80% Fewer Denials and $3.6M in Growth: The Revenue Your Health Center Is Leaving Behind

When I was the CEO of a federally qualified health center, I didn’t know what our claims denial rate or our first-pass claim rate was. I paid more attention to our days in AR-that was the number that kept me up at night. What I was keenly aware of was how much we were paying nurses to sit on the phone with insurance companies for prior auths, and billing staff stuck on the claims denial hamster wheel, never quite able to crack that week’s secret code to getting claims paid. No wonder our AR was aging. We were too busy playing the claim game to notice what wasn’t getting paid.

It was a revenue leak. And it was huge.

In the latest episode of the Community Health Collective Podcast, I sat down with Melissa Erlandson, a former physical therapist who spent time inside UnitedHealthcare before joining Athelas—an AI-powered health tech platform I’ve been recommending to clients. Melissa brings a rare combination: she understands the clinical side, the payer side, and the revenue cycle side. All three.

What she shared genuinely surprised me. And I’ve been doing this a long time.

The Revenue Leak Most Health Center Leaders Don’t See

As health center leaders, our attention is usually on the latest workforce issue or patient complaint. We don’t spend enough time quantifying how much it costs to pay humans to sit on the billing hamster wheel - or calculating the indirect cost of provider and staff burnout from spending hours on the phone with payers.

Melissa introduced a concept that stopped me: float. That’s the term payers use internally for the practice of delaying or denying provider payments so they can earn more interest on money they hold. A lot of the complexity in medical billing, she explained, is by design. Payers know that practices won’t chase a $5 or $8 underpayment - and they do that thousands of times a day across the country.

The result? Industry-wide denial rates run 12–18%, and sometimes as high as 30%. Most health centers don’t know their number. When they outsource billing, that visibility gets even murkier.

What AI-Powered Revenue Cycle Management Actually Does

Athelas uses a large language model - a billing rules engine - that knows current payer rules and ensures claims go out clean the first time. When denials do occur, the system buckets them by reason code, resubmits automatically where possible, and flags humans for more complex cases.

The result: denial rates drop to 2% or less, and first-pass claim rates reach 98%+ - versus an industry average of 82–88%.

But the part that fascinated me most was the remittance reconciliation agents. Athelas has an AI voice agent named Sophia that calls payers directly, navigates hold times, and retrieves EOBs and claim decisions - without a human ever touching it. Payers like UnitedHealthcare, Cigna, and Aetna are already using AI. Athelas is leveling the playing field for providers.

Ambient AI Scribing: Giving Providers Their Time Back

The revenue cycle piece is only half the story. Athelas also offers ambient AI documentation—a tool that listens during patient visits, transcribes the conversation, extracts only the medically relevant information, and generates a compliant clinical note that flows into the EHR.

Providers save one to two hours per day. That’s not a small number - it’s the difference between a provider who’s burning out and one who can be fully present with patients, look them in the eye, and actually practice medicine the way they intended.

The ambient scribe also suggests CPT and ICD-10 codes based on the encounter. The provider retains final approval—Athelas is careful to say they don’t do coding - but the suggestions push toward optimal reimbursement, reducing the undercoding that quietly costs health centers significant revenue.

What Implementation Actually Looks Like

Every health center leader I know flinches at the word “implementation.” Melissa addressed this directly. Athelas uses what they call forward deployment - for large enough organizations, a team is deployed on-site during onboarding. For FQHCs specifically, Athelas ingests two years of historical claims data to train the billing rules engine before go-live, preventing the revenue dips that can happen during transitions.

Full onboarding takes about 90 days. Change management is built into the process. And one thing Melissa said stuck with me: the providers and staff who are most overwhelmed are often the most afraid to adopt new tools - but they’re also the ones whose lives change the most when they do.

One important note: Athelas does not currently integrate with Epic. If your health center is on Epic, this may not be the right fit right now.

The Numbers That Matter

• Industry-average denial rate: 12–18% (sometimes up to 30%)
• Target denial rate with Athelas: 2% or less
• Industry-average first-pass claim rate: 82–88%
• Target first-pass claim rate: 98%+
• Average revenue lift with Athelas: 15–20%
• Time saved per provider per day: 1–2 hours

Get a Free Financial Health Assessment

If you’re wondering whether your health center has a revenue capture problem, Athelas offers a complimentary Financial Health Assessment. They pull two years of your denials data, analyze it, and show you what AI could have recovered. It’s free, there’s no obligation, and it gives you a clear picture of where your revenue is going.

To schedule a conversation with Melissa Erlandson directly, visit: 

hello.athelas.com/c/Melissa_Erlandson

► Listen to Episode #20 of the Community Health Collective Podcast