Expert Details
Medical Billing & Reimbursement, Healthcare Claims Auditing & Compliance, Revenue Cycle Recovery, Managed Care Administration, HIPAA Compliance Expert
ID: 740753
Texas, USA
Across these roles, Expert has established and led multiple revenue recovery departments from the ground up, implementing shared-risk, stop-loss, third-party lien recovery, and benefit-interpretation programs, and has been credited with recovering well over a million dollars in previously unrecognized revenue and cost savings across various organizations. Expert has trained and mentored large claims and billing staffs, chaired executive-level meetings on system contracts and benefits interpretation, and modernized practice management and reporting systems.
Expert currently serves as Owner, CEO, and Founder of a medical billing and audit firm recognized as a preferred partner by a county medical society and noted as the only billing service authorized in California to administer continuing education credit for chiropractic physicians. Expert holds numerous certifications in medical billing, coding, compliance, and claims auditing, and is active in numerous professional and industry associations related to chiropractic care, medical billing, and healthcare management. Expert is a registered medical billing expert witness with multiple national expert witness referral organizations and has delivered numerous professional presentations and continuing education seminars on billing compliance, insurance practices, and healthcare regulatory topics.
Work History
| Years | Employer | Title | Department |
|---|---|---|---|
| Years: 2014 to Present | Employer: Undisclosed | Title: Owner & CEO | Department: |
Responsibilities:• Built a billing service that earned Preferred Partner status with a county medical society, noted as the only billing service authorized in California to administer continuing education units (CEUs) for chiropractic physicians.• Provides insurance billing, claims, and collections services; recommended and endorsed by state chiropractic association members and an international chiropractic association affiliate. • Serve as Co-Chair of the Managed Care and Insurance Committee for a state chiropractic association. |
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| Years | Employer | Title | Department |
| Years: 2011 to 2013 | Employer: Consolidated Healthcare Services / A1 Imaging / Hallmark Surgery Center | Title: National Director, Billing/Collections | Department: |
Responsibilities:• Oversaw billing and collections for 54 current and past state-of-the-art Open MRI centers, primarily in the southeastern United States.• Mentored and trained a direct staff of 24 and an indirect staff of 72. • Enhanced utilization of practice management software and developed staff training programs that had previously been absent. • Met or exceeded monthly collections goals in 16 of the first 18 months in the role, compared to the department having met the goal once in the prior three years. • Reduced backlog without resorting to write-offs and initiated an automated insurance denial appeal process. |
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| Years | Employer | Title | Department |
| Years: 2006 to 2011 | Employer: Prime Healthcare | Title: Hospital Business Office Manager | Department: |
Responsibilities:• Incorporated managed care training and collections practices; collaborated with legal counsel on interpretation of medical records.• Promoted to Business Office Manager within five months of hire. • Supported benefits administration and customer service best practices related to claims and insurance plan inquiries. |
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Additional Experience
| Expert Witness Experience |
|---|
| Medical Billing Expert Witness on matters involving healthcare billing, claims, and compliance (including False Claims Act issues). |
Career Accomplishments
| Associations / Societies |
|---|
| • California Chiropractic Association (CCA) — Past Co-Chair, Managed Care and Insurance Committee • International Chiropractic Association of California (ICAC) — Education Staff • American Academy of Professional Coders (AAPC) • American Medical Billing Association (AMBA) • Health Billing & 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 & Instructor • Certified CE Educator (California Board of Chiropractic Examiners) • Certified Medical Reimbursement Billing Specialist • Certified Chiropractic Reimbursement Specialist • Certified Chiropractic Professional Coder • Certified Claims Auditor • Certified Claims Examiner • Certified HIPAA Professional • Certified Medical Claims Biller • Certified Compliance Officer • Certified Professional Biller • False Claims Act Compliance Certification • Auditing Entities and Mitigating Risk of Audits Certification • Chiropractic Billing Certification (AMBA) |
| Awards / Recognition |
|---|
| • Ranked among the top ten claims examiners out of approximately 3,000 companywide • Certificate of Recognition, Rancho Cucamonga Chamber of Commerce • Certificate of Recognition, County of San Bernardino • Preferred Partner status with a county medical society (awarded to only one billing service) |
| Publications and Patents Summary |
|---|
| 7+ distinct presentations/seminar topics delivered to professional and educational audiences, including a continuing-education series delivered as 16 seminars in a single year. Topics include proper use of billing modifiers, ethical and compliant billing practices, chiropractic billing and insurance history, the legality of insurer claims practices, ICD-10 transition preparedness, and strategies for appealing insurance claim denials. Presenter, American Association of Orthopaedic Surgeons (AAOS); Featured Lecturer, Foundation for Chiropractic Progress; additional presentations for chiropractic association chapters and a health sciences university. |
Fields of Expertise
Expert medical billing, medical billing, Healthcare Claims Auditing, Revenue Recovery, Chiropractic Billing, Insurance Claims Adjudication, Third-Party Lien Recovery, ICD-10, Claims Examiner, Healthcare Revenue Integrity, False Claims Act Compliance, Revenue Cycle Management, HIPAA Compliance, medical reimbursement, managed care, medical coding