Lori Burton Email and Phone Number

Promoted from Senior Contract Analyst position (04/16-07/17) to Manager of Contract Operations. Responsible for development and operationalizing of the new health system department which negotiates and operationalizes provider and health plan contracts, contract implementation and ongoing contract management for 10 provider entities within the System and mitigate risk via contract compliance. Educate and direct contracting analysts on regulatory statutes and payers’ provider manual interpretation, charged team with researching/validating contract compliance issues, including state and federal statutes and payers’ provider manual interpretation for best practice optimization. Equipped team with skills to resolve issues and influence payers on adherence to state and federal statutes. Accomplishments include:Foster and renew relationships between hospital system and payers, cultivating strong, trust-based relationships with the goal of working collaboratively on new initiatives and service lines to the benefit of both parties and their stakeholders.Mentor a team of consultants and analysts in contract analytics, risk mitigation, root cause identification and remediation and influencing payers/stakeholders in the importance of adherence to state and federal statutes. Provide guidance to internal and external operations teams to include Enterprise Revenue Cycle, Revenue Integrity, Central Provided Data Management, and several others to ensure compliance with contractual obligations.Member of an inter-disciplinary leadership team working to expand telehealth service offerings and establishment of virtual clinics throughout the state of Maine. Created operational level team in collaboration with Senior Leaders to review barriers to improved length of stay and other Integrated Care Management Council directed initiatives and determine potential solutions. During my tenure the department consistently exceeded departmental LEMs by 25-30% annually.

Collaborated with senior leaders to establish an in-house, managed care contracting department. The department is responsible for the negotiation and performance of all managed Medicare and commercial payer contracts for a non hospital system.

Promoted from Revenue Cycle Operations Support Coordinator (02/2014-07/2015). Involved in the creation and execution of organizational structure, job descriptions, interviewing, and vetting external strategic partner to assist with implementation across 9 facility footprint. Accomplishments include:Discovered vendor regulatory issue within the Denials Management System/835s and worked collaboratively across groups to optimize denials coding to reach compliance. This issue had resulted in a net revenue recovery of $3 million. Led design, build and implementation of a system-wide denials management tool.Supported regulatory compliance, drove operational efficiency and maximized system performance. Audited process flows for efficiency and improvements to identify areas of additional educational opportunity for front-line staff.Created standardized onboarding protocols for new staff members

Promoted from Patient Account Representative (Payer Follow-up). Investigated and implemented revenue cycle initiatives for all aspects of revenue cycle and EMR intitiatives. Communicated with internal and external stakeholders and managed/resolved all escalated project issues. Led 31 direct reports on multiple projects with budgets ranging from $1M to $10M. Accomplishments include:Led Medicaid project of 9 employees and 23 temps involving rebilling 168,000 partially or fully denied claims resulting in A/R day reduction by 14 in 90 days. Training on denials trending and automation of secondary billing resulted in additional increases to cash collections. Coordinated and implemented systems redesign, implementations, super user trainings, and billing logic / claim form setup optimizationsServed as operation subject matter expert (SME), during system-wide EMR implementation (Cerner).