Dave Dutton Email & Phone Number

Louisville, Kentucky, United States

Louisville, Kentucky, United States

Louisville, Kentucky Area

 Unit Lead for Government Inpatient Team of 16 associates (Auditors, Junior Auditors) generating $18M in annual revenue. Developed Government Inpatient training material and successfully trained 10+ Junior Auditors Developed Quality Control Process leading to team accuracy rate of 97% Subject Matter Expert for 6 Medicare inpatient concepts and 3 state Medicaid programs. Developed 2 new inpatient auditing concepts leading to $5M in added revenue for a national health plan.

Louisville, Kentucky Area

 Performed audits on paid healthcare claims identifying $2M per year in overpayments on behalf of a national health plan. Consistently met daily production goal of a minimum of 200 claims per day. Made recommendations to Team Lead/Audit Management regarding report revisions and enhancements. Responded to client inquiries regarding overpayments written.

Louisville, Kentucky Area

 Interfaced directly with 6 health plan clients on inbound call activity. Resolved member discrepancies. Managed the operations of a $22M Pharmacy Division of 30 associates (Team Managers, Recovery - Billing Analysists) generating $1.8M in monthly revenue on behalf of health plan clients. Implemented and executed a quality review process resulting in a staff QC accuracy rating of 98%. Implemented and executed a new recovery methodology resulting in more efficient and thorough collection of $5M in overpaid pharmacy claims.

Louisville, Kentucky Area

 Managed the centralized corporate reimbursement operations with 45 associates (Team Leads, Recovery- Billing Specialists). Performed detailed analysis of accounts receivables resulting in significant changes in front end insurance verification processes. Analyzed department work flow and reorganized into functional job responsibilities, creating a 10% increase in monthly department productivity. Designed reimbursement department training and streamlined processes.

Overland Park, Kansas Area

 Managed daily operations of 3 pharmaceutical Oncology reimbursement programs for Bristol Myers Squibb Oncology. Provided reimbursement consulting services to private and community based oncology practices nationwide educating them on heath plans’ billing procedures for new oncology drugs. Designed and implemented AccessMed’s reimbursement hotline and patient assistance program for Celgene Corporation’s drug Thalomid.  Presented pharmacy manufacturer’s support assistance programs for low income oncology patients at 3 state medical society meetings.

Overland Park, Kansas Area

 Managed accounts receivable and reimbursement issues in the region, which consisted of 8 branch locations in 6 states. Performed on site quality assurance reviews making evaluations and recommendations on staffing levels and performance improvement. Developed reimbursement training materials for the region. Successfully converted 8 branch office receivables to the Medical Manager billing A/R system.