Clinton B. Mayers Email & Phone Number

Glendale, California, United States

Wayne, Pa

Developed and managed a team of bill analysts for workers' compensation network provider billings to insurance companies and third party payors. Responsible for the collection and distribution of funds to physical therapy providers in the Anthem workers' compensation network. Involved in the automation process of the billing and collection system used for billing payors, including the introduction of EDI submission of provider bills.

Wayne, Pa

Identified, managed and contracted providers in target markets and resolved complex provider subscription and operations issues. Developed provider education activities for subscribed providers to assure provider satisfaction and dispute management (and resolution).

Orange, California, United States

Supervised the clinical/complex bill review team comprised of four physician reviewers and seven Sr. Clinical Bill Review Analysts. Successfully integrated a new Utilization Review software system for physician decisions with the bill review system to block denied services. Created the training required for processing medical/facility bills in multiple state jurisdictions and provided coaching to continually develop team values and skills. Responsible for managing the two largest bill review clients including petitions filed with various state workers’ compensation boards and provided Expert Witness testimony when required. Managed the bill review department which included the provider relations department for medical, surgical, and facility bill clients. Resolved issues quickly and professionally by identifying discrepancies and developing effective solutions.• Developed a successful provider relations team and call center.• Successfully boosted department efficiency 100% in the first 6 months by reorganizing workflows and expanding job descriptions.• Increased the Quality Assurance (QA) scores from 90% to 98% accuracy within the first year and maintained that until the company closed operations.• Provided training to the department for the software systems utilized by the company, changes in workers compensation fee schedules nationwide and specialty bill review processing.• Reduced production turnaround time 30% - from 10 calendar days to 7 calendar days by revamping the reporting system and increasing productivity below industry standards by focusing analyst processing to selected jurisdictions and medical bill types.• Successfully reorganized the bill review department after each of 3 rounds of layoffs by reassigning tasks, streamlining job responsibilities and continued to maintain production and QA at pre-layoff levels.

Lake Forest, Ca 92883

Oversaw a large team of bill review and UR specialists, managing multiple large clients for medical bill review and UR services. Provided reasonable fee determinations through proprietary methodology when no fee schedule exists. Testified as an expert witness at various workers’ compensation boards on multiple occasions. • Founded a Utilization review company and seamlessly integrated the UR software with our bill review company software in order to successfully produce accurate medical bill reviews to include the UR decision.• Performed hundreds of thousands of medical bill reviews (medical bills, facility bills, ancillary providers, pharmacy and specialty bills) in multiple state jurisdictions based upon workers’ compensation fee schedules and/or usual and customary fee reviews where no state fee schedule exists.• Successfully maintained a medical bill review turn-around time of 3 to 5 working days.• Developed a method to determine reimbursements for clients that have Longshore claims or Jones Act claims for maritime bills including payment negotiation services with various provider types when needed.• Developed proprietary PPO network with over 1K locations (with contract language containing UR requirements) as an MPN for clients.• Provided training to all staff for the software systems utilized by the company, changes in workers compensation fee schedules nationwide and specialty bill review processing.

Bachelor Of Arts (B.A.), Political Science, 3.0

Activities and Societies: Member of the Blackstonian Honorary Pre-Law Society, Selected to participate in the Urban Semester Course (16.

Associate Of Arts - Aa, Political Science, 3.0

Glendale, CA