain Medicaid patient eligibility and access through outreach, financial navigation, and technology.

B. Workforce Sustainability

• Ongoing challenge to recruit and retain sufficient clinical and administrative staff to ensure care delivery and operational stability.

C. Tech Enablement & AI Adoption

• Embrace of advanced technologies, with a particular focus on integrating AI for automation, analytics, and workflow improvements.

3. Deep Dive: Market Headwinds and Strategic Responses

Medicaid and ACA Concerns

• Medicaid: Pressure from federal-level decisions and OB3 legislation impacts supplemental funding.
  • Active strategies include working with the state to help patients maintain Medicaid eligibility, ensuring communities retain coverage, and protecting reimbursement streams.
  • Special concern for vulnerable populations and commitment to health equity.
• ACA: Uncertainty around subsidies may increase premiums and out-of-pocket costs, risking higher rates of uninsured or underinsured patients.
  • Revenue cycle and financial assistance teams are stepping up with payment plans, precise estimates, and support to keep patients covered. "One of our big concerns is that the number of insured will decline and for the portion that remain insured, it'll actually result in them presenting more as if they're underinsured due to those financial limitations." [06:37, Stephen Rinaldi]

Payer Pressures & Denials

• Payers are increasingly leveraging AI for claims denials and prior authorization, causing administrative delays and financial strain.
• UNC Health is ramping up its own analytics and automation for denials management and appeals to counter rising payer automation. "We're seeing a number of payer partners ... deploy technology to deny claims or to create administrative burdens that extend the timeline and the effort necessary to collect reimbursement. As we take a look at that from a provider perspective, it feels quite intentional." [08:51, Stephen Rinaldi]

4. The Evolving AI Arms Race in the Revenue Cycle

• Rapid adoption of AI by both payers and providers. Stephen likens the dynamic to an “arms race” and foresees escalating technical advances on both sides.

• UNC Health utilizes both in-house machine learning and external vendor solutions for tasks such as appeals, claims processing, and automation.

• Proactive use of AI allows for scaling up appeals—moving from appealing ~20% of denials to potentially close to 100%, impacting revenue. "When we appeal an inpatient denial, our success rate is close to 70%. But because the process is so onerous and time consuming, it's very difficult to appeal more than 20% ... So leveraging technology will be able to appeal closer to 100% of those." [12:54, Stephen Rinaldi]

• There’s ongoing concern about ensuring data security and maintaining “human-in-the-loop” oversight, especially given the still-maturing vendor offerings.

• Stephen speculates on an evolving landscape: "I don't know if it's ... the clone wars or the bot wars that will happen overnight, but at some point these models are all training each other. So I think we're going to learn a lot over the next couple years." [13:55, Stephen Rinaldi]

5. Areas of Excitement and Growth for UNC Health

Technology & Clinical Support

• Ambient listening solutions for clinical documentation, increasing provider efficiency.
• Clinical decision support tools in EPIC, including data aggregation from both digital and paper sources to enhance care.
• Significant ambitions in research, with AI expected to accelerate clinical discovery, drug development, and data-driven insights in collaboration with UNC’s academic and provider community. "One of the very important goals of UNC Health is to be an international and national leader in research and in our academic mission." [16:24, Stephen Rinaldi]

Major Capital Projects

• $3+ billion children’s hospital being built in the Research Triangle in partnership with Duke Health—the first standalone children’s hospital in North Carolina.
  • "We're building a three plus billion dollar children's hospital ... partnering with Duke Health ... which I think is going to be wonderful for the community." [16:59, Stephen Rinaldi]

Network Expansion

• Addressing North Carolina's rapid population growth (7.5% since 2020, mostly from migration) by expanding care models, connecting with independent physicians, constructing new adult and acute care hospitals, and pursuing rural health strategies.
  • "We're building another standalone hospital here in the Triangle ... recently applied for a con to work to build a hospital in the western part of the state." [19:05, Stephen Rinaldi]
  • Dedicated programs and partnerships to better serve rural communities’ care needs.

Notable Quotes & Memorable Moments

• On payer tactics and tech arms race:
  "As we take a look at that from a provider perspective, it feels quite intentional. Whether or not it is subject to debate." [09:11, Stephen Rinaldi]

• On impact of AI in appeals:
  "You only need a modest increase in volume and certainly at the same win rate to shift the table." [13:12, Stephen Rinaldi]

• On the future of research and AI:
  "I think we're going to see some exciting use of that technology in that space, maybe helping us get to clinical therapies or drug development or other insights quicker..." [16:35, Stephen Rinaldi]

• On systemwide growth and rural strategy:
  "At some point, the conversation of rural health strategy needs to come into the discussion ... we're working with the state and other partners to develop the best strategies and programs to address care needs that are present across our state and rural communities." [19:43, Stephen Rinaldi]

Key Timestamps

| Timestamp | Topic | |-----------|-------| | 00:32 | Stephen Rinaldi’s background and role | | 02:24 | Current healthcare challenges: payer and workforce | | 04:30 | In-depth: Medicaid and ACA pressures | | 08:51 | Strategies for denials and payer automation | | 10:36 | AI arms race in the revenue cycle | | 12:54 | AI impact on appeals and scalability | | 15:11 | Exciting tech advances at UNC Health | | 16:59 | Children’s hospital initiative with Duke Health | | 18:12 | Expansion plans: new facilities and rural strategy |

Conclusion

Stephen Rinaldi provides a candid, forward-looking overview of the complex financial, technological, and strategic terrain in U.S. healthcare from his vantage at UNC Health. The discussion highlights ongoing payer/provider challenges, the transformative promise (and perils) of AI, and major institutional investments to meet the needs of a rapidly growing and changing North Carolina.

For listeners interested in revenue cycle management, healthcare AI, and health system strategy, this episode delivers a concise yet richly detailed window into the realities and future outlook facing large nonprofit health organizations.