A New VP of Patient Financial Services' Guide to Success in a Large Health System Using Epic

Stepping into the role of Vice President of Patient Financial Services (PFS) at a large, complex health system marks a pivotal point in your career. With Epic as your unified EMR and revenue cycle platform, and with a centralized yet multi-entity structure spanning hospitals, clinics, and service lines, you are now positioned to drive enterprise-wide transformation. This guide outlines practical, operational strategies tailored to a newly promoted VP with deep domain expertise—and a mandate to make meaningful change.

1. Define a Unified Strategic Vision

Your first and most important responsibility is setting a clear and actionable vision for Patient Financial Services across the system. As VP, you now have the platform to unify previously siloed efforts across facilities. Begin by:

• Establishing measurable KPIs for cash collections, A/R days, denial rates, cost-to-collect, and patient satisfaction.

• Leading a Revenue Cycle Steering Committee to drive alignment between PFS, Finance, Clinical Operations, and IT.

• Rolling out a unified PFS performance scorecard across facilities, using Epic's reporting and analytics capabilities.

Example: Benefis Health System implemented a cross-functional revenue cycle committee that led to improvements in denials, cash flow, and A/R days by aligning disparate teams around shared goals.

2. Standardize and Simplify PFS Workflows

With multiple facilities likely operating under different historical norms, standardization is key. Use your seniority to:

• Unify front-end processes for registration, financial clearance, and point-of-service collections.

• Standardize back-end workflows, especially for billing, insurance follow-up, denial management, and refunds.

• Review central vs. decentralized functions—maximize the efficiency of your centralized business office (CBO) model while preserving local support for patient-facing services.

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Issue a PFS operations playbook detailing these standardized protocols. This should include:

• Copay/deductible collection scripts and thresholds.

• Insurance verification using Epic’s automated tools.

• Charge audit workflows and escalation paths.

• Common denial workflows and appeal processes.

• Consistent statement cadence and write-off guidelines.

Example: A multi-state Epic client used automation to standardize over 2,000 estimate templates and automate late charge rebills, improving estimate accuracy and operational efficiency.

3. Leverage Epic to Automate and Improve Workflows

You’re in a strong position with a fully implemented Epic system. Now is the time to move from stabilization to optimization. Key focus areas:

• Patient Estimates: Ensure estimates are generated at the time of scheduling for high-liability services. Train staff to use Epic’s estimate tools and educate patients on costs upfront.

• Eligibility and Coverage Checks: Mandate use of Epic’s real-time eligibility verification to prevent downstream denials.

• Denials Management: Expand use of Epic's denial module. Implement reason-specific workflows and automated workqueues to segment denials by type and assign by specialty.

• Automation Rules: Develop and enforce Epic automation logic for small balance write-offs, charity care screening, and payment plan approvals.

Examples:

• UCHealth automates 35,000 estimates/month using Epic.

• Henry Ford Health’s move to MyChart bill pay increased online payments by 20% and saved $1M/year.

• Yale New Haven automated remittance, prior auth, and denial routing, freeing FTEs for complex work.

4. Improve the Patient Financial Experience

Your oversight now includes not just financial performance but also patient satisfaction. Use this influence to:

• Expand self-service bill pay through MyChart, including guest pay options and consolidated statements.

• Deploy patient-friendly statement formats with clear language and explanations of benefits.

• Standardize financial counseling processes. Assign financial counselors or specialists to high-liability service lines and automate referrals through Epic.

• Offer multiple, flexible payment plan options, with Epic’s tools to automate eligibility and term setup.

• Implement a closed-loop feedback process: survey patients about billing experiences and incorporate insights into training and system updates.

Examples:

• Atrium Health used MyChart and text reminders to generate $19M in digital collections and save $182K in labor.

• Allegheny Health Network automated estimates and deployed Epic-integrated engagement tools to improve clarity and speed to payment.

5. Build a High-Performance Team Structure

You now lead a team of directors and site leaders. Clarify reporting lines and performance expectations by:

• Assigning site-specific KPIs to local leaders, aligned to system-level goals.

KPI	Metric Description
Net Collections	% of net revenue collected within period
Cash-to-Net Revenue Ratio	Cash posted ÷ net revenue
Denial Management	% of denials overturned by reason code
Front-End Collection	POS collections per encounter
Billing Accuracy	Clean claims rate on first submission
A/R Management	% of A/R aged > 90 days
Workqueue Productivity	% of Epic WQs completed within assigned time frames
Financial Assistance	% of charity cases approved within 10-day TAT
Refund Timeliness	Avg days to process overpayment refunds

• Implementing structured performance review cycles and scorecard reviews.

• Hosting monthly revenue cycle operations meetings across facilities to foster shared learning.

• Promoting cross-training and career pathing for PFS staff to increase retention and morale.

Example: Benefis unified clinic and hospital RCM teams under shared goals and dashboards, reducing write-offs and improving productivity.

6. Collaborate Across the Revenue Cycle Ecosystem

As VP, your success depends on partnerships. Drive alignment by:

• Collaborating with Patient Access to ensure complete and accurate data entry.

• Working closely with HIM and Coding teams to prevent billing delays and claim rejections.

• Partnering with Clinical and Operational leadership to address documentation and charge capture gaps.

• Engaging IT and reporting teams to develop custom dashboards and address system pain points.

Examples:

• An integrated effort at Yale New Haven brought together Epic, IT, and revenue cycle to streamline prior auth and denial handling.

• Joint Patient Access and PFS teams at several organizations improved pre-arrival workflows and check-in accuracy using Epic automation.

7. Advocate for Resources and Innovation

Now that you're in the C-suite orbit, use your voice to:

• Justify staffing expansions or role shifts using productivity and performance data.

• Make the case for Epic upgrades or new modules (e.g. machine learning denial prediction, chatbot billing support).

• Push for investment in patient engagement tools, including texting platforms, interactive voice, and self-scheduling.

• Align PFS improvements with broader organizational goals like equity, access, and community engagement.

Examples:

• Omega Healthcare clients achieved improved ROI by implementing UiPath RPA in revenue cycle.

• Nordic’s predictive Epic denial tools redirected manual effort and reduced avoidable denials.

• Cofactor’s denial suite cut appeal times by more than half and introduced new documentation initiatives, improving DRG downgrade overturn rates for a midwest hospital.

8. Foster a Culture of Continuous Improvement

Finally, your greatest long-term impact will come from cultivating a culture that owns and drives results. To do this:

• Establish internal benchmarks and celebrate top performers monthly.

• Create open forums or office hours where front-line staff can bring feedback.

• Conduct periodic deep-dives into persistent problem areas (e.g. authorization-related denials) and resolve them at root cause.

• Encourage experimentation: pilot small innovations before rolling out system-wide.

Example: Epic Galaxy community users report multi-million-dollar savings by using Epic tools like Revenue Guardian to reduce missed charges and unnecessary manual work.

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In Summary: As a newly promoted VP of PFS in a large Epic-based health system, you now have the tools, platform, and visibility to make transformative changes. Use your knowledge of the intricacies of revenue cycle operations to standardize workflows, align teams, and harness Epic’s full potential. By emphasizing collaboration, automation, patient experience, and operational discipline, you will lay the foundation for a stronger, smarter, and more patient-friendly financial services organization.