What happens when automation stops being about speed and starts being about intelligence?

That’s the question Stuart Newsome, Infinx VP of RCM Insights, posed in a recent Office Hours session, outlining six major shifts that are reshaping how healthcare organizations approach revenue cycle management (RCM). These aren’t theoretical trends—they’re active transformations driven by the emergence of AI agents as trusted digital teammates.

Here’s a look at what’s changing—and why it matters.

1. From Automation to Intelligence

For years, automation in RCM meant bots that performed tasks like checking claim statuses or logging into payer portals. Helpful, but limited.

Now, organizations are asking bigger questions: Can this system make decisions? Can it prioritize? Can it route claims based on payer behavior?

That’s where AI agents come in. Unlike traditional scripts, they understand context, adapt over time, and pursue outcomes—not just complete steps. The real value? AI agents don’t just make work faster; they make it smarter.

2. Coverage Validation Is Now Clinical

Insurance checks used to be administrative afterthoughts. But in 2025, delays in verification or prior authorizations can derail patient care—leading to canceled MRIs or rescheduled surgeries.

AI agents now play a front-line role in ensuring care moves forward. They can validate coverage, launch prior auths, catch mismatched diagnosis codes, and flag issues before they interrupt clinical workflows.

The shift? Coverage validation is no longer just paperwork—it’s part of patient care.

3. From Fragmentation to Integration

Over the years, RCM systems evolved into patchwork solutions. One tool for prior auths, another for denials, a third for analytics. The result? Disconnected workflows and costly gaps.

Organizations are moving toward platform consolidation—and where rip-and-replace isn’t feasible, AI agents act as bridges. They monitor for mismatches, route tasks between systems, and surface the right data at the right time.

This isn’t just about fewer logins. It’s about reclaiming clarity in a complex ecosystem.

4. Cybersecurity as Operational Continuity

February 2024 marked a turning point when a [major cyberattack](https://www.aha.org/change-healthcare-cyberattack-underscores-urgent-need-strengthen-cyber-preparedness-individual-health-care-organizations-and) halted thousands of providers overnight. In that moment, cybersecurity went from IT concern to RCM crisis.

Today, AI agents are part of the defense strategy. They detect anomalies in claims activity, log every action, and alert teams when something breaks—even before human eyes catch it.

Security isn’t just about protecting data anymore. It’s about keeping cash flowing and operations running.

5. ROI Must Be Proven, Not Promised

Vague promises of cost savings or streamlined workflows no longer cut it. Leaders want answers: How much did we collect? How many denials did we avoid? What did this tool actually deliver?

Modern AI agents are built for transparency. They log every task, map actions to outcomes, and generate clear dashboards. No need to guess. No need for a separate committee to track ROI.

If a tool can’t prove its value in 90 days, it may not be worth keeping.

6. Rethinking the Workforce Model

We’re not going back to 2018 staffing levels. The old model—more patients = more billing staff—is no longer sustainable.

What’s emerging is a blended workforce: people and agents working together. Staff members handle edge cases, escalations, and judgment-based work, while AI agents take care of routine, rules-based tasks.

The best organizations aren’t using agents to replace people—they’re using them to elevate people. That’s not just a staffing strategy. It’s a cultural one.

Final Thought

These six shifts signal more than a technical evolution. They represent a new mindset in revenue cycle leadership—one that values intelligence, integration, accountability, and human-centered design.

AI agents aren’t here to replace your team. They’re here to scale their expertise, reduce burnout, and help you focus on the work that truly moves the needle.

Want to dive deeper? Watch the full Office Hours episode: Six Shifts Shaping RCM Influenced by AI Agents