Heather Agostinelli, VP and Head of Specialty RCM: Leading with Passion and Purpose

In this installment of our Leadership Spotlight Series, we feature Heather Agostinelli, Vice President and Head of Specialty Revenue Cycle Management at XiFin. Guided by the belief that every claim represents a patient waiting for answers, Heather leads XiFin’s specialty RCM strategy across specialty pharmacy and molecular/genetic diagnostics . Her work pairs people skills with innovation, advances scalable models and performance-driven AI capabilities in areas such as improved prior authorization, and focuses team effort on claims with the highest likelihood of reimbursement.

From Psychology to Revenue Cycle Leadership

Heather’s path to a career in healthcare was anything but typical. Originally from Annapolis, Maryland, she grew up sailing on the Chesapeake Bay before pursuing a degree in behavioral psychology at the University of South Carolina. Shortly after graduation, she was recruited by the Behavioral Analysis Unit (BAU) of the FBI, a fascinating opportunity she ultimately declined in favor of building a family and pursuing a career that would enable her to help others in a different way.

After 16 years working in pathology revenue cycle management, her curiosity, RCM expertise, problem-solving skills, and a people-first leadership style earned her a role as one of the founding leaders of the laboratory RCM division at McKesson. During her eight-year tenure in that role, Heather advanced and refined RCM operations for large laboratories.

Recognizing her combination of industry expertise and leadership vision, XiFin brought Heather on board in 2019 to manage strategic revenue operations. In this role, she strengthened XiFin’s leadership in providing scalable RCM operations for large diagnostic organizations through outsourced billing services. Heather worked closely with some of XiFin’s largest diagnostic customers to help them improve the effectiveness and efficiency of reimbursement processes.

Today, Heather leads XiFin’s Specialty RCM division, overseeing initiatives that support laboratories, molecular diagnostics, and pharmacy organizations navigating the most complex billing environments in healthcare.

Driving Excellence Through Connection

For Heather, the greatest reward of her role is the people—her XiFin colleagues and the customers she serves. She describes her team as “rock stars,”recalling how they kept operations running seamlessly when COVID-19 unexpectedly disrupted the world and created one of the busiest times in laboratory history.

“Even while the world was shutting down, laboratories were operating beyond full capacity,” she recalls. “Our customers had senior executives entering claims just to keep up. It was a powerful reminder of how mission-critical our work is.”

That experience deepened her appreciation for the commitment of diagnostic and pharmacy providers who continued serving patients during a period of immense uncertainty.

A Career Defined by Purpose

Heather’s professional mission is clear: to make sure that every test, procedure, and treatment that can change a life gets reimbursed. She’s especially moved by moments that connect operations to outcomes.

“When I recently visited a customer lab specializing in pediatric genetic diagnostics, I was reminded that each specimen represented a sick child who has no voice in the process and a family waiting for answers,” Heather explains. “A definitive diagnosis leads to a treatment plan—and XiFin helps fund that mission by ensuring providers are reimbursed for the vital work they do.”

Her passion for purpose-driven work has also shaped her leadership style, which is grounded in empathy, collaboration, and a commitment to accountability. She credits her mentors and the friendships built at XiFin for keeping her inspired every day.

Tackling Today’s Specialty RCM Challenges

From molecular diagnostics to specialty pharmacy, Heather knows that constant payor policy changes and complex reimbursement requirements are among the most significant obstacles healthcare providers face. For molecular and genetic testing, in particular, inconsistent medical necessity criteria, undefined CPT codes, and limited access to patient medical records create additional hurdles.

“Staying ahead of these dynamics requires constant learning, technology innovation, and collaboration across payors, providers, and RCM partners,” she notes.

Leading the Future of Specialty RCM

Heather especially appreciates how the XiFin engineering and development teams continually work on new enhancements to improve our customers’ experience and results. There are several developments and new capabilities on the horizon that she is looking forward to introducing to our customers.

For example, one of the initiatives Heather is most excited about involves a new AI capability that predicts the likelihood of prior authorization approval. This capability will be particularly valuable for molecular, genetic, and specialty pharmacy providers who face frequent prior authorization challenges.

Heather’s priorities for 2026 center on leveraging AI and automation to transform specialty RCM, including enhancements to identify claims with the highest likelihood of reimbursement to better prioritize team workload, as well as improvements to enhance cost estimation at the payor plan level.

Through these initiatives, Heather and her team aim to make RCM not just more efficient—but more adaptive and patient-centered.

A Life Beyond the Office

Outside of work, Heather treasures time with her two adult sons and enjoys interior design, cooking, and traveling with friends. A seasoned traveler, she has explored destinations around the world, with Scotland and Ireland ranking among her favorites for its rich history and timeless charm.

Words of Wisdom for Future Leaders

When asked what advice she would share with aspiring healthcare leaders, Heather smiles and recalls the best advice she ever received—from her father:

That philosophy has guided her entire career. By leaning into challenges others avoid, Heather has built a legacy of impact—helping XiFin’s customers deliver better patient care, achieve stronger financial outcomes, and navigate one of healthcare’s most complex landscapes with confidence.