Execution Fails When the People Closest to the Work Aren’t Enabled to Succeed

Opening

Revenue cycle performance ultimately lives with the people closest to the work.

Patient access representatives, coders, billers, and follow-up teams make hundreds of decisions every day that directly determine cash flow, denial risk, and yield. Yet in many organizations, those roles are expected to perform at a high level without consistent training, clear standards, or practical guidance.

Leaders assume capability because the role exists.

Experience says otherwise.

Across systems I’ve worked with, performance gaps were rarely caused by lack of effort. They were caused by people being asked to execute without being fully equipped to do so.

Where Capability Gaps Actually Show Up

Patient access and authorization teams are often the earliest point of failure — not because they don’t care, but because expectations are unclear.

Many PARs are trained once, informally, then left to learn through trial, error, and tribal knowledge. SOPs exist, but they’re outdated, inconsistent, or disconnected from payer reality. Variability becomes normalized.

The result is predictable:

• Authorizations that are technically “obtained” but not defensible
• Documentation that meets local habits, not payer standards
• Rework that flows downstream and surfaces as denials weeks later

By the time billing sees the issue, the opportunity to prevent it has already passed.

Why Training and Standard Work Matter More Than Volume

The strongest performance environments I’ve seen treated training as infrastructure, not onboarding.

PARs weren’t just told what to do — they were shown how, why, and what happens when it’s missed. SOPs were explicit, payer-specific, and operationally realistic. Edge cases were addressed, not ignored.

Standard work reduced variability. Variability reduction improved yield. Yield improvement reduced downstream cost.

Training wasn’t optional. It was continuous.

And accountability followed.

Holding Payers Accountable Is Part of the Job

Execution also breaks down when organizations quietly accept payer behavior they shouldn’t.

Timely adjudication requirements are known. Contractual obligations exist. Appeal rights are defined. Yet many organizations operate as if payer noncompliance is inevitable rather than actionable.

In high-performing environments, payer accountability was not delegated solely to AR follow-up. It was governed.

Patterns were tracked. Noncompliance was escalated. Contracts were enforced. Appeals were pursued consistently, not selectively.

Going to war with payers doesn’t mean being adversarial.

It means being disciplined, persistent, and unwilling to normalize bad behavior.

That posture changes outcomes.

What Changes When Capability Meets Execution

When PARs are trained with clear SOPs, denial drivers decline upstream.

When documentation standards align with payer reality, rework falls.

When payer accountability is enforced, cash accelerates without adding staff.

The organizations that sustained improvement didn’t work harder.

They worked with clarity.

Execution improved because capability improved.

Closing Perspective

Revenue cycle performance isn’t just a leadership or strategy problem.

It’s a systems problem that lives in training, standard work, and accountability — especially at the front end.

Execution fails when the people closest to the work are expected to succeed without the tools to do so.

When they’re enabled, outcomes follow.