Summary
In this episode of the RCM Experts Podcast, host Carrie Bauman moderates an insightful conversation with Aaron Fulner, a seasoned healthcare IT leader with extensive experience in health plan operations and AI adoption. Aaron shares how AI is already driving immediate ROI in administrative automation, such as prior authorization and claims processing, improving efficiency and member satisfaction.
The discussion explores AI’s role in risk adjustment by enhancing documentation accuracy and reducing provider burden, boosting revenue opportunities through data-driven insights and predictive analytics.
Key Takeaways
- AI delivers measurable ROI by automating prior authorization and claims processing, reducing turnaround times and boosting member satisfaction.
- AI enhances risk adjustment by scanning clinical documentation in real time to identify coding gaps and increase coder efficiency.
- Personalized AI chatbots and virtual assistants improve member engagement with 24/7 tailored communication.
- AI predicts high-cost episodes, optimizes provider networks, and detects fraud, transforming medical cost management.
- Responsible AI governance requires representative training data, continuous auditing, human oversight, and transparency.
- The future of AI in health plans is prescriptive and hyper-personalized, recommending optimal interventions to improve outcomes while lowering costs.