The following is a guest article by Karly Rowe, President at Inovalon’s Provider Business
The way providers work has reached a tipping point. Mounting administrative burden, less time with patients, and tightening margins are pushing physicians – and in some cases entire organizations – out of practice.
The data underscores the urgency:
- Physicians spend an average of 15.5 hours per week on paperwork and administrative tasks
- Nearly 35% of physicians intend to leave their current role within five years
- Roughly 60% of physicians are likely to leave the profession entirely
Financial pressures compound the workforce strain. Nearly four in ten hospitals are operating at a loss, and among those with positive margins, one in ten reports margins below 10%. Clinicians, revenue cycle teams, and healthcare leaders need technology that helps them work faster without sacrificing accuracy, trust, or confidence that critical tasks are being completed correctly.
The reality is driving increased interest in agentic AI. From automating time-consuming steps like prior authorization and eligibility verification to preventing denials and accelerating appeals, agentic AI is reshaping how healthcare organizations manage complex workflows. When deployed thoughtfully, AI acts as a co-pilot, handling repetitive tasks, supporting decision-making, and allowing human expertise to remain firmly in control. The result is not only greater efficiency, but more engaged teams and more resilient operations.
Opportunities for Agentic AI in Healthcare
Agentic AI refers to systems with advanced reasoning capabilities that can independently complete defined tasks and infer next steps – such as identifying missing patient information during check-in or anticipating documentation requirements before submission. These agents accelerate manual processes while maintaining quality, accuracy, and trust across clinical and operational teams.
Within the revenue cycle, two areas stand out as especially ripe for transformation: prior authorization and claims management.
Prior Authorization
Prior authorization is required for many procedures, medications, tests, and care transitions. It remains one of the most burdensome administrative processes in healthcare. According to physicians, 93% report that prior authorization delays care, and nearly one-third say those delays have led to serious adverse events for those patients.
Requests are often delayed due to missing information, repeated submissions, and appeals, creating weeks of uncertainty for patients awaiting care. Throughout this process, physicians are expected to manage appeals while balancing full patient panels and other administrative responsibilities. Payers, meanwhile, must repeatedly review the same requests as they are resubmitted with incremental updates.
Recent CMS updates require decisions within 72 hours for urgent requests and 7 days for standard requests. While these timelines represent progress, they largely ask already-strained organizations to move a broken process faster.
Agentic AI offers a meaningful shift. Instead of clinicians starting from a blank form, AI agents can generate a complete prior authorization request by anticipating payer requirements and populating the necessary documentation upfront. Physicians then review and validate the submission rather than building it line by line. If a request is denied, the agent can interpret the rejection and draft appeal documentation for clinical review, significantly reducing turnaround time while preserving physician oversight.
Claims Management
Reducing claims denials remains a top priority for healthcare leaders, and agentic AI plays a powerful role in prevention and remediation. Many denials originate at the front-end of the revenue cycle, where incomplete or inaccurate patient data slips through registration and intake. These small errors compound downstream, resulting in backlogs, rework, and delayed reimbursement.
When agentic AI is embedded across both front- and back-end workflows, providers can increase accuracy at every step. Front-end teams can use AI agents to validate demographics, benefits, and secondary or tertiary coverage before services are rendered. On the back-end, AI agents can review claims prior to submission to verify payer-specific requirements, flag denial risk, and explain why a claim may be vulnerable.
Because claims accuracy depends on clinical documentation, agentic AI can also support clinicians by ensuring diagnoses and procedures are fully and appropriately documented. This creates a more complete clinical record, supports accurate ICD-10 coding, and ultimately contributes to better patient care and financial outcomes. Unlike static rules engines, AI agents continuously learn from outcomes, exceptions, and payer behavior, improving performance over time.
Trust and Oversight Will Determine AI’s Impact
As providers explore agentic AI across the revenue cycle and beyond, speed and automation must be balanced with strong governance. The most successful implementations prioritize transparency, explainability, and human validation at every step.
AI agents should never operate as black boxes. It is the shared responsibility of healthcare leaders across finance, operations, clinical teams, and IT to ensure AI is deployed thoughtfully, monitored closely, and designed to support, not replace, human judgment.
The true value of agentic AI lies in empowerment. By offloading repetitive, manual tasks to purpose-built agents, healthcare professionals can focus on higher-value work — supporting patients, improving care coordination, and strengthening the financial health of their organizations. Providers that succeed will not be those that adopt the most AI, but those that operationalize it responsibly, at scale, with humans firmly at the center.
Karly Rowe is President of Inovalon’s Provider business, where she leads the organization delivering software solutions to tens of thousands of healthcare providers nationwide. She has full financial and operating responsibility for the Provider business, overseeing customer operations, partnerships, and commercial strategy while working cross-functionally across product, engineering, sales, marketing, finance, and HR to drive scale and performance. Prior to Inovalon, Karly held senior product and strategy leadership roles at Experian Health, where she brought data-driven products to market and built strategic partnerships across EHRs, healthcare technology vendors, and pharmacy standards organizations. She holds a Master of Business Administration from Arizona State University and a Bachelor of Arts in Marketing and Retail Management from Syracuse University.
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