Culture, Leadership, and Innovation in Tech: Building a Future-Ready Healthcare Revenue Cycle with Alex Chamorro

Alright. Well, thank you, everybody. This is the first edition of our revenue cycle insights podcast. Today, we have Alex Chamorro, CBO director at Houston Methodist and a longtime client and a longtime friend, and I can't tell you how happy, Alex, that that we are to have you Thank you. With us. Thank you for making some time. I know you're busy. Thank you. It's really an honor and a privilege to be here. Thank you for thinking of me. We've worked together for many, many years, too many to count since you and I were both kids. You know, it's interesting. For sure. We were we were competitors in the eligibility business a hundred and fifty seven years ago. It's so cool to see where you're at right now, you know, the journey. We've kinda taken it together. Right? Yes. First, congratulations on everything that you've accomplished. It's it's it's awesome to see this and see where you're at. And thank you for taking me and us along with you on the journey. So it's been great. And it has been a good journey. Right? We've had some fun in between all the craziness too, I I'd say, and a lot of success. Alex, let's start. Walk me through the journey a little bit. Tell me about where it started and how it started and how you come to the seat that you're in. Well, yes. It has been a an interesting an interesting journey. So I guess just some of the basic logistics have a bachelor's in healthcare social work. I have a master's in healthcare administration. I started my, my career at a local medical school hospital here in Texas. And I started my career as a social worker caseworker. So helped with, you know, discharge planning that part of the revenue cycle. And then when I went in to get my master's degree, that's when I met you. And I started working in the eligibility space, screening patients for Medicaid and any other resources that we had available that were available to them to help cover their services. I did that while I was working on my master's degree. And then when I finished the master's degree, essentially, I was able to transition into hospital operations in the revenue cycle, Then have the opportunity to transition into where if you think of kind of the revenue cycle as a continuum, the front end being traditionally registration patient access and the back end or the end of the revenue cycle being more the billing and collecting with the mid revenue cycle perhaps being utilization management and medical records, coding, that kind of thing. So I went from registration to the back end and started working in the CBO or in the central business office or essentially the port where the patient the services have already been provided, and now we're billing and collecting. I started in customer service, then folded in some cash applications, and managing the incoming payments from both patients and insurance companies. Then that moved into government billing, collecting, and eventually evolved into my current role where I now am the director in our central business office. And my oversight includes all things billing all for all payers, for all of our hospital system for all of our hospitals in our system. And it includes the collections in, which is collections, follow appeals, denials, and credit balances for the traditional government products. I also own compliance and audit response. So in the alphabet soup of audits and different agencies who request information, and then there's audit findings and a response is needed, my team kind of, you know, represents our organization and appropriately responds. And I also have oversight into all things revenue integrity, which includes the charge description master, managing, all of our charges and charge processes, if you will, at a high level for Houston Methodist. That's quite a bit, you know, and in terms of additional because I like learning. I am also a certified coder, and I am a six sigma black belt. Wow. Hello. Yes. Any spare time? I do. I I, I live in the Houston area, and I enjoy teaching English. I'm a I volunteer for a variety of different things through my organization of faith. I have a little dog. That's awesome. Well, I tell you, when you talk about teaching and teaching English and continuing to learn, you know, I think it was was John Wooden that said it's what you learn after you know it all that counts. Right? And you certainly live by that. You've been Yes. You've been at this a long time, and and you're still, you're still out there learning and teaching and teaching us and and me and our team, and it's been a great interaction. You know what? I like that quote that you just said. I do like that. You're you're free to use that. Yeah. Okay. I I will use it. And since I don't know it all, I I am still forever learning, and I think that's what keeps you relevant. Anything keeping you up at night as it relates to revenue cycle? Well, there's a couple of things that I track on my radar. For those of us who lived through the cyber attack on health care last year, That was that was very real. And so what keeps me awake at night is, you know, thinking you can't possibly think of the next nefarious act. Right? But you think about how ready are you in the event of. And so we've had a series of just interesting situational things that impact not only the larger industry of health care at large, but but also even locally. Things things like the cyber attack. How ready are you? How nimble are you? Can you recover quickly? Can you step out quickly? Maybe natural disasters that impact your operations. And so how can you maneuver and pivot and, you know, continue to function to not only provide a service to patients, but also keep the lights on. Right? Right. So I guess if I had to package all of that, what keeps me up at night and kind of where I'm continuing to expand my focus is where can we be ready? Where do I where where is their readiness? And where am I dying where am I dying need redundancy to help prevent negative impact to not only my industry and my slice of the industry in terms of my immediate organization, but also to our community. Right? So Yeah. Where where do I need to add redundancy? Where do I need to look at worst case scenarios? Where do I need to lead and have those conversations with all of our key partners and stakeholders? Trying to stay a step ahead. Trying to stay a step ahead of the bad guys. Yeah. Yeah. Well and living in Houston, like you said, we see our more than more than our share. You know? I've been here thirty years. There's been so so many you know, not one, not two, four, five things in thirty years that that have upended the whole city. The other thing I would say, Scott, that, you know, the first part of that is readiness and reactiveness, and and it's kind of responding to our ability to respond and recover from from an outside event, right, that impacts us. The other area, maybe, I would say, a focus that keeps me up at night from a from a wonderful perspective is where can I innovate? Where can I bring in automation innovation? Where can I maximize our efficiency? Where can I channel our talent in the things that really need the attention and have AI and machines and technology work for me? Right? And not just be a tool, but to be part of my overall solution. Where can I where can I innovate? Where can I be edgy on the innovation? Where can I think outside the box? And, you know, you depending on kind of your different sources out there, you'll hear revenue cycle is a wonderful frontier in innovation. What are other innovative leaders doing in their spaces that we can leverage in health care? Right? So Right. Those are some of the things that I think about. Well and and and, fortunately, for us, you work with your business partners, your vendor partners, and trying to accomplish some some new things. All the time, you're pushing us, asking us, and we appreciate that. And then in turn, we try to share things that we hear from other clients and other things in the industry with you. Have you heard about this, or are you doing this? And and so it's a it's a really cool relationship. And and so, you know, we're on the winning end of that with you and that you keep us moving forward all the time, cutting edge and and staying on on top of the game, which, by the way, we were just named best in class in eligibility. I saw that. I saw the report. It came out yesterday or earlier this week. I saw that. So congratulations. Congratulations. Thank you. It's a reflection of of our our clients, the things we learn from our clients, the relationships we have, the team that we have, and people like you pushing us to keep trying to get better. And so that's that's one of the results. Right? That's one of the rewards. And and so that's very cool. So thank you. Let's talk about team building for a minute. Sure. Right? What's your edge? What's your what's your goal there? What what's your style? So team building, you know, if you're not careful, that can be kind of a of a buzzword. My overall approach to team building is that nothing happens by chance, and I will add these two words, intentional and deliberate. I believe very much in leading through the power of relationship. And so in order to do that, you have to be intentional. You have to be deliberate. You have to invest in time, energy in your team. And so part of my journey has been to grow in this space to learn to be more intentional and deliberate. And, also, maybe I would add vulnerable, transparent with the team. And sometimes as leaders and maybe the higher up you go, you kinda think that's kind of counterintuitive. And I would say no. Actually, it's the solution that will be secret sauce to success, because people will follow a leader they can connect to. And then one of the areas that we've been focused on at Houston Methodist, which has helped me to grow in this space as well, has been team building in the in the in the context of development. An employee who feels all the statistics, this checks off all the boxes. Right? If I feel invested in and developed in, if I'm involved in the innovation, then I won't be afraid of it and I'll welcome it. If I collaborate in designing and architecting workflows and things that impact my daily life, and I'm engaged and I get to know you, I'm building relationship with not only my immediate leader, but my further up leaders and my teammates, then overall, you're hitting all the engagement and team building needs, if you will. And then if you add that that leader that's leading that team is vulnerable and feels safe, you know, engaging in vulnerability and encourages that in the team and builds relationship and builds connections. So when it comes to have the tough conversations, you've built a foundation of trust. You can trust that you can still stay connected to me. You can trust that I still have good intentions for you. You can trust that even though we're hitting some bumps, we can still take this ship to safe harbor. Now all this sounds wonderful. It's easier said than done, but it takes intentionality and deliberate planning, deliberate thinking through, being intentional with your with with your staff. It doesn't just happen with a potluck. It doesn't just happen with, I don't know, a game that you play, you know, an icebreaker that you add at the beginning of a staff meeting. All those things are good and they're excellent tools, but there's so much more to team building than the potluck or the icebreaker. We have so many challenges in the revenue cycle. And when you add that now in the post pandemic world, we are remote, also more important to build relationship and connection and to feel connected. We leverage that time when you come on-site. This is where, you know, we've filled in or we fill in some of those intentional things that I just talked about. Some development opportunities, some one on one, some team huddles, some, you know, feedback sessions, a workshop here or there. I'm I'm leveraging that time that you are on-site to connect. I'm enhancing it and supporting it remotely, but then I'm really taking advantage of that time that you are on-site. Is it a challenge to maintain the Methodist culture, or is it those two or three days that you're really, really pressed to to to cover those things or to do the things that that make Methodist Methodist? That's an excellent question. And I think, as I think about that, Scott, it starts with the employees buy in to the vision. So I think our organization does a pretty good job of the high level vision. But then me as that mid level management is I'm helping them bridge to that big vision. And so, again, it doesn't happen just by circumstance or by chance. It's deliberate. It's it's intentional. Every opportunity I get, I'm tying the employee back to that vision. I'm tying them back to our purpose. It's like a relationship. You're gonna nurture it. Right? You you have intentionality in your relationship. You know? You've heard some of the wisdom. You have dedicated date nights. You have things that you're doing within the scope of your relationship to nurture certain things in your relationship. So we do things to nurture culture. We reinforce things. Great answer. All of these are. Any leadership role models? Well, you know, that's an interesting question for somebody who's a lifelong student. I I don't I don't just have one. I mean, I have leaders in my local sphere that I admire and respect, and I deeply respect my immediate leader. She's been a mentor. Most of you, of course, will know her, Lisa Shalacy. She's been a mentor in my life and has probably been one of the singular most influential leaders in my life. Then there's numerous other leaders at Houston Methodist that whenever I have opportunity to see them, I'm like, yep. Copy paste that into Alex. Down download. That works. When I see our senior leaders, people like Roberta Schwartz or maybe a doctor Mark Boom, they're such engaging speakers, and I confess, I'm I think I wanna be like them when I grow up. Right? That kind of thing. Mary Barra, the, CEO of GM, I thought that was great. A lady lead CEO, leader of an automotive the the automotive manufacturing company in the United States. Hello. Sarah Katz, the CEO of Oracle tech company. Fortune five hundred calls her the most powerful woman in the industry. You know, Condoleezza Rice, Michelle Obama, those are some of I look to the you know, I listen when they speak. I wanna you know, there's things that I like about both of these ladies and wanna emulate. Then I think about the thought leaders that are out there, in the industry. A good thought leader that I follow and has taught me a thing or two is Brene Brown. So, you know, so I I look for shining stars, not just in my local community, but out there in the industry, thought leaders, people that that have powerful messages that I can connect with. Again, going back to what I just said, if people can't connect to you, they won't follow. Hey. Hey. Let me ask you this. So you're in the same world that that I'm in in that so we've got major health systems. You know, CHRISTUS, you guys, Memorial Hermann, all UHS. You name it. We got and so we we deal with with you in in your group and in that corporate, right, at the CBO. So our job is to keep you happy. And at the same time, keeping the hospital CFOs and case management, those people happy too in the whole system. Right? And so so it's not a a one trick pony in in our approach. It's we're we're we are in the same boat. Right? You report up, right, to Lisa, but you also, in a sense, have clients. Right? I mean, correct me if I'm wrong, but the hospital CFOs. Right? And so how do you talk to me about managing those relationships from inside the system. Also an excellent question. Yeah. Shucks. Yeah. I know. It's it's really difficult. So, yes, you know, I I wear many hats. You've described it excellent. I've yes. I I have a core function in in Houston Methodist at large, but I'm also a service provider. I don't actually generate the care. I don't generate, you know, the charges are gonna that are gonna ultimately turn into cash. I'm a service provider. And part of our process and part of our vision as a CBO in that scope of service provider is we do see our facilities as our clients. And so our role is to meet them where they're at, to understand what their priorities are. And sometimes that may mean educating them that maybe one priority is a little misaligned and really this needs to be the priority. And maybe that means us being open to the idea that maybe a priority for us is not for them and maybe we're misaligned. But it's, again, I'm repeating myself, but it's the art of relationship, right? And it's connecting to each one of my facilities that I serve. What's important? What are they caring about? What are they looking at? What are the metrics they're looking at? Am I hitting those buttons? Am I meeting those needs? Is there something that they're needing that I can provide? Is there something that I that they're needing that they don't know it yet and can't articulate it, but I can come to them and say, hey. I saw this need. Let me let me do this. Not to mention personalities. Different personalities. That too. Right. You have to you have to learn to read people and manage different personalities and varying degrees of intensity and Sure. And being strategic through your relationships. Right? And so being able to read the political landscape, being able to read a room, whether it's a physical real room or if it's a virtual room. It's sometimes reading between the lines and reading, you know, the tea leaves. It requires a lot of that higher ordered thinking, a lot of emotional awareness, a lot of situational awareness, and being, again, very intentional and deliberate with your relationship strategy. I invest in my key stakeholders. I make sure I'm meeting with them. I'm engaging with them. And and I'm connecting and I'm hearing their needs, and I'm sharing my needs too because there's there's an element of, in order in order for me to help you, I need this from you. Yeah. Right. Right. And it's important that you hear that from me. Right? Otherwise, we can't expect expect this result if you're not giving me what I need to get there. Right? So it's that intentionality through relationship and investing and getting moving through your strategy in that space. Does that make sense? Yeah. Yeah. It makes it makes a lot of sense. That's always I've always seen the similarities in what you do and what we do. Right? And that you're dealing with corporate, and then you're also dealing with Yes. You know, multiple hospitals, multiple leaders, multiple departments, and whatever, and trying to juggle that and keep everybody happy and be successful. So so is there anything you've got you've got our attention? You've got a platform. Is there anything you wanna say that that's not an answer to my question, something that you might wanna say to the industry or whoever might watch this thing? I'm sure there'll be millions of people watching this, or maybe tens. Ends people. No pressure. Okay. Thank you for that. You know, as I think about our relationship and kind of how we engage, I think of the phrase iron sharpens iron. I'm hungry. What do you see out there? Do I have a blind spot? Where can you get out ahead of me? Where can we partner and do something creatively and different? And certainly, there's lots of opportunity to do that. There's a lot that's there's a lot of change happening in our world that's gonna ultimately impact our front door in the health care industry. Where can we partner together? And so it's more of where can we watch full watchfully react and respond together collaboratively and strategically, right, with an eye to innovation. You know? So sometimes we get caught in the everyday and, oh, these results and these metrics and all that is good, especially if you're finance people like me at numbers. Yay. We probably leak out on give me an Excel spreadsheet any day. So Right. But it's lifting the conversation. Right? And it's going beyond the the the daily tasks and the metrics and what what are we doing? You know? Where can we leverage the innovation? Where can we raise this up? What's happening out there in our community, in the political landscape? Where do we have any joint blind spots we need to be aware of? And what can we do together as partners to be strategic and be ready, right Right. For some of the things that may coming may may be coming to our to our front door. There's a lot of legislation that's being flirted with. Right? That's another thing that sometimes keeps me up at night. Yeah. Right. And I and I wonder, oh, gosh. You know, who this is a call to action. I need to be more involved in advocacy because our leaders need to hear from us in the front lines and say, this is how this legislation is going to impact Right. Me, your service provider, and, ultimately, your constituents. Right? And so there's an opportunity for us to collaborate together as key stakeholders to to be that voice. Right? Good question. So I I I think about that. There's an opportunity there. Well, you guys do a great job after some of these large meetings, a a and I and things like that, where you guys will come back and say, hey. We saw this. How does that fit? Or are you guys doing this? And sometimes it you know, we need to do a better job of selling ourselves back back not selling, but relaying back to you. And and we spoke about that at at the fourth quarter, our fourth quarter meeting about that's one of our takeaways was to continue to come back to you with you know? And sometimes we'll have things that you have no idea we've already implemented that in in, you know, to our our normal process. But Yeah. So, yes, you guys are are are good at that, and and you keep us. You push us to to, stay ahead of the game, right, and as it relates to technology and different things that are out there. So, well, I mean, I hate to end this. This has been this has been fantastic. What a great way to start our our revenue cycle insights podcast. I'm curious. How did this come about? This is first, I wanna congratulate you. I think this is fabulous. But can I ask you a few questions? Tell me more about your vision for this podcast. Who how are you going to share this? Who who do you envision your ultimate audience being? Tell me a little more about how did you get here. Well, I'm I'm I'm sure we're gonna put this on the on the company website and a few others out there for people that that are interested to come in, and clients hit our website, you know, all the time. Right. And and people who maybe wanna be a client and to see what what it is that we're up to, right, and what kind of company we are. And I would love to take credit for this, but it wasn't me. Our we've got a great marketing team. They're vital to to what we do and to keeping us out there in the market, you know, as shining stars in in in the market. And so that's it was their idea. Well, I would say kudos, you know, Kathy and marketing team for really something I think that is quite visionary, and that I think, adds some homage to your name, Elevate. It elevates your vision. It elevates your visibility. It elevates your services and the things that you provide. And so it's probably that and many more things that you are likely thinking of. But I think I say kudos to you. I've never been invited to a podcast from one of my key stakeholders. So that was a first. So this is definitely something I wanted to say yes to. Oh, that's awesome. Well, we're glad that you did the things that Methodist does for the community. This city is lucky to have you. Alex, thank you so much. Thank you. Thank you. On behalf of all of us, thank you. Golly. This was great. You know, we we did go a little bit over, but you've been so gracious with your time, and you were so good that I couldn't stop it. So, hey, thanks a lot. I'll see you soon. Thanks, guys. Have a wonderful day. You're the best. Alright. Alright. You guys too. Take care.