Expert with high success rate in all types of appeals of denials. Detail-driven. Accurate. Highly experienced in Clinical Medicine, with 7+ years as Physician Assistant, immersed in patient care in emergency rooms, inpatient, and outpatient setting. 15+ years appealing denials of hospital charges by private insurers, Medicare, Medicaid, RACs, and External Review Boards, Achieved up to 70% success rate in overturning medical denials by written appeals and in Medicare and Medicaid hearings as medical witness. Applies advanced clinical/medical background; held leadership positions. Combines complex experience in direct care with detail-driven research, writing, and advocating. Achieves strong, comprehensive outcomes.15 years Clinical Appeal Writing5 years Research, Clinical, Medical, Detail-driven7 years Clinical Physician AssistantAREAS of EXPERTISELEADERSHIP / INFLUENCE: Overturning Denials, Clinical Appeals Research and Writing, Project Management, Presentation Delivery, Training, Mentorship, Collaboration, Trusted Advisor, Persuasion, Goal Achievement.WRITING / RESEARCH: Expansive case expert, detail-driven, accurate; policy, law, and medical denial overturns.DENIAL TYPES (selected): Alleged lack of medical necessity, experimental/investigative, inpatient stays less than 30 days apart for same/similar diagnosis. Down-coded DRGs, line-item denials, bundling, observation vs. inpatient, air transport, level of care, coding, non-emergent, lack of documentation, and specific services provided in Skilled Nursing Facilities, Inpatient Rehabilitation, Inpatient Psych, NICU, and ICU. Have been successful getting insurers to change clinical policies after in-depth research. CLINICAL: Patient care in emergency rooms, inpatient, and outpatient settings, held leadership positions.Technology, Methodologies, Tools✓ Expert knowledge and experience with ICD-10 coding, HCPCS, CPT, and DRG.✓ Written many coding appeals for inpatient and outpatient services.✓ Thorough knowledge of Microsoft Office Suite: Word, Excel, Access, and PowerPoint.✓ Experienced with several large database platforms and familiarity with Epic.Publications▪ Articles: Published 2 articles in peer-reviewed medical literature.▪ Book Chapter: Co-authored book chapter on medicine and public health, published by Random House and reviewed in the NY Times1.▪ Award Winner: Wrote clinical article that won the American Academy of Physician Assistants Association annual national award for best clinical article by a physician assistant.
