The conversation then dives into a digital Medicaid and charity care initiative designed to reach uninsured and underserved patients at scale. Garrick outlines the operational problem, how manual tracking led to missed opportunity, and why enabling mobile-first document capture and automated filing materially improved identification, throughput, and audit readiness, especially as presumptive eligibility timelines tighten.
Garrick also discusses where AI and automation can create real value across healthcare RCM, from insurance verification bots to faster detection of shifting payer denial patterns. He closes with leadership lessons on change management, vendor skepticism, and the mindset required to stay ahead as technology reshapes hospital business models.
The conversation then dives into a digital Medicaid and charity care initiative designed to reach uninsured and underserved patients at scale. Garrick outlines the operational problem, how manual tracking led to missed opportunity, and why enabling mobile-first document capture and automated filing materially improved identification, throughput, and audit readiness, especially as presumptive eligibility timelines tighten.
Garrick also discusses where AI and automation can create real value across healthcare RCM, from insurance verification bots to faster detection of shifting payer denial patterns. He closes with leadership lessons on change management, vendor skepticism, and the mindset required to stay ahead as technology reshapes hospital business models.
“Every component of the revenue cycle has an opportunity for AI to improve operations, but you have to test it, validate the ROI, and be clear about the outcome you’re trying to achieve.”
— Garrick Stoldt, Chief Financial Officer, St. Peter’s Healthcare System
Guest: Garrick Stoldt, Chief Financial Officer, St. Peter’s Healthcare System
Host: Praveen Chandran
Praveen Chandran
Hi everyone, and welcome to another episode of The RC Executive Lounge podcast series. I’m your host, Praveen, and I’m really thrilled you’re all here today.
I’m personally excited to welcome a guest whose experience and perspective make this a conversation you do not want to miss. We’re joined by Garrick Stoldt, Chief Financial Officer at St. Peter’s Healthcare System in New Brunswick, New Jersey.
With more than 40 years in healthcare finance and over 21 years at St. Peter’s, Garrick has played a central role in navigating Medicaid cuts, 340B pricing pressures, rising payer denials, and the strategic integration of AI into financial operations. He is a Certified Public Accountant, a Fellow of the Healthcare Financial Management Association, and was recognized as one of New Jersey’s leaders in finance in 2021.
He also serves as an adjunct lecturer in healthcare finance at Rutgers University’s business school. Garrick, welcome to the show, and thank you so much for joining us.
Garrick Stoldt
Thank you very much for having me. I really appreciate it and I’m excited to dive into the conversation.
Praveen Chandran
There is so much happening in healthcare finance and revenue cycle management today, especially with agentic AI and other emerging technologies entering the field. At the same time, teams are dealing with ongoing pressures from denials, payer delays, patient financing, and staffing gaps.
How do you think about setting strategic priorities, both three to five years out and in the next 10 to 12 months?
Garrick Stoldt
The pressures on healthcare systems are greater than ever for multiple reasons. Governmental pressures from Medicaid cuts, managed care policy changes, denials, and payment delays are enormous.
Recently, Kaufman Hall published guidance on what health systems need to do to confront these challenges, and much of it comes back to fundamentals. It’s about going back to the basics of revenue cycle strategy, improving operational efficiency, and tightening how patients are identified, classified, and managed across the continuum.
That includes making sure patients are properly admitted versus observation status, improving emergency department throughput, reducing length of stay, and adjusting workforce models accordingly. It’s also about improving outpatient access, reducing wait times, and increasing new patient visits that ultimately drive admissions.
We’ve been on that journey for about a year and a half now. Much of it was driven by rising denials, but we also anticipated Medicaid pressures and changes to provider tax and transfer payment programs. In New Jersey, we’re somewhat in the middle compared to other states, but we still need to prepare for changes ahead.
Every so often, you have to reassess your entire organization. Things change, staffing creeps up, payer behavior shifts, and suddenly what worked two years ago no longer works today.
In revenue cycle specifically, we saw denial rates spike starting in mid-2022 as payers tightened policies across multiple categories. That forced us to rework staffing models, improve utilization review, strengthen physician advisor processes, and ensure we were doing peer-to-peer reviews on every eligible case.
We also invested more in denials management on the back end so we could identify trends and redirect resources quickly. It’s a constant adjustment.
Praveen Chandran
RCM teams always have long lists of priorities, but organizations have to make hard choices. Can you share an example where you had to say no to a good initiative in favor of something more critical?
Garrick Stoldt
We recently evaluated an AI-driven clinical resource that would have helped patient care, but there was no return on investment. The ROI was zero.
We had a senior management discussion about how we assess AI opportunities, and we agreed that if an initiative doesn’t have a clear return in today’s environment, it shouldn’t move forward until we’ve maximized other areas.
We’ve already said no to certain clinical AI projects, while moving forward with others that show promise. For example, we’re piloting AI in physician office practices to help identify and manage problem lists in the electronic health record.
That kind of tool has the potential to prevent serious medical incidents by identifying risks earlier. We’re also using AI in emergency department workflows to help clinicians focus on what they do best.
Praveen Chandran
You mentioned that your denial rate is around four percent, which is among the lowest in the industry. At events like HFMA, topics like denial prevention, patient financing, and financial assistance are front and center.
How do these areas fit into your strategic priorities year over year?
Garrick Stoldt
They’re always a priority because revenue cycle performance can slip very quickly. Before the pandemic, our denial rate was around two percent. Now we’re at four percent, and we feel good about that given the avalanche of new payer issues we’re dealing with.
We make sure that one hundred percent of denials for inpatients receive peer review and go back to payers. We’ve improved our success rate from around thirty-five percent to about eighty percent.
But even when a denial is overturned, that doesn’t guarantee payment. We’ve seen about ten percent of overturned claims fail to adjudicate properly, which requires additional follow-up. Without that extra step, we’d leave money on the table.
This kind of insight only comes when you track every case closely and refine processes continuously.
Praveen Chandran
Let’s shift to a specific initiative you led around expanding access. What challenge were you trying to solve?
Garrick Stoldt
We see a large number of uninsured patients coming through our emergency department and clinics. Many of them aren’t enrolled in Medicaid or charity care when they arrive.
Historically, we relied on manual processes and resource advisors to interview patients and track documentation using spreadsheets. We provided presumptive Medicaid eligibility on day one, but then had a limited window to collect documentation, and many patients never completed the process.
Because we’re a mission-driven organization, we never turn patients away. But we knew we were missing a significant number of eligible patients, which also meant missing supplemental Medicaid payments.
We partnered with a vendor to implement a mobile-first, AI-enabled workflow. Instead of staff screening patients manually, they now educate patients on how to use a simple app on their phone to upload documentation.
Most underserved patients still have smartphones. This approach reduced staff-patient handoffs, accelerated documentation, and allowed applications to be completed within shrinking eligibility windows.
The system also automated reminders and filings, significantly increasing Medicaid and charity care identification. It improved audit readiness and reduced the burden on staff and auditors alike.
Praveen Chandran
How did you approach vendor selection, and what lessons did you learn during implementation?
Garrick Stoldt
This was a relatively new product. We learned about it through state-level contacts and quickly realized no one else was doing this at scale.
Some EHR vendors offered partial solutions, but they didn’t complete applications or enable mobile-first workflows. This vendor was unique in focusing on underserved populations, which aligned with our mission.
Implementation required re-educating staff. Some were initially concerned about job security, but no one lost their job. Roles shifted from manual screening to patient education and higher-value follow-up.
For patients who couldn’t use the app effectively, staff had more time to provide hands-on support. Overall, it improved outcomes for both patients and staff.
Praveen Chandran
Looking ahead, what role do you see agentic AI playing in revenue cycle operations?
Garrick Stoldt
There’s almost no part of the revenue cycle that couldn’t benefit from AI. We’ve explored bots for pre-registration and insurance verification, especially to expand coverage across all encounters, not just high-dollar cases.
AI can also help detect payer behavior changes faster than retrospective analysis. Payers constantly adjust policies in ways that delay or reduce payment, and predictive analytics can help us respond more quickly.
We’re also seeing value in aggregating statewide data to identify payer trends and pursue regulatory or legislative solutions when needed.
Praveen Chandran
Change management is hard, especially in complex RCM environments. How do you build momentum for change?
Garrick Stoldt
You have to involve everyone early and be clear about the outcome you’re trying to achieve. Revenue cycle touches clinical teams, finance, operations, and payers.
You also need to be candid about disruption. If people know what’s coming, they’re more likely to support the change. Fear, especially around job loss, has to be addressed head-on.
Most people want positive change. The key is helping them see how the change benefits both the organization and their role within it.
Praveen Chandran
If you could offer one piece of advice to another CFO or RCM leader facing similar challenges, what would it be?
Garrick Stoldt
Sometimes you need an independent perspective. It’s easy to get too close to internal processes and personalities.
Whether internally or with outside support, stepping back and evaluating raw processes objectively is critical, especially as payer behavior forces constant change.
Praveen Chandran
Garrick, thank you for sharing such thoughtful insights. I know our listeners will walk away with a lot to think about.
Garrick Stoldt
Thank you very much for having me.