Expert Details

Medical Billing & Coding: Reimbursement, Claims Auditing & Analysis, Healthcare Fraud & Abuse, Revenue Cycle Management, Compliance and HIPAA

ID: 734982 California, USA

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Expert is a medical billing, coding, and healthcare reimbursement professional with extensive experience across insurance carriers, hospitals, imaging centers, physician groups, and managed care organizations. His career spans leadership roles in claims adjudication, billing and collections, revenue recovery, compliance, and audit functions, with a focus on improving reimbursement accuracy, regulatory adherence, and financial performance within complex healthcare systems.

Expert founded and leads a medical billing and audit firm specializing in insurance billing, claims audits, compliance, and revenue recovery. Under his leadership, the firm achieved preferred partner status with a county medical society and authorization to provide continuing education units for licensed healthcare professionals. He has also served in leadership positions within professional associations, contributing to policy discussions and managed care initiatives related to billing practices and insurance oversight.

Expert has provided litigation support as a medical billing and reimbursement expert witness. His forensic work includes analysis of medical billing records, coding accuracy, insurance claims processing, and compliance with federal and state regulations.

Work History

Years Employer Title Department
Years: 2014 to Present Employer: Undisclosed Title: Owner, CEO, and Founder Department: Owner, CEO, and Founder
Responsibilities:
Medical billing, auditing, and compliance firm.
• Provides insurance billing, claims auditing, collections, and reimbursement services.
• Earned preferred partner status with San Bernardino County Medical Society.
• Authorized billing service in California to provide continuing education units (CEUs) for physicians.
• Recommended and endorsed by professional chiropractic organizations.
• Served as Co-Chair of the Insurance and Managed Care Committee for the California Chiropractic Association.
Years Employer Title Department
Years: 2011 to 2013 Employer: Consolidated Healthcare Services / A1 Imaging / Hallmark Surgery Center Title: National Director, Billing and Collections Department:
Responsibilities:
• Directed billing and collections operations for a national network of imaging centers.
• Developed and mentored billing staff and implemented training programs.
• Improved collections performance and implemented automated insurance denial appeal processes.
• Enhanced utilization of practice management software systems.
Years Employer Title Department
Years: 2009 to 2011 Employer: Prime Healthcare Title: Hospital Business Office Manager Department:
Responsibilities:
• Managed hospital business office operations including managed care training and collections.
• Collaborated with legal counsel on medical record interpretation related to claims.
• Promoted rapidly based on performance.
Years Employer Title Department
Years: 2007 to 2009 Employer: Perot Systems (acquired by Dell) Title: IDX Systems Analyst Department:
Responsibilities:
• Conducted audits of claims systems, benefit tables, and eligibility documentation.
• Facilitated executive-level meetings regarding system contracts and benefit interpretation.
Years Employer Title Department
Years: 2004 to 2007 Employer: Pomona Valley Hospital Medical Center Title: Claims Supervisor Department:
Responsibilities:
Supervised and trained claims analysts handling inpatient, outpatient, ambulance, skilled nursing, and ancillary claims.
Years Employer Title Department
Years: 2003 to 2004 Employer: Desert Physicians Management Title: Revenue Recovery Manager Department:
Responsibilities:
Established revenue recovery functions focused on third-party liens and risk reconciliation. Recovered previously unidentified revenue.
Years Employer Title Department
Years: 2002 to 2003 Employer: Arcadian Management Services Title: Manager, Revenue Recovery Department:
Responsibilities:
• Created and led a revenue recovery department for healthcare provider groups and health plans.
• Developed cost containment, audit, and shared-risk recovery methodologies.
• Achieved significant recovery through third-party lien operations.
Years Employer Title Department
Years: 2000 to 2002 Employer: USC University Affiliates IPA Title: Manager, Contractual Analysis and Auditing Department:
Responsibilities:
• Served as liaison for contract interpretation and regulatory compliance.
• Developed policies and procedures for shared risk, stop loss, and benefit interpretation.
• Conducted high-level audits resulting in substantial revenue recovery.
Years Employer Title Department
Years: 1997 to 2000 Employer: ProMed Healthcare Administrators Title: Manager, Revenue Recovery / IT & IS Supervisor / Report Writer Department:
Responsibilities:
• Implemented departments governing shared risk, stop loss, liens, and insured services.
• Achieved significant cost savings and revenue recovery.
• Promoted to financial analyst and information systems leadership roles.
Years Employer Title Department
Years: 1995 to 1997 Employer: MedPartners / Pacific Physician Services / US Family Care Title: Supervisor, HMO Recovery / Customer Service / Director of Mailroom Operations Department:
Responsibilities:
Supervised departments responsible for shared risk, stop loss, liens, insured services, and coordination of benefits.
Years Employer Title Department
Years: 1992 to 1995 Employer: Aetna Insurance Company Title: Senior Claims Adjudicator / Auditor / Trainer / Lead Department:
Responsibilities:
• Achieved top performance rankings in claims production and quality.
• Advanced rapidly to senior examiner level.
• Trained and mentored claims personnel.

Additional Experience

Expert Witness Experience
Expert provides litigation support involving medical billing practices, coding accuracy, insurance reimbursement, claims adjudication, audits, compliance, and managed care disputes. Services include medical billing audits, claims analysis, compliance evaluations, expert reports, and testimony support.

Career Accomplishments

Associations / Societies
• California Chiropractic Association (CCA) – Past Co-Chair, Managed Care and Insurance Committee
• International Chiropractic Association of California (ICAC)
• American Academy of Professional Coders (AAPC)
• American Medical Billing Association (AMBA)
• Healthcare Billing and Management Association (HBMA)
• Medical Group Management Association (MGMA)
• San Bernardino County Medical Society (SBCMS)
• Los Angeles County Podiatric Medical Society (LACPMS)
• Business Network International (BNI)
• Rancho Cucamonga Chamber of Commerce
Licenses / Certifications
• Certified Professional Coder (CPC) & Instructor
• Certified Chiropractic Professional Coder
• Certified as a Specialist in Medical Reimbursement & Billing
• Certified as a Medical Claims Biller, Auditor, and Examiner
• Certified HIPAA Professional & Compliance Officer
• Certified CE Educator, California Board of Chiropractic Examiners
• False Claims Act Compliance Certification
Awards / Recognition
• Certificate of Recognition, Rancho Cucamonga Chamber of Commerce
• Preferred Partner Status, San Bernardino County Medical Society
Publications and Patents Summary
Expert has delivered multiple continuing education seminars on medical billing, coding, insurance practices, and compliance, and has presented for professional medical and chiropractic organizations and academic institutions. Topics include insurance billing ethics, modifier usage, ICD-10 implementation, Medicare billing, and insurance appeals.

Fields of Expertise

medical billing, false billing, billing service, legal billing, Healthcare Reimbursement, Claims Audit, Revenue Cycle Management, Insurance Billing Disputes, HIPAA Compliance, managed care, medical coding, Insurance Claims Analysis, Healthcare Fraud, Healthcare Abuse, Medical Billing and Collections, Medical Records Review

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