Sandra Gubbine shares how revenue cycle leaders should set priorities in a healthcare environment that is constantly shifting. She explains why sustainable process design and disciplined resourcing matter more than reactive “firefighting,” and why saying no is often the highest-leverage decision, especially during major revenue cycle system transitions.
The conversation explores where patient financing and financial assistance programs fit into the RCM roadmap, including the reality of medical debt constraints and the importance of partnering with patients through payment plans and charity care pathways. Sandra also reframes “denials” as a broader set of payer behaviors, including record requests, payment delays, and DRG downgrades that can quietly create millions in revenue leakage.
Sandra then walks through a digital initiative to reach uninsured and underserved populations, with lessons on vendor partnership, due diligence, and implementation discipline. She closes with a practical view of agentic AI in revenue cycle, using it to prioritize work for follow-up teams and proactively guide patients into Medicaid or financial assistance, and a leadership principle that compounds, self-reflection as the foundation for trust and change.
Sandra Gubbine shares how revenue cycle leaders should set priorities in a healthcare environment that is constantly shifting. She explains why sustainable process design and disciplined resourcing matter more than reactive “firefighting,” and why saying no is often the highest-leverage decision, especially during major revenue cycle system transitions.
The conversation explores where patient financing and financial assistance programs fit into the RCM roadmap, including the reality of medical debt constraints and the importance of partnering with patients through payment plans and charity care pathways. Sandra also reframes “denials” as a broader set of payer behaviors, including record requests, payment delays, and DRG downgrades that can quietly create millions in revenue leakage.
Sandra then walks through a digital initiative to reach uninsured and underserved populations, with lessons on vendor partnership, due diligence, and implementation discipline. She closes with a practical view of agentic AI in revenue cycle, using it to prioritize work for follow-up teams and proactively guide patients into Medicaid or financial assistance, and a leadership principle that compounds, self-reflection as the foundation for trust and change.
“You can have all the technology in the world, but if you don’t bring your people along, you’ll never get the change done.”
— Sandra Gubbine, Vice President of Revenue Cycle, AtlantiCare
Guest: Sandra Gubbine, Vice President of Revenue Cycle, AtlantiCare
Host: Praveen Chandran
Praveen Chandran
Hi everyone, and welcome to another episode of the RC Executive Lounge podcast series. I’m your host, Praveen, and I’m thrilled you’re all here today.
Today’s guest is someone I’ve been looking forward to speaking with for quite some time. We welcome Sandra Gubbine, a highly respected and visionary leader in the revenue cycle industry.
Sandra has held various positions in revenue cycle leadership, up to and including Assistant Vice President. In her 30-year career in healthcare, she has overseen up to 300 professionals across patient access, medical audits, utilization review, financial counseling, and full revenue cycle operations.
She is also an adjunct professor at Rowan University and a Rowan MBA alumna, demonstrating a strong commitment to both education and operational excellence. Sandra has earned her CPA, is a Fellow of the Healthcare Financial Management Association, and has also earned a doctorate in business administration.
Under her leadership, one of her revenue cycle teams earned the HFMA MAP awards four times, highlighting her skill in driving performance and innovation.
Sandra, welcome to the show, and thank you so much for joining us today.
Sandra Gubbine
You’re welcome. Thank you.
Praveen Chandran
Fantastic. Let’s dive in. With so many pressures on finance and RCM teams today in healthcare, from payer delays to staffing gaps, how do you go about setting your top strategic priorities for the organization, looking three years ahead as well as the next year?
Sandra Gubbine
I think the thing that we always have to keep in mind is that healthcare is ever-changing. You always have to be prepared for that. Looking forward three or five years is getting harder because the landscape is so dynamic.
The best thing you can do is invest in the right people and the right processes. When we put things together to improve revenue cycle collections and processes, you need to be looking at what you’re putting in place and whether it can handle the long term.
If you’re just reacting, you can’t be in that reaction mode. It’s very easy to get stuck there in healthcare. If you stay in reaction mode, you never really move forward, and you just keep putting out fires like a firefighter.
The best approach is to strategically look forward and ask what is sustainable. If we implement these processes, can we sustain them into the future? Are we using our people’s skills at the top of their capability?
I don’t need people stamping paper all day. That’s not a talent I need. It’s really about looking at what resources we have, best utilizing them, and continually pushing them to grow, alongside processes that will carry us forward long term.
Praveen Chandran
As you think about priorities, every organization has to make tough choices. Can you share an example where you had to say no to a good initiative in favor of something more critical?
Sandra Gubbine
Right now, I’m working on a huge project upgrading our revenue cycle systems at the healthcare system I’m with. I recently had to tell someone no when they wanted something done in our old system that we’re replacing in 18 months.
They said, “If I have it now, it’ll work.” And I said, “I’m sorry, the answer is no.” Not just because we’re sunsetting the system, but because the talent and skills I need must be focused on our future system.
Yes, it might help short term, but it won’t give me long-term value. I need to focus on what’s new, not what’s ending. I had a second request come through that faced the same issue.
You also have to ask, is this a new problem? In this case, it wasn’t. It had been around for five years. So it can stay, and we’ll bridge the gaps until we move to the new technology.
It’s not easy because people don’t like hearing no. But resources are limited everywhere. You have to decide what’s more important, driving the organization forward, or getting a quick win.
Praveen Chandran
At events like HFMA or MGMA, we hear a lot about patient financing and denial prevention. Where do these fit into your strategic roadmap?
Sandra Gubbine
We’ve gotten into patient financing, especially in the acute care hospital environment. Patients face large deductibles and need surgeries, sometimes requiring thousands upfront.
We work with companies to support that and also accept CareCredit, which is common, so patients can get zero-percent financing. With the economy and laws, especially in New Jersey, where medical debt laws are strict, you really want to partner with the patient.
Payment plans and interest-free options are critical. I’m also in a state with a rigorous charity care program, so we try to help people in every way possible.
Denials are never-ending, but we’ve found in the last three years that it’s not just denials. Payers have increased medical record requests threefold before paying. It’s a delay tactic.
If we don’t send records, we don’t get paid. Then there are DRG downgrades. At first, people thought a few thousand here or there didn’t matter. But when it happens hundreds of times, it turns into millions.
If you’re only focused on denials, you’re losing a lot of money. Payment delays, record requests, and reductions all matter.
Praveen Chandran
Let’s talk about a recent initiative you led to expand access. What challenge were you solving?
Sandra Gubbine
We launched an initiative focused on our underserved and uninsured populations. We implemented software to reach more of these patients.
It was hard because we were taking away paper and moving to electronic workflows. Staff thought it was the latest thing that would go away. One mistake we made was calling it a pilot.
That signaled it wasn’t permanent, so we didn’t get buy-in. We also underinvested in some capabilities, thinking we’d handle them manually. Those were mistakes.
If you believe in a project, you need to go all in. We would have seen improvements at least 12 months sooner if we had fully committed.
Praveen Chandran
How did you go about selecting a partner for this initiative?
Sandra Gubbine
We found a startup company, and they found us. We had never used technology in this area before. Traditionally, patients would just come see a financial counselor when they could.
We had to challenge the partner. What they wanted to do and what we needed weren’t perfectly aligned. The right partner listens and welcomes being challenged so both sides can be better.
Praveen Chandran
What were some implementation lessons from a technology perspective?
Sandra Gubbine
You really need to do due diligence. Understand how it affects staff, technology, processes, and patients.
Our biggest pitfall was not pulling staff in early enough. You can have all the technology in the world, but if you don’t have the right people, it won’t work. It’s 20% technology and 80% people.
Even small implementations can fail if you don’t bring everyone along.
Praveen Chandran
What measurable impact have you seen, and how do you track success?
Sandra Gubbine
Before, we had no metrics because everything was paper-based. Once we implemented technology, we realized our targets were way too low.
Staff could handle three times as many Medicaid applications and financial assistance cases. We now reach nearly 100% of eligible patients, compared to about 10% before.
We see increased Medicaid dollars and better patient outcomes. That’s the biggest success.
Praveen Chandran
What role do you see agentic AI playing in revenue cycle?
Sandra Gubbine
It’s very exciting. It puts the right information in front of the right people at the right time.
Instead of staff spending an hour organizing work, AI prioritizes accounts based on payer behavior and urgency. It lets people work at the top of their skill set.
I started 30 years ago with paper piles. Now technology tells you exactly what to focus on. That’s powerful.
We’re also using AI to reach patients. Within 24 hours, it can text uninsured patients, ask questions, and guide them to Medicaid or financial assistance.
That used to take phone calls and manual interviews. Now it scales and reaches everyone.
Praveen Chandran
Are there other technologies you’re watching closely?
Sandra Gubbine
Healthcare RCM has struggled with old technology. We’re looking at tools to create cleaner claims and involve clinicians in revenue cycle outcomes.
Clinicians want to help, they just don’t always know how. Revenue cycle includes the entire organization, not just the business office.
Praveen Chandran
What metric do you obsess over?
Sandra Gubbine
Cash. If I don’t collect cash, revenue doesn’t matter. Cash is the truth.
Praveen Chandran
How do you build momentum for change?
Sandra Gubbine
It’s about communication and involvement. Change is hard. You have to help people out of their comfort zones.
If you don’t work with people, you’ll blame technology when it fails. You need trust.
Praveen Chandran
What’s one piece of advice you’d give to another RCM leader or CFO?
Sandra Gubbine
Learn to self-reflect. Learn to see how other people see you.
If I don’t self-reflect, I can’t build trust. That applies at every level, in every industry.
Praveen Chandran
Sandra, thank you so much for joining us today. I know our audience will walk away with practical insights and a lot to think about.
Sandra Gubbine
Thank you so much for having me.