Pauline T Newton

• Restructured Operational oversight to the Central Region Facilities, building relationships with Clinical Areas, hiring and training new Business Office Leadership, educated and train new Billing Teams
• Turn around Days in A/R from 63.6 down to 49.5 within 7 months, by collaborating with Case Management and other clinical areas assisting in retrieving appropriate authorizations to decrease denials going forward and generation of expedited claims submissions for the >$250,000 in yearly revenues
• With the efforts of our Revenue Cycle teams in the Central Region was able to achieve the following: Medicare AR >60 days to below 55 of total AR; Medicare Managed Care AR >90 below 5% of total AR; BCBS AR >90 below 3% of total AR; Medicaid & Medicaid Managed Care AR >90 below 6% of total AR & Commercial & HMO plans AR >90 below 4% of total AR and Over all Denials and Charity Care below 3.2 % of total adjustments.

• Developed, implemented and Operational oversight of a Central Business Office policies/processes, encompassing in all scopes of Patient Financial Services within the Revenue Cycle for the Healthcare System in 3 regions comprising 8 Acute Care facilities, 3 Skilled Nursing Homes, 5 Personal Care facilities & 1 Independent Living facility
• Managing the A/R for over 1.6 Billion dollars in revenue yearly
• Averaging Days in A/R between 37 & 42
• Developed and implemented a robust Point of Service Collection program in which we are progressing to over 2% of total cash/reimbursements for 2 of the 3 regions
• As well as implementing a system wide Financial Assistance Program based upon 501R rules and regulations
• Project Management with majority of Vendor relationships within PFS Revenue Cycle, ensuring timelines are met and ROI is being achieved thru tracking and trending of each vendor’s performance on a weekly/monthly basis
• Development and roll out of Executive Dashboards report to Senior Leadership on weekly, monthly, quarterly & FYE basis and being able to articulate any deviations and how KPI’s are being met and/or improvement progress methodology, including timelines
• Working in conjunction collaboratively with peer Revenue Cycle & Clinical leadership to insure open discussion and resolutions to achieve optimal charge capture, reimbursements & resolving denials (i.e
• No Precerts/Auths; Medical Necessity, Maximum benefits met, etc.) Working closely with Rev Cycle PFS Teams for Cerner system roll outs to 4 of your Acute facilities maintain Days in AR in the low 40’s to high 30’s, maintaining receivables greater than 90 below 20% of total AR and sustaining bad debt at the 3% or lower range, reviewing payer denials and appeals processing – tracking and trending all system denials
• Provide statistical detailed reporting to Fund Development area to secure special grant programs.

• Operational oversight of central business operation for 4 Acute facilities, 1 Rehabilitation facility as well as Cash Handling/Posting (including daily balancing and GL reconciliation) for 29 CHS Facilities – as well as oversight of Registration, POS Collections, Financial Counseling, Billing/follow up, collections and denial management
• Responsible for development and reporting of all Revenue Cycle financial and aging analysis, benchmarking & cash flow to Senior Leadership
• Worked with PFS Revenue Cycle Teams to maintain AR at 120 days & greater averaging 13% of total receivables.

• Operational oversight of all Business Office operations of 2 Acute IP facilities, 2 Community based clinics and Physician billing including; Patient Registration, Financial Counseling, financial dashboards for Executive teams, Financial Counseling, Cash Posting, GL reconciliation; claims submissions and follow up, denials management
• Able to decrease Days in AR by Fiscal Year End to 42.5 from 58.3 and generating cash collections to exceed net revenue by 110%
• Maintained AR over 60 days below 21% of total AR.

• Operational oversight of all Business Office operations including; Billing & Follow up, cash posting/balancing, insurance/financial counseling as well as Patient registration and updating CDM
• Work collaboratively with Peer Directors in clinical areas to achieve streamlined process of charge capture
• Motivated team to maintain Days in AR at acceptable levels under 40 days thru streamlining analytical billing practices and denials management to increase cash flow
• Maintain AR great than 90 days below 18% of total AR.

• Revenue Cycle Operations for Physician Billing services for the Hamot Physician Network
• Included but not limited to; New business negotiations & implementations, charge capture, CDM maintenance, charge entry, billing/follow up, cash handling & cash posting, denial management, provider credentialing and payer enrollments, maintaining and reporting Executive Dashboards as well as individual provider dash boards including RVUs
• Review and update Physician fee schedules
• Worked collaboratively with Director of Reimbursement/Contracting for negotiating payer contracts
• Worked in conjunction with the CFO and directors of Physician Network to implement and roll out new/acquired practices and/or new procedures/processes
• Managed Dept
• Budget, including; staffing requirements, AP approvals & inventory control
• Implementation of incentive bonus program for Revenue cycle employees through achieving monthly goals and accountability standards
• Project Manager over implementation of Order Facilitator between Physician Network Practices and the Facility’s Patient Access/Patient Registration for electronic orders eliminating calls, faxes and/or hard copy orders.

• Operational oversight of five work groups; Medicaid/Medicaid Managed Care Billing & follow up, Financial Counselors; Cash Posting; Insurance Advisors & Collection Specialists
• Implementation of new benchmarks honing in on industry best practices along with Peers within the Revenue Cycle achieving lowest days in AR for the Organization history of 39.4 days (previously had been in the low 50’s to high 40’s)
• Organized Cash handling Committee, implementing an electronic receipt system and controlled monitoring of all cash flow within the Organization
• Was able to institute Lockbox and Point of Services Collections processes
• Rolled out a predictive dialing system to enhance the collections & payment plan process and increase cash flow by 10% and decreasing bad debt from 2.1% down to 1.8% in the course of 6 months.

• Responsible for oversight of 5 Revenue Cycle areas; Patient Accounting, Cash Handling/Cash Posting; Credit & Collections, Physician Billing & Contracting, Patient Access/Registration
• Evaluation and management of Charge master resulting in enhanced revenue procurement for the facility
• Developed financial and statistical reports for both facility and professional practices which opened lines of communication between Senior Leadership, Departments and System/Community Providers
• Setting standards for goal setting of industry benchmarks which motivated staff to achieve work efficiencies allowing for greater productivity and enhanced cash flow
• Designed and implemented and improved Financial Assistance Program for the Organization which enhanced access to care for the uninsured and under insured in our communities we served
• Working in conjunction with our Medicaid Eligibility Vendor which also improved cash flow.

• Operational oversight 4 areas; Purchasing, Patient Accounting, Admissions and Triage/Extended Care call centers
• Responsible for development and implementation of product formularies for both medical supplies and DME statewide for all program sites
• Negotiated both capitated and fee for service agreements with multiple vendors & payers to open access to Hospice care for Medicare/Medicaid patient population
• Increased market share through the education about Hospice Care in Community forums and employer groups
• Community Liaison with special interest groups for Charitable events for Children’s Hospice Services
• Supported Grant Procurement Team by providing all statistical reports needed for specialized funding
• Accountable for all AR Cash flow, denials management, recertification for continuing Hospice care with Payers as well as Third Party Payer contracting
• Worked collaboratively with I.T
• Development Team creating a thoroughly multi-functional software product (HPMS) to accommodate operational & reporting needs of the Organization’s Financial Services, Program Integrity and Patient Care Service areas
• Developed and implemented standards and procedures for both Financial Assistance Program and Quality of Life Funds.

• Oversight of all daily fiscal operations for 22 outpatient Psychiatric Clinics, 13 Medical clinics, 6 Psychiatric Acute facilities and 2 Med/Surg acute facilities as well as all “Day Hospital” Psychiatric Services, including; claims management & follow up, cash handling/cash posting & financial reporting
• Accountable for development, implementation and reporting of all Revenue Cycle Financial/executive dashboards, Aging Trend Analysis, Organizational cash flow and industry KPI/Benchmark performance
• Development and maintenance of standardized fee schedule/Charge Master for all outpatient services
• Development and distribution of monthly newsletter to keep Clinical staff abreast of changes to payer regulations for the assistance in maximizing appropriate reimbursement.

Honors: Cum Laude