This is our story of collaborating with a leading cancer center to transform its Revenue Cycle Management (RCM) operations. We streamlined fragmented processes, enhanced quality and scalability, and leveraged Artificial Intelligence (AI) and analytics to drive operational efficiency, reduce costs and improve care delivery.
As we know…
The healthcare industry faces mounting pressures to balance rising operational costs with the demand for high-quality, patient-centric care. RCM is a critical component in this equation, encompassing clinical and non-clinical functions like coding, medical transcription and quality management. However, fragmented processes, inconsistent quality and reliance on manual interventions often hinder operational efficiency and compliance, making it challenging for organizations to scale effectively.
Therefore, it’s paramount for healthcare providers to embrace next-generation technologies and domain experts to streamline processes and drive transformative outcomes.
The challenge for the client was…
It faced several industry-wide hurdles in its RCM operations, compounded by unique internal complexities. It sought to optimize processes and strengthen capabilities in the following areas:
As the domain expert and transformation partner…
WNS enabled a holistic, end-to-end overhaul of the client’s RCM operations, leveraging technology, process optimization and clinical expertise. Key aspects of the solution included:
-
Process Re-design and Consolidation
Streamlined operations and reduced redundancies to enhance efficiency, minimize errors and lower operational costs
-
Workforce Optimization and Analytics
Leveraged data analytics to optimize workforce allocation, ensuring effective resource utilization and driving improved productivity and performance
-
Robotics, AI / ML for Automation
Automated repeatable tasks using advanced robotics and Artificial Intelligence (AI) / Machine Learning (ML), accelerating processes and enabling human resources to focus on complex, value-added activities
-
American Academy of Professional Coders (AAPC):
Deployed a team of highly skilled, AAPC-certified coders to deliver superior accuracy and ensure compliance with healthcare coding and billing standards
-
Expansion into Inpatient and Emergency Response Services
Demonstrated flexibility and a comprehensive approach by expanding from outpatient coding to inpatient and emergency response coding services, addressing a broader spectrum of client needs
-
Coding Audit Services
Introduced an additional quality control layer through coding audits, ensuring adherence to regulatory standards and identifying improvement opportunities
-
Clinical Expertise
Leveraged a workforce with deep clinical and transcription expertise to enhance coding accuracy and minimize the risk of errors
-
Remote Process Migration
Facilitated efficient migration to remote processes, ensuring business continuity and operational flexibility, especially in dynamic environments
-
Specialized Training
Delivered in-house training programs to equip staff with the skills and knowledge required to align with organizational standards and practices
-
Volume / Quality Baselining and Documentation
Established robust baselines for volume and quality, enabling ongoing monitoring and continuous improvement
-
Auto-upload Capabilities
Simplified integration with client applications through automated upload solutions, reducing manual errors and increasing operational efficiency
-
Standardized Quality Tools
Employed in-house tools to maintain consistency and reliability in quality assurance processes
-
Health Insurance Portability and Accountability Act (HIPAA) Compliance
Ensured strict adherence to healthcare regulations to protect patient data and maintain trust, supporting secure and compliant operations
The transformative solution…
Delivered significant operational efficiencies and measurable business benefits for the client, including:
Clinical & Non-Clinical Functions
percent productivity improvement through electronic data interchange adoption
percent productivity improvement through streamlined upstream processes
Medical Coding
percent accuracy at the chart level and 96 percent at the evaluation and management level
percent TAT achieved, completing batches two days ahead of the deadline
Increased the pool of AAPC-certified medical coders
Medical Transcription
Provided customized prioritization and classification of records
Enabled seamless auto-upload from WNS systems to client applications
Prior Authorization
+ prior authorization cases processed annually
percent of cases reviewed and initiated within a 24-hour TAT
percent+ accuracy in processing
FAQs
1. Why is Revenue Cycle Management transformation critical for cancer centers and complex healthcare providers?
Cancer centers operate in highly complex environments with high-value treatments, frequent prior authorizations, and strict compliance requirements. Fragmented RCM processes can delay reimbursements, increase denials, and divert clinical focus away from patient care. This case study shows how modernizing RCM with AI, analytics, and process consolidation enables healthcare providers to control costs, improve accuracy, and scale operations—while still supporting timely, patient-centric care delivery.
2. How do AI and analytics improve both efficiency and financial outcomes in healthcare RCM?
AI and analytics improve RCM by automating repeatable tasks, reducing manual errors, and providing real-time visibility into performance metrics such as productivity, turnaround time, and quality. In this transformation, analytics-driven workforce optimization and AI-enabled automation helped eliminate redundancies, improve decision-making, and prioritize work more effectively—leading to measurable outcomes like 30% cost savings and a 40% productivity increase.
3. What role does clinical expertise play alongside AI in successful RCM transformation?
AI alone cannot address the nuances of healthcare revenue cycle operations. Clinical expertise is essential to ensure accurate coding, compliant documentation, and meaningful quality audits. In this case, the combination of AAPC-certified coders, clinical specialists, and AI-driven tools ensured high accuracy, consistent quality, and faster turnaround times—demonstrating that technology delivers the best results when guided by deep domain knowledge.
4. Can modern RCM transformation support compliance and scalability at the same time?
Yes. This case study illustrates that compliance and scalability are not competing goals when RCM transformation is done right. By standardizing quality tools, implementing coding audits, baselining volume and quality, and ensuring HIPAA-compliant processes, the healthcare provider achieved 100% compliance while also scaling services across coding, transcription, and prior authorization—without compromising accuracy or turnaround times.
5. What differentiates WNS from traditional healthcare RCM service providers?
WNS goes beyond transactional RCM outsourcing by delivering AI- and analytics-led transformation at scale. In this case, WNS combined deep healthcare domain expertise, AAPC-certified coders, advanced automation, and data-driven process re-engineering to create a unified, high-performance RCM ecosystem. The result was not just efficiency gains, but sustained improvements in compliance, scalability, and care enablement—outcomes traditional, labor-led RCM models struggle to achieve.
6. How does WNS ensure long-term value and continuous improvement in RCM engagements?
WNS embeds continuous improvement into every RCM engagement through analytics-based baselining, standardized quality frameworks, ongoing coding audits, and performance-driven KPIs. By continuously monitoring volume, accuracy, turnaround time, and compliance metrics, WNS helps healthcare providers adapt to changing regulations, fluctuating demand, and evolving care models—ensuring long-term value rather than one-time operational fixes.