Healthcare

Extensive experience in healthcare administration, policies and regulation, and clinical practice, focusing on using healthcare measures to improve performance outcomes and in teaching future medical professionals.

• Serves in multiple positions on professional associations addressing healthcare reform and regulatory issues.
• Serves as an instructor and clinical extern supervisor in a nationally accredited University training program.
• Develops and implements rural healthcare services for historically underserved populations to increase ease of access to care.

Multi-State contracted in-network provider to third-party payors, Medicaid, and all Medicaid Managed Care Organizations.

• Specializes in providing independent and impartial expert evaluations in cases of contested eligibility determinations and differential diagnosis.
• Reviews healthcare data, research, and professionally recognized sources of medical evidence for reliability to support the accuracy of claims and diagnoses and to provide clinically relevant, outcome-driven, evidence-based treatments.
• Strategic planning, development, and implementation of a program to manage claims from various payor sources, design performance reports and measures, and works with providers and payors to correct errors in payments and documentation.
• Supports programs that examine the comparative benefits of a fee-for-service model of care versus a performance-driven reimbursement.
• Supports state-level Medicaid initiative to incentivize provider groups by rewarding quality performance, reduced costs, and improved health and prevention outcome measures.