“It’s about meeting the needs of the community.” Strengthening Revenue Cycles in Tribal Healthcare

Insight in Indian Country Podcast

Trusted Expertise to Serve Tribal Nations | REDW National Tribal Practice

Episode 54 – Strengthening Revenue Cycles in Tribal Healthcare with Melissa Goad

Revenue cycle management isn’t just a back-office operation—it’s a strategic tool for strengthening care delivery in Tribal communities. This episode, REDW National Tribal Practice Leader Wes Benally sits down with Melissa C. Goad, CRCR, CPA, MBA, a healthcare finance veteran with 30 years of experience spanning both payer and provider perspectives. Melissa shares her transformative journey as CFO of a 638 Tribal Healthcare Facility on the Navajo Reservation, where she led a comprehensive revenue cycle optimization initiative that delivered a tenfold return on investment.

From fixing data flow challenges and reducing denials by up to a third, to implementing culturally sensitive front-end operations and embracing industry best practices, Melissa’s insights offer a practical roadmap for Tribal healthcare organizations looking to maximize reimbursements and close gaps in care. Her approach? Take it layer by layer, build cross-functional teams, and remember that optimizing revenue cycles ultimately means securing the resources needed to serve the community better.

Chapters

• 00:00 – Introduction and Melissa’s Healthcare Background
• 02:05 – The Importance of Revenue Cycle Management
• 04:45 – Assessing Opportunities in Tribal Healthcare Settings
• 06:36 – Embracing Industry Best Practices
• 12:24 – Denials Management and Registration Challenges
• 17:37 – Data Flow and EHR Customization Issues
• 20:13 – The Power of Cross-Functional Teams
• 25:05 – Cultural Considerations in Tribal Healthcare
• 30:02 – Results and Recommendations

Takeaways

• Revenue cycle optimization is about ensuring continuity of care and honoring commitments to the community, not just financial health.
• Tribal healthcare facilities face unique challenges including geographic isolation, staffing limitations, complex billing regulations like the All-Inclusive Rate (AIR), and often inadequate technology.
• Starting with a thorough assessment before implementing changes prevents costly assumptions and builds a strong foundation for improvement.
• Registration is one of the most critical points in the revenue cycle—if data starts wrong, it ends wrong.
• Embracing proven industry best practices rather than over-customizing systems can dramatically improve outcomes.
• Cross-functional teams that include both clinical and revenue cycle staff are essential for identifying and fixing denial patterns.
• Cultural sensitivity in patient-facing operations, including language support and understanding Tribal-specific requirements like CBI collection, strengthens both patient experience and reimbursement accuracy.
• Organizations can expect to see returns within 6 months of implementing systematic fixes, with some facilities achieving tenfold ROI on revenue cycle investments.

Ready to Strengthen Your Revenue Cycle?

Melissa’s experience demonstrates what’s possible when Tribal healthcare organizations invest in specialized revenue cycle expertise—her facility saw denials drop by up to a third and achieved a tenfold return on their investment. REDW brings this same level of expertise to 638 healthcare facilities and Tribal health organizations across Indian Country. From navigating the complexities of AIR billing to optimizing data flows and building culturally sensitive registration processes, our team understands the unique challenges Tribal healthcare leaders face.

Whether you’re considering a 638 transition or looking to improve existing operations, connect with REDW’s Tribal healthcare advisors to explore how we can help strengthen your organization’s financial health and expand care for your community.

REDW Advisors and CPAs is proud to bring you the Insight in Indian Country Podcast, covering important advisory, accounting, and finance topics that impact Tribal Nations and business affairs.

Meet Your Host

Wesley Ryan Benally, CPA

REDW Principal and National Tribal Practice Leader

As the leader of REDW’s National Tribal Practice, Wes is committed to improving financial literacy throughout Indian Country and hosts the Insight in Indian Country Podcast. He oversees audits of a wide range for Native American communities, state and local government agencies, and non-profits nationwide, is a member of the Arizona State Board of Accountancy’s Peer Review Oversight Advisory Committee, and serves as an instructor with Arizona State University’s American Indian Policy Institute. In addition, as a Board member for a tribal gaming entity that operates in two states, Wes keeps up with regulatory issues important to tribal gaming operations. Wes is an enrolled member of the Navajo Nation.

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