Abstract

Healthcare systems' operational effectiveness and financial viability depend heavily on effective revenue cycle management, or RCM. However, administrative inefficiencies, disjointed systems, complicated regulations, and manual workflows make it difficult for both Africa and the US to optimize RCM procedures. This study offers a unified methodology for utilizing information technology (IT) and artificial intelligence (AI) technologies designed for business process automation to optimize RCM. The methodology streamlines claim processing, improves billing accuracy, lowers denial rates, and improves cash flow by combining predictive analytics, cloud-based health information systems, robotic process automation (RPA), and machine learning algorithms. Healthcare providers in Africa frequently struggle with underfunded systems, inadequate data infrastructure, and manual processes that restrict scalability and impede timely reimbursements. In order to solve these problems, the suggested approach integrates mobile-based solutions for inclusive access, intelligent claims auditing for error reduction, and AI-powered document recognition for digitizing records. On the other hand, the U.S. healthcare system continues to have high administrative expenses and reimbursement cycle delays in spite of technology developments. By implementing blockchain-enabled transaction verifiability, interoperability frameworks, and AI-driven denial management tools to guarantee adherence to changing payer regulations and regulatory mandates, the model improves U.S. RCM. Healthcare providers in Africa frequently struggle with underfunded systems, inadequate data infrastructure, and manual processes that restrict scalability and impede timely reimbursements. In order to solve these problems, the suggested approach integrates mobile-based solutions for inclusive access, intelligent claims auditing for error reduction, and AI-powered document recognition for digitizing records. On the other hand, the U.S. healthcare system continues to have high administrative expenses and reimbursement cycle delays in spite of technology developments. By implementing blockchain-enabled transaction verifiability, interoperability frameworks, and AI-driven denial management tools to guarantee adherence to changing payer regulations and regulatory mandates, the model improves U.S. RCM.