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

Episode Overview

Health centers are under enormous financial pressure—thin margins, rising denial rates, and providers drowning in documentation. In this episode, Jill sits down with Melissa Erlandson, a former physical therapist turned clinical account executive at Athelas, to break down where revenue quietly leaks out of healthcare organizations, how AI is changing the revenue cycle, and what ambient scribing technology is doing to reduce provider burnout. This is a practical, no-hype conversation about technology that is already working for practices and health centers across the country.

In This Episode, You’ll Learn:

• Why payers intentionally design complexity into the billing process—and what the term “float” means for your bottom line
• The two biggest places revenue quietly leaks out of healthcare organizations (and why most leaders don’t see them)
• Why industry-wide denial rates run 12–18% (and sometimes up to 30%)—and what a healthy denial rate actually looks like
• What “first-pass claim rate” means, why it matters, and what benchmark your organization should be hitting
• How AI billing rules engines work—and how they get denial rates down to 2% or less
• How Athelas’s AI voice agent “Sophia” calls payers, navigates phone trees, and extracts information without a human ever touching it
• What ambient AI scribing actually looks like during a patient encounter—and how it saves 1–2 hours per provider per day
• Why coding suggestions from the ambient scribe improve revenue capture—and the important nuance around provider accountability
• How Athelas’s forward deployment and 90-day onboarding process works—and why change management is the most overlooked part of implementation
• What a free Financial Health Assessment from Athelas includes—and how to get one for your organization
• Why the health centers seeing 15–20% revenue lifts are not outliers

Key Takeaways

“A lot of the complexity in medical billing is by design. Technology is uniquely positioned to overcome that complexity and get providers paid what they’re owed sooner.”

— Melissa Erlandson

“Payers are already using AI. We’re in an era where it’s AI against AI—except for the providers who haven’t yet deployed AI in their practices.”

— Melissa Erlandson

“The folks who are most overwhelmed are often the most afraid to use it. But those are also the ones whose lives could change the most.”

— Melissa Erlandson

“Is it worth a little discomfort for three months while it gets implemented? Financially, and for the wellbeing of your staff and your culture—the answer is yes.”

— Jill Steeley

Key Revenue Metrics Every Health Center Leader Should Know

From the conversation with Melissa:

• Industry-average denial rate: 12–18% (sometimes as high as 30%)
• Target denial rate with AI: 2% or less
• Industry-average first-pass claim rate: 82–88%
• Target first-pass claim rate with AI: 98%+
• Average revenue lift clients experience with Athelas: 15–20%
• Time saved per provider per day with ambient scribing: 1–2 hours
• Athelas platform processes over $10 billion in claims annually

How Athelas’s AI Revenue Cycle Works

• Billing rules engine: A large language model that knows all current payer rules, ensuring claims go out clean the first time
• Automated eligibility checks: Replaces manual front desk phone calls and reduces patient billing confusion
• AI Denial Defense: Buckets denied claims by reason code (CARC/RARC), resubmits automatically where possible, and flags humans for nuanced cases
• Remittance Reconciliation Agents: AI voice agent “Sophia” calls payers directly to retrieve EOBs and claim decisions—without a human on hold
• Robotic Processing Agents: AI that logs into payer portals, navigates two-factor authentication, and extracts data automatically
• Humans in the loop: Athelas staff review flags, identify patterns, and work with practices to build new rules that prevent recurring denials

Ambient AI Scribing: What It Is and How It Works

Athelas describes their ambient scribe as a “three-click system”:

• Listens to the conversation between provider and patient during the visit
• Transcribes and extracts only medically relevant information
• Generates an organized, compliant clinical note that flows directly into the EHR
• Provides coding suggestions (CPT and ICD-10) for provider review and approval—the provider retains final decision-making authority
• Saves 1–2 hours per provider per day
• Frees providers to maintain eye contact and be fully present with patients

What Implementation Looks Like

• Athelas uses a “forward deployment” model—for large enough practices, a team is deployed on-site during onboarding
• Full onboarding typically takes 90 days with weekly meetings involving onboarding and engineering teams
• For FQHCs: Athelas ingests two years of historical claims data to train the billing rules engine before go-live—preventing revenue dips during transition
• Change management is built into the process: staff are shown and coached on the technology before it’s activated
• Current limitation: Athelas does not currently integrate with Epic; most other EHR systems are supported
• Start with a discovery meeting to assess fit—Athelas won’t ask for financial data until the relationship and solution fit are established

Free Financial Health Assessment from Athelas

If you’re wondering whether your health center has a revenue capture problem, Athelas offers a complimentary Financial Health Assessment:

• Athelas pulls and analyzes your last two years of denials data
• Provides a high-level overview of uncaptured revenue and what AI could have recovered
• In cases with more complex patterns, a deeper analysis is available
• The assessment is completely free—no cost to the practice
• Athelas does not currently integrate with Epic; practices on Epic are not a fit at this time

Mentioned in This Episode

Athelas — AI-powered revenue cycle management, ambient AI scribing, and full-cycle billing platform for healthcare organizations | www.athelas.com

Schedule a meeting with Melissa Erlandson (Clinical Account Executive, Athelas) | hello.athelas.com/c/Melissa_Erlandson

Athelas Case Studies — Real results from practices using Athelas RCM and Ambient AI | www.athelas.com/case-studies

CEO Bootcamp — Jill’s 5-month program for FQHC executives covering revenue diversification, cost reduction, and strategic leadership | www.fqhc-ceo.com

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Have a topic request or feedback? Jill would love to hear from you. [email protected]