Guest: David Kelly, Chief of Ambulatory Operations & Vice President of Revenue Cycle, Mary Rutan Health
Host: Praveen Chandran
Introduction and Community Hospital Leadership Background
Praveen Chandran
You’re listening to The RC Executive Lounge podcast, the show where healthcare revenue leaders share real-world strategies, hard-earned lessons, and bold ideas shaping the future of revenue cycle.
Hi everyone, and welcome to the final episode of Season 1 of The RC Executive Lounge podcast series. I’m your host, Praveen, and I’m really glad you’re all here.
First, a heartfelt thank you to our audience for the overwhelming support throughout Season 1. Because of you, we’ll be back for Season 2 of The RC Executive Lounge in February 2026.
With that, I’m excited to welcome a guest whose experience spans operations, revenue cycle, managed care, physician relations, and strategic growth in a community hospital environment.
David Kelly serves as Chief of Ambulatory Operations and Vice President of Revenue Cycle at Mary Rutan Health in Bellefontaine, Ohio. In his role, David oversees both financial performance and operational efficiency across the ambulatory enterprise and medical groups, ensuring the organization maximizes revenue, controls costs, and delivers high-quality clinical and patient financial services.
David has been with Mary Rutan Health for more than seven years and brings eighteen years of healthcare experience, including over fourteen years in revenue cycle and acute care operations. His background spans patient access, HIM, physician relations, and technology platforms such as Epic and Meditech.
What I find especially compelling is David’s commitment to the independent mission of a community hospital, balancing modern operational strategies with long-term sustainability in a rapidly changing healthcare environment.
David, thank you so much for joining us and welcome to the lounge.
David Kelly
Thank you for having me, and for letting me close out Season 1. That’s very cool. I hope this is an episode people enjoy and that it helps bring them back for Season 2.
I also appreciate the kind introduction, even though hearing your own bio read back can feel a little awkward. I’m always humbled when people want to hear my perspective, and I hope there’s something useful here for your audience.
Strategic Priority Setting in Revenue Cycle and Ambulatory Operations
Praveen Chandran
RCM and finance teams face pressure from regulations, payer delays, and staffing gaps. How do you set strategic priorities for the next twelve months while also thinking three to five years ahead?
David Kelly
I’m in a somewhat unique position because I oversee both ambulatory operations and revenue cycle, and I sit at the executive level reporting directly to the CEO.
That’s a blessing because many revenue cycle leaders don’t have a seat in enterprise strategy conversations. I’m able to weigh in directly from a revenue cycle perspective when broader organizational priorities are discussed.
Looking ahead to 2026, one of our biggest priorities is patient engagement. Trust between hospitals and patients has eroded since the pandemic, and we need to earn that trust back.
We’re asking questions like how we better educate patients on deductibles, copays, and coinsurance. Earlier this year, our CEO asked how we could do more for patients and increase charity care support. We’ve spent the year evaluating peer approaches, and we’ll be implementing several changes in 2026.
Revenue cycle teams understand this deeply, but sometimes others don’t. The patient experience begins and ends with revenue cycle, from scheduling to a zero balance. We’re the bookends of the patient journey.
Financial sustainability is also critical, especially for a community hospital. Retaining independence isn’t about pure cost reduction or chasing upside revenue. It’s about balance and yield, finding the right equilibrium between cost and performance.
Patient Engagement, Denial Prevention, and Eligibility Accuracy
Praveen Chandran
Where do denial prevention, patient financing, and financial assistance fit into your priorities?
David Kelly
In 2026, financial counseling and patient financing are very high priorities for us. We’re reviewing our patient statements to ensure they’re as clear and understandable as possible.
On denial prevention, I think the most important revenue cycle transaction has shifted. Fifteen years ago, it was claim submission. Today, it’s eligibility.
If insurance is wrong at scheduling or registration, everything downstream breaks. Authorizations, estimates, patient responsibility, all of it.
We’ve invested heavily in registration quality assurance, training, and onboarding. Even at our size, we have dedicated trainers. Based on feedback from operational leaders, we’re revitalizing that program next year.
Eligibility accuracy ties directly to denial prevention, patient engagement, and patient dollars. It’s foundational.
Making Tradeoffs Under Resource Constraints
Praveen Chandran
Can you share an example of a good initiative you had to pause due to limited resources?
David Kelly
One example involved patient billing simplification. We outsource anesthesia billing, which meant patients could receive multiple statements from different entities.
We explored combining post-insurance balances into a unified statement for a better patient experience. It would have been impactful, but we didn’t have the resources at the time.
That said, good ideas rarely disappear. They get moved to a back burner. As we finalize planning for 2026, this is something we may revisit.
Zero Balance Review and Recovering Found Revenue
Praveen Chandran
Tell us about a recent initiative you did move forward with.
David Kelly
Earlier this year, we launched a zero-balance review program with a specialized vendor. It’s not a new concept, but resource constraints had prevented us from prioritizing it internally.
The vendor was able to go much further back chronologically than our team ever could. We’ve recovered payments on accounts dating back six years.
For a community hospital, even mid-six-figure recoveries are meaningful. This program has been a real win.
Vendor Selection and Implementation Lessons
Praveen Chandran
How did you select the vendor, and were there any surprises during implementation?
David Kelly
We use an outsourced vendor management office to run RFPs and manage contracting. They help us assess the vendor landscape and handle the selection process, though the final decision is ours.
Implementation was smooth overall. One ongoing challenge is ensuring clean documentation flows back into our EMR so vendors don’t overlap work on the same accounts. That’s still being refined, but it hasn’t overshadowed the success of the program.
Measuring Revenue Cycle Success and Yield
Praveen Chandran
How do you measure success for initiatives like this?
David Kelly
We meet with the vendor monthly and review dollars in flight, closed accounts, and actual payments received. Ultimately, success is measured in cash collected.
They only get paid if we get paid, which aligns incentives. For us, it’s found money, and the yield has been strong.
The Role of AI and Automation in a Touchless Revenue Cycle
Praveen Chandran
What role do you see AI and agentic automation playing in revenue cycle over the next few years?
David Kelly
I’ve learned to be cautious with AI timelines. Years ago, I thought we’d have a fully touchless revenue cycle by now, and that hasn’t happened.
That said, automation is mandatory given labor shortages. Even automating 80 or 90 percent of work can dramatically improve performance.
The challenge is separating hype from reality. We’re currently a development partner with an AI company focused on payer takebacks, but we entered that cautiously, with extended timelines and strong compliance oversight.
You can’t sit on the sidelines, but you also can’t believe every promise.
Transformational AI Use Cases and Future Technologies
Praveen Chandran
Are there areas where AI could deliver truly transformational impact?
David Kelly
Outbound payer calls. If AI agents can handle routine benefit verification calls, that frees people for higher-value, patient-facing work.
Ambient documentation for providers is another area with huge potential. Documentation burden is one of the biggest pain points in healthcare.
Longer term, we need more portable medical records. Whether it’s interoperability or something else, patients should be able to access care seamlessly across locations.
Leadership, Change Management, and Trust
Praveen Chandran
How do you build momentum for change in such a fast-paced environment?
David Kelly
It starts with connecting teams to patients, purpose, and independence. Revenue cycle teams can feel disconnected from patient care, so it’s important to reinforce how their work supports the mission.
Transparency is central to my leadership style. That doesn’t mean oversharing, but it does mean explaining the why, sharing frustrations appropriately, and following through on commitments.
Trust is a currency. You either build it or spend it. When you need support for a difficult initiative, having trust in the bank makes all the difference.
Closing Reflections and Leadership Advice
Praveen Chandran
Any final advice for fellow RCM leaders?
David Kelly
Be intentional about how you lead. Whether it’s transparency or another principle, it has to be genuine.
And remember, so much of our stress is tied to choices we’ve made. That perspective has helped me manage the challenges of leadership and stay grounded.
Praveen Chandran
David, thank you for sharing such thoughtful insights and for closing out Season 1 with us.
David Kelly
Thank you. I really appreciate it.
