Manager Medical

BARRY R. DALTON

*** *.. **** ******

Salida, CO 81201

951-***-**** = Cell

accksp@r.postjobfree.com

EDUCATION

Michigan State University - Bachelor of Arts, 1973

Lansing Community College - Associates Degree, 1970

SKILLS

. 23 Years Corporate Medical Consulting Business Management (Owner).

. HIPAA Compliant Expert In-Patient and Out-Patient UB-04 procedures.

. CMC/EDI submitters to Medi-Cal/Medicaid/Medicare.

. Workers' Compensation Claim/Lien Recovery.

. Commercial Billing/Recovery/HMO & PPO Billing & Recovery

. Currently teaching evening classes in Medical Coding & Billing

. System familiarity: Eclipsys, SSI, MDX, Cerner, HMS

EXPERIENCE

HEART OF THE ROCKIES REGIONAL MEDICAL CENTER: 11/14/12-12/27/13

PFS MANAGER

. Oversee all Business Office functions: Billing, Collections, Access

. First PFS director to successfully set-up new 855-R for new clinic. I

was able to work directly with the Claims Processing Manager at

Novitas (Medicare) and get them to agree to process claims dating back

over 1 year from date-of-service. This effort brought in over

$200,000 to the Hospital.

. Following the same criteria used for Medicare, I was able to get

Colorado Medicaid to agree to the same terms, processing claims going

back over 1 year from date-of-service. This effort netted the

hospital another $89,000 in payments.

. Sat in on ICD-10 steering committee

. In the process of developing a better tool for Patient Charge

Estimator for Surgeries, CT Scans, etc. The Hospital was using

software developed by Craneware, and we were still ironing out some of

the technical problems

. Oversaw a staff of 24 Full-Time employees

. Also produced monthly statistics for Clinics using Nextgen Report

writer

. Had just successfully helped in the process of getting 2 of our

Physicians who did an internal medicine clinic within the Hospital set-

up to do Provider - Based Medicare Billing

ST. VINCENT HOSPITAL 04/18/11-11/14/12

BUSINESS OFFICE MANAGER

. Oversee all Business Office functions: Billing, Collections, Access

. Chairman of Revenue Cycle Committee

. Co-Chairman of IT Steering Committee: We are in the process of doing

our EHR build, and also pursuing an entire HIS build.

. First person in over 4 years to get our 855-B, 855-I, and 855-R

approved by Trailblazer, Medicare.

. In working closely with our HIM Director, we have been able to reduce

our DNFB days from 23.5 days in December, to a current 2.57 days!

EVEREST COLLEGE 03/01/10-01/31/11

INSTRUCTOR-MEDICAL INSURANCE, BILLING, & CODING

. Instruct students in proficient usage of ICD-9, CPT, and HCPC Coding

. Instruct students on the basic bodily structure and body systems

. Lab time affords the students to increase their proficiency in typing,

Word, Excel, and in teaching Medisoft Billing System.

GOOD SAMARITAN HOSPITAL 06/24/09-11/30/09

BUSINESS OFFICE MANAGER

. Responsible for directing staff in ALL initial Billing

. Responsible for coordinating follow-up and collections

. Responsible for monthly reporting to the COO

. Responsible for coordinating efforts with the Access Manager for

admissions, and in working closely with HIM Manager for Medical

Records and TARs.

HEARTLAND REGIONAL MEDICAL CENTER 03/07-06/09

. Billing Manager for 450 Bed Hospital-Community Non-Profit

. Annual Gross Billings almost $1 Billion

. Billings include Facility-based, Acute, Mental Health, and now LTAC

. Billings also include Professional billing for over 115 Physicians

. Average AR days run between 49-53 days

. Billing System is Eclipsys

. Registration System is Cerner

. Familiar with Microsoft Office Suite, Outlook, Word, Excel

. Manage a Staff of 25 Employees-All up-front billing and Follow-up

. Employee satisfaction has improved over 200% since my hire as Manager

. Sit on Revenue Cycle Committee where we discuss NDCs, CCI edits, etc.

. Work closely with Team Leaders in Access, HIS, and Revenue and

Reimbursement,

. And Care Management. A good Inter-Departmental collaborative Team

approach

. Set-up a worksheet utilized by Care Management, HIS, and PFS to track

TARs Have established good networking with the State's Director

processing TARs and

. Pre-Certifications

. Set-up Committee with Access Leaders and Clinic Coordinators to

improve

. Up-front Registrations. This teamwork has helped reduce registration

errors

. I have direct access to California's Appeals Director & Over-1-Year

Supervisor

. I have taught Medical Coding and Billing at Maric College

. We are in the early stages of developing our Denial Management System

MARIC COLLEGE-POMONA, CA 10/05-03/07

. Instruct students in proficient usage of ICD-9, CPT, and HCPC Coding

. Instruct students on the basic bodily structure and body systems

. Lab time affords the students to increase their proficiency in typing,

Word, Excel, and in teaching Medisoft Billing System.

DALTON'S MEDICAL CONSULTING SERVICE

1987-Present: Owner

Dalton's Medical Consulting Services specializes in Accounts

Receivable Recovery for Hospital Facilities. Company's area of

expertise has been working aged Receivables over 120 days post-

discharge date and consisting of Medi-Cal/Medicaid, Medicare, and

other Insurance/HMO follow-up.

During the past 23 years led Company to helping Clients reduce their

outstanding Accounts Receivables by over $55,000,000.00 Dollars,

bringing in actual Cash Revenues of over $30,578,000.00. Applied

knowledge of the guidelines and regulations of Healthcare and

maintained Compliance with HIPAA mandates. Attention to detail in

working aged claims has kept Dalton's Medical Consulting near the top

of the Consulting Industry's percentage leaders in recovery of

assigned claims. For over 23 years Company has successfully

recovered over 90% of all billable assigned claims.

Partial Listing of Past/Present Clients:

1. Children's Hospital Los Angeles: March 1997-April 1999-Reduced

Accounts Receivable by $49,090,062.24 bringing in Net Revenues of

$10,201,959.82.

2. St. Bernardine Medical Center: April 1999-April 2003-Billing

Contract for Out-Patient Managed Care and Cross-Over Claims-Billed

over 32,000 Claims with a Billed Amount of over $13,400,000.00

3. Coastal Communities Hospital: March 1993-August 1995-Medi-Cal

Follow-up and Billing Project-Reduced Accounts Receivable by

$18,035,111.01, bringing in Net Revenues of $7,610,150.92.

4. City of Hope National Medical Center: June 1996-April 1998-Medi-

Cal Follow-up Project-Reduced Accounts Receivable by $8,125,305.76,

bringing in Net Revenues of $1,951,902.71.

5. Pacific Alliance Medical Center: April, 2003-Current-Ongoing

assignments in working aged Accounts Receivable claims in Medi-Cal

and Medicare.

6. Community Hospital San Bernardino: December 1998-Current-Cross-

over Billing only-9,500 Claims with Total Charges over

$2,091,918.94.

7. Chino Valley Medical Center: September 2002-February 2005-Medi-Cal

Follow-up Project, with Up-Front Billing for Medi-Cal and Medicare-

Up-front In-Patient Billing: 684 of 701 Claims Billed have Paid-

97.57% Success Rate-Accounts Receivable Reduced $9,656,421.21 with

Net Revenues of $2,149,651.54. Follow-up Project has reduced

Accounts Receivables by $4,957,951.99 with additional Net Revenues

of $756,460.90. Medicare Payments have exceeded $5,450,000.00.

OTHER EXPERIENCE

1979-1980: Business Office Manager for a 70 bed Hospital in Los

Angeles, CA. Responsible for all Business Office Operations including

Patient Access.

1980-1987: Consultant for Professional Financial Services, a

Collection Agency specializing in Hospital Accounts Receivables.

Responsibilities included various on-site assignments working for

Business Offices contracted with Professional Financial Services.

Contact this candidate