Susan V. DALTON R.N. CPC

*** ********** *****

Safety Harbor, FL. 34695

727-***-****

abh6a5@r.postjobfree.com

EMPLOYMENT

**/**** - ******* *************

Manager/Consultant

Trans1 Wilmington, N.C.

. Medical Device / Surgical Reimbursement Consulting to

Surgeons and their staff

. Surgeon documentation and coding education

. Office staff billing and coding, EMR education

. Assist in Appeals process

. Consistent Payer Policy reviews

. State Regulatory laws reviewed

. Travel 30% - 60 %

. Home office in Florida

6/2009 - 11/2009 Clinical Nurse

Reviewer

United Health Group Oldsmar, FL.

. Medical Claim reviews

. Gate keeping for MD Claim Review

. Unet System Analyst

. Coding Reviews

. Documentation Review

. Claim Approval/Denial

6/2008 - 6/2009 Manager of

Patient Coordination

Laser Spine Institute Tampa, FL.

. Manager of Patient Coordinators

. Coordinating Patient Care for preparation of Surgery in

ASC

. Coordinating Patient discharge needs

. Preparation of Medical Clearance

. Outside Channel relationships -managing and maintaining

. Balancing Sales/Operation relationships

. Supervision of balancing Surgery/Clinic Schedule

. Maintaining Surgery- Sales/Cancellations

. Payroll

. Reporting Scheduling data/analysis

. Patient and Staff Education on Arthroscopic Spine Surgeries

. Departmental Policies and Procedures

. EMR Utilization - Amkai

Susan V. Dalton

page 2

1/2005 - 6/2008 Clinical Advisor/Systems Innovations Analyst/Medicare

Risk Adjustment Auditor-Coder

Humana Insurance Co. Tampa, FL.

* Education to Physicians and their staff on

Coding/Billing/Documentation for CMS (MRA) Documentation,

Coding and Billing practices.

* Public Speaking Seminars for Education Purposes for Large

Groups of MD's, Practitioners, RN's and other Staff

* Managing Physician relationships

* Development of Educational Tools

* Development of MRA education in 5 Counties in the Tampa Bay

Area

* Trouble shooting Billing practices

* Use of EMR

* Chart Auditing for Documentation/Billing errors

* Data Validation for CMS

* Analyst of data

* Proficient in Word, Excel, PP

Strong Computer Skills

9/2002 - 12/31/04 Quality Assurance

Director/Medical Management

Consult Care Inc. Tampa, FL.

* State of Florida Juvenile Detention Centers

* State of Florida Juvenile Residential Centers

* Private Juvenile Residential and Detention Centers

* Preparing facilities Medical Clinic for State Quality

Insurance Inspections

* Preparing facilities Medical Clinic for National

Accreditation

* Preparing and Updating Facility Operating Procedures

* Generating Forms and guidelines for Daily Operation of

Medical Clinics

* Directing Medical staff of Facility Operating Procedures

* Chart and Log Utilization reviews

* HIPPA Compliance Officer

* Management in all Aspects of Clinic day to day operation

* Hiring and Termination

* 14 Facility Medical Clinics in all traveling throughout the

State of Florida

3/1996 - 9/2003

Obstetrics Registered Nurse

Morton Plant Hospital

Clearwater, FL.

* Float to three different hospitall

* Floors included: Medical/Surgical, Oncology, Orthopedics,

Geriatrics, Pediatrics, Telemetry - cardiac, Urology,

Obstetrics, Gynecology, Mother -baby

Technical Skills: Proficient in most Computer Applications and

troubleshooting; also Excel, PP, Word, Amkai EMR.

EDUCATION

PMCC/FMU - Preparation for AAPC CPC Exam

Clearwater Fl

2007

Springfield Technical Community College

Springfield, MA.

1992 Associates Degree in Nursing

Taconic High School

Pittsfield, MA.

1983 Graduate Graphic Arts/ College Prep

Previous Name: Susan V. Belot (1983 - 1997) References

furnished upon request

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