Spotlight: Ishan Balakrishnan @ Cair Health

A spotlight is a short-form interview with a leader in health tech. In this spotlight, you'll hear from Ishan Balakrishnan, founder of Cair Health.

What does Cair Health do?

Cair Health is building the agentic operating system for modern revenue cycle management (RCM). Our AI agents automate the most complex and labor-intensive parts of the RCM workflow – from eligibility and coding through claims, denials/appeals, phone calls and payment posting – allowing organizations to scale efficiently, reduce errors, and accelerate collections.

We work across three core segments:

• Modern clinics and management service organizations (MSOs)
  We help tech-forward clinics and multi-site operators improve cash flow and scale without adding billing headcount by increasing first-pass acceptance and preventing denials upstream.
  
  

• Business Process Outsourcing (BPO)/RCM providers
  We serve as a force multiplier for billing teams managing large claim volumes, automating policy checks, claim edits, and denial prevention to drive higher throughput and margins.
  
  

• Specialty electronic health record (EHR) platforms
  We partner with EHRs to embed intelligent RCM workflows and payer-aware claim logic directly into the product, turning billing from a downstream service into a native, automated capability.

How did you end up working in health tech?

While working at a digital health accelerator, I saw the same issue across different businesses in healthcare: claims and reimbursement were consistently the bottleneck, regardless of how good the product was.

That insight, combined with firsthand perspective from my cofounder Shehbaz’s mom – a nurse at a large skilled nursing facility – made it clear that RCM problems aren’t abstract. They directly impact operations, staffing, and patient care.

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

My role is to translate real-world RCM workflows into scalable software. That means working closely with billing teams, payers, and partners to understand where claims break, then building product and data systems that prevent those issues before they happen – without adding operational complexity for customers.

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

RCM will shift from being reactive to predictive. Instead of teams chasing denials weeks after submission, systems will automatically structure claims correctly the first time, flag risk before submission, and adapt in real time as payer behavior changes.

Human teams won’t disappear, but their role will move up the stack—from manual data entry and follow-ups to exception handling, strategy, and oversight—powered by much better automation underneath.