Spotlight: Federico Ruiz @ Puppeteer AI

A spotlight is a short-form interview with a leader in health tech. In this spotlight, you'll hear from Federico Ruiz, Founder and CEO of Puppeteer AI.

What does Puppeteer do?

Puppeteer builds AI agents that handle the patient work that clogs your day: calls, follow-ups, symptom checks, scheduling, and routine questions, so clinicians can focus on care. Our agents hold natural phone conversations, ask clinically relevant questions, summarize to the chart, and keep checking in after the visit. Think continuous, proactive navigation of each patient’s journey, with humans in the loop for anything sensitive or complex. The outcome is less admin, fewer missed appointments, and more capacity without more headcount.

How did you end up working in health tech?

I was working at Meta at the time, but my head was already in the space of building something of my own. I had just launched LangAI, and I was really interested in how agents could evolve beyond the narrow use cases we were seeing then. Back in those days, “agents” weren’t a mainstream concept – it still felt like an open frontier.

I stayed close with Alan and the founders of Light-it, and through those conversations, the opportunity came up to work on a project together. Their background in healthcare and my focus on agents fit naturally, and that collaboration turned into the starting point for Puppeteer, a company built around the idea that agents could actually support clinicians and patients in meaningful ways.

So the path wasn’t a grand plan. It was Meta giving me exposure to big-scale problems, LangAI showing me the potential of agents, and trusted friendships that created the right conditions to start something new in healthcare.

How does your role intersect with revenue cycle management (RCM)?

When you think about RCM, a lot of the problems trace back to the same operational gaps: missed appointments, incomplete paperwork, delays in follow-up, or patients not having the right information at the right time. My role is to make sure our agents close those gaps.

For example, if someone misses an appointment, the agent can call right away to reschedule. If benefits need to be confirmed, the agent can collect and structure that information before the visit. And in value-based programs, our agents can keep nudging patients on adherence and preventive care, which not only improves outcomes but also makes sure organizations meet their quality metrics.

So my intersection with RCM isn’t on the billing side, it’s on the upstream side: making sure the right things happen with patients, consistently, so that revenue capture becomes a natural outcome of smoother operations.

What do you think RCM will look like two years from now?

I think we’ll see a shift from RCM being a back-office function to something that’s much closer to the point of care. Conversations with patients, whether over the phone, in the waiting room, or through an AI agent, will generate structured data that flows directly into eligibility checks, claims, and follow-ups. The gap between “talking to a patient” and “having everything ready for billing” will keep getting smaller.

At the same time, value-based care is going to push revenue away from just transactions and more toward outcomes. That means systems will need to stay connected to patients long after the visit, reminding them about meds, nudging them to book labs, checking in on recovery. The financial side will depend on how well organizations can keep patients engaged and adherent, not just how fast they code a claim.

In short, RCM will still be about dollars, but it will feel less like accounting and more like care continuity, because that’s where the revenue will come from.