METHOD / DOMAIN FIRST GOAL / RELIABLE AI BEHAVIOR

RCM Brain First. Agent Second.

Before I ask an AI system to perform revenue-cycle work, I want to know what a competent specialist should actually do.

What information matters? What decision has to be made? What evidence supports it? What changes when the case stops following the happy path?

Once that is clear, the system has something real to inherit.

Automation should inherit expertise.

The goal is not to take a messy human workflow and make it happen faster.

The goal is to understand the judgment underneath the workflow, preserve the parts that matter, automate what can be automated, and create a reliable path for everything else.

Fast wrong answers are still wrong answers.

Six steps. One feedback loop.

I treat AI workflow development less like writing instructions once and more like building an operational system that gets tested, challenged, and refined.

01

INVESTIGATE

Understand the work before touching the automation.

Start with the operational problem as it actually exists, not the simplified version of it.

  • What happened?
  • What has already been attempted?
  • What evidence is available?
  • What payer, account, or workflow state are we in?
  • What outcome are we actually trying to reach?
02

DEFINE

Decide what competent work should look like.

Before evaluating a model, define the standard it is being evaluated against.

  • Correct conclusion
  • Required evidence
  • Appropriate next action
  • Escalation criteria
  • Definition of “done”
03

TRANSLATE

Turn specialist judgment into something a system can use.

Specialists make dozens of small decisions that often never appear in formal documentation. Those decisions have to become visible before they can become scalable.

  • Workflow logic
  • Decision points
  • Examples
  • Exceptions
  • Human handoffs
05

VALIDATE

Check the result, not just the action.

An agent can execute every documented step and still fail the actual operational objective.

  • Was the conclusion supported?
  • Was the right action taken?
  • Did the action succeed?
  • Did the account state change as expected?
  • Is the problem actually closer to resolution?
06

LEARN

Turn failure into system intelligence.

A bad output is useful if it teaches you something about the workflow, evaluation standard, available evidence, or system behavior.

  • Document the failure
  • Identify the failure mode
  • Find the underlying gap
  • Refine the workflow or evaluation
  • Test again

The workflow ends.
The learning loop doesn’t.

Every failure, escalation, exception, and unexpected result is information about how the system understands the work.

01 Specialist judgment
↓
02 Agent behavior
↓
03 Observed result
↓
04 Failure + feedback
↺
refine the system and run it again

A few things I’m pretty stubborn about.

01

Plausible is not the same as correct.

A fluent answer can still rely on unsupported assumptions, incomplete evidence, or the wrong operational interpretation.

02

“Done” is not the same as resolved.

Task completion matters only if the underlying revenue-cycle problem actually moved toward the intended outcome.

03

Edge cases are not noise.

They expose assumptions, brittle logic, missing context, and places where the workflow understands less than we thought.

04

Uncertainty is a valid output.

If the evidence is insufficient, the right answer may be “I don’t know yet.” A safe system has to know when to stop guessing.

05

Human review should have a reason.

“Human in the loop” should not mean a specialist silently fixes everything the automation could not handle. Escalation should be intentional, observable, and useful.

I’m not looking for an agent that never fails.

I’m looking for a system whose failures are understandable, detectable, and useful.

01

It uses the evidence it actually has.

02

It knows when the evidence is not enough.

03

It takes actions that match the current operational state.

04

It escalates situations it should not resolve alone.

05

Its mistakes can teach us how to make the next version better.

Enough methodology.
Show me the work.

See how these ideas show up in agent development, evaluation, QA, and real revenue-cycle workflows.

View case studies