GetixHealth Podcast

Insights from a Revenue Cycle VP: Establishing Operations at a New Organization

Alex Oey · August 17, 2026

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Transcript — follow along with the video

Elizabeth Allen(0:11) Thanks, Amanda, for joining us today, and we're going to just kind of talk through your last year and a half with ValleyWise. (0:19) I know it's been a lot of work, and I know you have made significant impact in your short time that you've been there, so I appreciate your time today. (0:29) To give a little background, why don't you introduce yourself and tell us where you've come from and what your position is at valleywise.
Amanda De Los Reyes(0:36) Sure. (0:37) Well, thank you for having me today. (0:39) I've been at ValleyWise as the VP of Revenue Cycle for the last 18 months or so, and I have responsibility for end-to-end revenue cycle, including scheduling.(0:49) Prior to that, I was at Legacy Health for 21 years, and the last about 12, I was in revenue cycle. (0:54) When I left Legacy, I was the Senior Director of Revenue Cycle and had responsibility for about 600 FTEs, and my new role, it's about 400, so a little bit less, but a lot more complex of a system, so it's been great. (1:11) Legacy is a community-based system, and ValleyWise is a safety net hospital.(1:15) However, we also have the Arizona Burn Center and FQHCs, and we're a level one trauma center, so a lot of moving parts there, but it's been a really great experience.
Elizabeth Allen(1:25) And you just recently moved into a new hospital, which we'll talk a little bit about that as we (1:30) talk through our discussion today, but just wanted to get kind of an idea, as you came (1:37) from a system which was a similar size but different policies, different culture, and (1:44) coming into this new role and kind of standing up and identifying your priorities and your (1:51) strategies, kind of talk through when you first came into ValleyWise, how did you look (1:58) at the priorities?(1:59) How did you align your leaders in your different departments and kind of bring them into the fold on the different goals that you kind of were setting for yourself? (2:09) And I'm sure they changed as they went, as you learned, but kind of talk us through a little bit about that.
Amanda De Los Reyes(2:13) So the first thing I did was meet with everybody kind of without any preconceived notions on anything and looked at kind of where the metrics were, and then, of course, talked with Claire, my boss, the CFO at ValleyWise, to find out what some of her priorities were. (2:29) And she had been managing the revenue cycle herself mostly because there was a gap in time from when the previous leader left and when I was hired. (2:39) And so she had a lot of insight that was very valuable that I wouldn't have otherwise had, which is really helpful when your boss knows exactly what they want you to start working on from the beginning.(2:50) But I think it was really just getting to know everybody, kind of seeing what the baseline was and hearing from them, but not making any decisions like immediately, just really trying to understand and make sure that I was asking questions about why things were the way that they were or why things were set up the way they were because there were sometimes some very good reasons for it. (3:12) And so that part for me was really helpful just to have a really good baseline understanding of kind of what the state of affairs were and moving there. (3:21) But to start with the prioritization, one of them was to speed up our cash and reduce our AR days.(3:29) So really started diving in and looking at some of what was the baseline, where might there be some gaps or what can we do to take some action that way. (3:38) And so I had to start with after our initial meetings, I met with each of the directors for an hour every week, sometimes more, in addition to all of our other standing meetings. (3:48) And that was really just to make sure that we were staying connected and I was getting as much information as I possibly could to kind of understand where everything was currently at in current state(3:58) So some of those things have changed and I'm meeting with some directors more than others. (4:04) I also did not have a patient access director when I first started. (4:08) And so luckily for me, patient access is the area of revenue cycle that I know the best probably.(4:16) And so that was very helpful. (4:19) So I actually sat in the patient access department and just got to know the team really well and understand their processes and that type of thing. (4:28) And then began recruitment for a patient access director(4:31) And it took quite some time, about six months. (4:35) You know, finding a great patient access leader is very difficult, especially a lot of people want to work from home now. (4:42) And so that was a challenge, but I wanted to get someone that was a good fit(4:45) and so we actually had to do two different tries, two different kind of separate rounds of interviews, because the first one, we just didn't find anyone that we thought would be a good fit, that had the right experience. (4:58) And I needed to have somebody who had Epic experience, because there were some things we need to work on within Epic to get back to kind of foundation. (5:06) So I'm very happy I held out and hired byron simmons.(5:11) And he's been amazing. (5:13) And he's been there for, well, I'd say about nine months now. (5:17) And so the impact that he's made in that time has been tremendous.(5:20) So a lot of my time at the beginning was focused on patient access, because I had directors in the other roles. (5:27) So that was a challenge.
Elizabeth Allen(5:28) People underestimate, no, I shouldn't, people underestimate. (5:31) I think there is such an importance in having that front end set up with all the right processes when you are obviously focused on the back end, but going there first and making that a priority. (5:47) And I guess it just fell into that kind of priority, because there was a need.(5:51) But just starting there, I mean, that impact probably was significant, or you saw some of the significant impacts of that on the back end, which I think is great. (6:03) Now, with that, that's obviously a big first step that you were putting into place. (6:10) Now, seeing where, bringing people in that are qualified, understanding the processes (6:15) and where some of the areas that you needed to kind of bolster up with Epic, what other (6:20) challenges were you kind of facing as you kind of peeled back the onion, looked behind (6:26) the hood or looked under the hood, I guess, so to speak, and how, talk us through, I think (6:31) as everyone out there, whether they've been there for a year and a half or they've been (6:35) there for five years, you're constantly faced with different challenges that are coming (6:39) up.(6:39) So kind of talk us through how you saw some of those challenges and what you put in place Yeah, I mean, I think you're absolutely right.
Amanda De Los Reyes(6:47) The front end is kind of where it all starts. (6:50) And, you know, if you get everything right from the very beginning, you know, it's more money in the door quicker, less denials and everything. (6:57) And just the first thing we did was really look at processes and not to say that it's perfect.(7:01) We still have some opportunities, but just kind of looking at what some of the major things are. (7:06) But at the same time, I was really monitoring our AR and it came down significantly. (7:14) But that was another area of opportunity, really diving in and looking at the processes.(7:19) And we do have some unique complex processes just because of our payer mix and who some of our payers are that you wouldn't necessarily work with in a traditional health system. (7:30) So we do have a significant behavioral health population. (7:34) And the way that those are, those accounts are built is a lot different than just a regular commercial acute care account.(7:41) And we do have a really high mix of Medicaid. (7:45) And so some accounts have, you know, we'll have two different payers for different parts of the claim. (7:49) And so just working through some of those issues, but also looking really at our denials and what our opportunities are as far as the denials.(7:57) So my second kind of focus area was definitely on the patient financial services department. (8:01) So from the, you know, pre-billing collections and those types of things and where the opportunities were and honestly putting some pressure on some of the payers that had not really been swift to take any action before. (8:15) And there were things that were tolerated that shouldn't have been tolerated as far as their speed to pay us and things like that.(8:22) And just looking at sometimes we were getting denials that were billed correctly and there shouldn't have been a denial and really getting some focus on some of those things because it was taking our teams a lot of work to be able to appeal those denials and that type of thing. (8:35) So that is still a really big area of focus for us and continues to be. (8:42) And I have a new director in that area who is amazing.(8:46) And I got really lucky because Vanessa is, I knew her through HFMA, but I had no idea that she was looking because she had been with Kaiser for such a long time. (8:56) So I just didn't know that she was looking. (8:58) And so the second that I saw her resume come through, I was like, oh my gosh, I called her immediately and said, I didn't know you were looking(9:06) You're amazing. (9:06) And she's actually our regional exec right now for region 11. (9:09) So I knew her from that.(9:12) But Kaiser is an Epic shop. (9:13) So she knew Epic really well, which is going to be huge for us because there are some things that aren't built to foundation and that type of thing. (9:21) And so she knows those processes really well.(9:24) And she's only been with us since the end of January. (9:26) So there's still a lot of opportunity we're working through. (9:29) But I feel like now I kind of have my dream team.(9:34) My coding team is very high performing. (9:37) And my leader there has been with the organization for over 12 years and is very knowledgeable and well-respected in the community. (9:45) He's an advocate for education and very thoughtful.(9:49) And so that's not really an area that I need to focus on, very low coding denials and things like that. (9:57) And he has a very well-versed leadership team as well that's very strong. (10:02) So I think, you know, and he has a CDI under him as well.(10:06) The other area that's a little bit interesting for me is the patient assistance center, better known as our PAC. (10:13) So it's a call center. (10:15) And we schedule all of the appointments for the system, including all of our FQHCs.(10:21) So it's not uncommon for us to get over 5,000 calls on a Monday. (10:24) In fact, recently, there's been a few times that we've been really close to 6,000 calls. (10:29) So it's a high volume.(10:31) And we also have a referral center there. (10:33) So they process referrals and that type of thing. (10:36) And it runs really well.(10:37) Our biggest challenges there are working with the providers and making sure that their time isn't blocked for specific types of appointments so that we can get patients in. (10:47) And so we're doing a lot of work in that area that's been really helpful. (10:51) But there's still some opportunity there.(10:53) And that's going to be one of our goals, strategic goals for this next year. (10:58) And Claire's leading that work. (10:59) So that'll be fantastic.(11:00) So we're really looking forward to diving into that a little bit more. (11:05) But that's good. (11:06) And then my other area with the charge master and revenue integrity, my director, Siobhan, you know, has been there for 42 years.(11:16) She's like a wealth of knowledge. (11:17) I mean, she's incredible.
Elizabeth Allen(11:19) yes.
Amanda De Los Reyes(11:20) Literally a gem. (11:21) She's fantastic and knows everything about everything. (11:24) And what's been helpful to me is she's been like my right hand a lot of the time because she knows how everything kind of functioned before I got there and why things are the way they are.(11:34) But her team is just fantastic. (11:36) And so there's really not a lot for me to focus on there. (11:39) So my work is kind of focused on the other three areas still, patient access, PFS, and the PACS.(11:46) So those are kind of what my new priorities are, if you will.
Elizabeth Allen(11:50) Well, good. (11:50) So one thing that you touched on that is different, and I know with being in a county hospital and seeing the different payer mix of different, it's just different payers where you can have Medicaid with commercial or, you know, however you have to deal with the payers. (12:04) How are you or who are you using within your organization in addressing some of those?(12:13) I know you touched on it. (12:14) I heard a little bit of it where you're like, there's some payer, you know, behaviors, I guess, I mean, everyone has, but it's such a hot topic. (12:23) So kind of give us some tips or ideas or thoughts around how you're addressing it within your area.
Amanda De Los Reyes(12:32) Yeah. (12:32) So I think for the payers, it's really working with the team to have the metrics so that (12:37) we know, you know, what their average speed to pay is and some of those things, tracking (12:41) their denials and determining, you know, if there's maybe anything invalid or a lot of (12:47) times when they send over the denial codes, you can't really tell what they're actually (12:50) denying because there's not anything that's standard.(12:53) It's funny to me that we have to go on a standard form, but they don't have to send standard denial. (12:58) So working through some of those things, but really working with the leaders to work with their teams to start identifying trends earlier so that they are escalating those. (13:07) You know, I found that a lot of people had some really good insight, but they just weren't sharing and the leader may not have been asking and assume they would be sharing, but they weren't.(13:16) And so really talking even to the frontline staff about if you see something or you see a theme, you know, make sure that you escalate those. (13:23) And then so we have the joint operation calls or jocks with the payers and making sure that we always have good attendance at those and that we have an agenda set in advance so they know what we are wanting to look at. (13:35) And that a lot of times I run into where they want to cancel the meetings, the payers want (13:39) to cancel and really holding them accountable and making sure that we keep all of those (13:44) meetings is really helpful and often leads to better resolution because if you really (13:50) don't have anything to talk about, you can cancel the meeting and that's what they want (13:53) to do so they are better off to resolve my issues. (13:57) But I think just really that's what we've been focusing on is making sure that the team is escalating their concerns.
Elizabeth Allen(14:04) Shared information, identifying trends and then the communication with the payers and sounds like it's been kind of a process for you guys. (14:13) So I know we only have a few more minutes, but just wanted to kind of get your feeling. (14:19) You basically are standing up your operations a little bit when you're bringing in new people.(14:25) You've got the existing culture, you're leveraging obviously the knowledge of your, you know, people that have been seasoned and been there for a long time. (14:33) Kind of what in your mind, what would you say is your success so far and what would you say has been something you're pivoting on after a kind of a look back and maybe expectation? (14:49) Like, oh, I thought I would be doing this, but now we're going to be doing this.(14:51) And it sounds like Epic is a little bit in that area, which you don't really know until you know, but kind of talk through a few of the successes that you feel like you've made and kind of where some expectations changed, you know, mid-process as you sit here today.
Amanda De Los Reyes(15:08) Yeah, I think probably the biggest success was just setting up a dream team of revenue cycle leaders because that's how we're going to move forward and get things done. (15:17) And I think we're just now in a steady state and I admire all five of the directors and I think they're all very strong leaders and they're well-respected by their teams, which really helps. (15:29) And so I think that's the biggest success.(15:30) I think the other thing is the cashflow improvement, just making a few tweaks here and there on some processes and really helping the team understand some of those things and pushing forward. (15:42) I think that's probably the other thing. (15:44) There's still a lot of opportunity, but I think the one thing where we're kind of pivoting is we're still focused on cash collections.(15:52) But now that we've opened our new tower a couple of weeks ago, we have some more IT resources and so we're going to be doing an Epic refuel. (16:00) And so Valleywise has been on Epic since 2012, but the leadership at the time really liked the previous system, which was McKesson Star. (16:10) And so they currently call it Son of Star because they tried to build it like Epic, like Star.(16:16) And that's not how Epic functions, but they just didn't know any better. (16:19) And the IT team is amazing at Valleywise and they can basically, you know, they'll say, well, you can do whatever you want. (16:25) Where I think other IT teams that I've worked with in the past have said, you know, no, that's not foundation.(16:31) You know, this is what could be the outcome. (16:33) They were trying to be overly helpful. (16:35) And so we really need to kind of get back to foundation and go through Epic's checkbook and do that.(16:41) And I actually had the opportunity to do that as well right before I left Legacy. (16:45) So I'm really looking forward to doing it at Valleywise because I know the value that it can bring. (16:50) So we're hoping to kick that off within the next couple of months and it will be at least a year project and it's very intensive.(16:58) So, you know, some of our IT resources, that will be their full-time job for quite some time. (17:03) And we have to, on the operational side, have to be able to dedicate that time too, because if you don't, I've been part of refuels in the past where the leaders just weren't aligned and didn't spend the right amount of time and they just couldn't get things off the ground in other areas. (17:19) So with the revenue cycle, refuel is what we're going to be focusing on.(17:23) And so I'm really excited about that. (17:24) I think that will be a major success for us.
Elizabeth Allen(17:28) Oh gosh, I can't wait to hear more about it. (17:30) All right. (17:31) Well, thank you for your time today.(17:32) And we'll check back this time next year and see how it's all going.
Amanda De Los Reyes(17:36) Appreciate your time. (17:37) Thank you.

Executive summary

In this insightful discussion, Amanda, the Vice President of Revenue Cycle at ValleyWise Health, shares her experience leading revenue cycle operations over the past 18 months at a new organization. She highlights how she prioritized key initiatives, built a strong leadership team, improved cash flow, and navigated challenges posed by a complex payer mix. Amanda also emphasizes the importance of holding payers accountable, identifying denial trends, and maintaining open communication. Looking ahead, she expresses excitement about upcoming projects, including an Epic refuel, aimed at further optimizing their revenue cycle processes.

Key takeaways

Prioritizing front - end revenue cycle processes for maximum impact
Building a strong revenue cycle leadership team
Optimizing processes to improve cash flow

Insights from a Revenue Cycle VP: Establishing Operations at a New Organization

Key takeaways

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Meet The Speakers

Amanda De Los Reyes

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Key takeaways

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Meet The Speakers

Amanda De Los Reyes

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