Healthcare finance teams are navigating an increasingly complex environment – balancing operational efficiency, cash visibility, and system integration while ensuring patient care remains uninterrupted.

For UNC Health Appalachian, simplifying treasury operations wasn’t just about efficiency. It was about creating a scalable foundation for the future.

Working closely with PNC, the organization took a close look at its banking footprint, rethought its treasury structure, and implemented more streamlined processes that supported both progress and continuity.

The Starting Point

Like many growing healthcare systems, UNC Health Appalachian had multiple banking relationships with account structures that had become more complex over time as the organization expanded and needs changed. This led to redundant accounts, manual processes, limited cash visibility, and reconciliation challenges tied to payment detail constraints.

Leadership saw an opportunity to simplify and modernize but needed an experienced provider to help guide that change in a way that balanced progress with day-to-day realities.

The Approach

Working closely with UNC Health Appalachian’s finance team, PNC conducted a detailed assessment of account structures, pain points in workflows, and reconciliation processes. Together, they identified opportunities to simplify operations while maintaining continuity.

From that discovery, the teams developed a future-state treasury model built on five core principles:

  • Simplification to reduce unnecessary complexity.
  • Standardization across account structures and workflows.
  • Automation to minimize manual processes.
  • Control through enhanced visibility and governance.
  • Scalability to support growth and system alignment.

“Every recommendation started with understanding UNC Health Appalachian's operating environment. From there, we built a treasury model designed to support their current priorities and future objectives,” said Olivia Walters, PNC Treasury Management Officer.

The Solution

PNC helped UNC Health Appalachian simplify and modernize its treasury operations by focusing on a few high-impact changes. First, PNC identified an opportunity to reduce the number of accounts spread across several financial institutions by approximately 56%. This recommendation helped simplify the account structure, reduce redundancy, and support a centralized approach to liquidity management.

To improve cash visibility and control, PNC worked with the organization to centralize liquidity management through a Zero Balance Account (ZBA) structure with an automated investment sweep. The approach provided a more consolidated view of cash, simplified daily funds management, and increased earnings on operating liquidity.

Automation helped further streamline treasury operations. “By automating key workflows and introducing file-based payment processing, we helped the team reduce friction in their day-to-day operations while strengthening controls,” Walters said.

Finally, to address reconciliation challenges and improve posting efficiency for commercial insurance payments, PNC helped implement cash management files aligned with systemwide standards. The result was greater visibility into payment details, improved matching accuracy, and more streamlined revenue cycle processes.

“PNC took the time to understand how our team works and ensured every step forward was manageable. That made all the difference in achieving adoption without disruption,” said Elisa Miller, System Controller, UNC Health Appalachian.

The Impact

With a modernized treasury structure in place, UNC Health Appalachian now has:

  • improved visibility into cash and liquidity;
  • streamlined processes and reduced operational complexity;
  • a scalable framework aligned with systemwide standards; and
  • a strong foundation for continued revenue cycle transformation.

Looking ahead, the organization is well positioned to further optimize payment posting, enhance payer connectivity, and deepen coordination between treasury and revenue cycle functions.

Parker Marsh, Senior Relationship Manager for PNC Healthcare Banking, notes: “UNC Health Appalachian’s experience demonstrates how a thoughtful, well-executed approach – supported by a trusted provider – can help healthcare organizations simplify operations while preparing for what’s ahead.”

Learn more about how PNC can help healthcare organizations modernize treasury and revenue cycle operations through solutions that improve visibility, control, automation, and reconciliation.