Experience

Devoted Health

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Medical Director, Utilization Management and Appeals

  • Apr 2022 - Present

  Work from Home I am so pleased to announce I have joined the Devoted Health team! I simply cannot say enough great things about Devoted Health!!



Humana

• United States
• Insurance
• 700 & Above Employee

• Medical Director | Medicare Clinical Review - Grievances and Appeals

  • Sep 2017 - Apr 2022

  United States

• Central West Medical Director

  • Apr 2015 - Sep 2017



Executive Health Resources

• Principal/Physician Advisor

  • Nov 2012 - Apr 2015

  Colorado Springs, Colorado Area In charge of supporting physicians and legal entities with detailed medical issues, case handling, rebuttals, appeals and talent pool growth. Effectively assist C-level executives, client regulatory departments and peers in navigating Medicare and Medicaid environments, including CMS guidelines, Social Security Act sections 1870/1879, Medicare Program Integrity Manual, Medicare Program Benefits Manual and other pertinent regulations. • Acquired and maintained deep understanding of CMS… Show more In charge of supporting physicians and legal entities with detailed medical issues, case handling, rebuttals, appeals and talent pool growth. Effectively assist C-level executives, client regulatory departments and peers in navigating Medicare and Medicaid environments, including CMS guidelines, Social Security Act sections 1870/1879, Medicare Program Integrity Manual, Medicare Program Benefits Manual and other pertinent regulations. • Acquired and maintained deep understanding of CMS rules and regulations for a wide range of medical procedures. • Recognized for expertise in post-pay Medicare denial appeals, concurrent review, peer-to-peer, NCD/LCD application & compliance, outpatient chemotherapy, outpatient surgical procedures, intensity-modulated radiation therapy and other areas. • Key participant in orienting and developing colleagues in handling ALJ hearings, including medical/legal cross-examinations, rebuttals and preparation of accurate documentation. Show less



Anesthesiology Associates Colorado Springs

• Partner

  • 1992 - 2011

  Colorado Springs, Colorado Area Built and maintained a successful and reliable anesthesiologist career with extensive clinical experience, representing an average of 1,000 to 1,200 cases annually, in operating room, surgery center and private surgery office settings. Proficient in leading teams in providing timely services in cardiac, neuro, pediatric, orthopedic, obstetric, bariatric and acute/chronic pain situations. Closely liaised with OR administrators to ensure high standards, practice efficiencies and continuous… Show more Built and maintained a successful and reliable anesthesiologist career with extensive clinical experience, representing an average of 1,000 to 1,200 cases annually, in operating room, surgery center and private surgery office settings. Proficient in leading teams in providing timely services in cardiac, neuro, pediatric, orthopedic, obstetric, bariatric and acute/chronic pain situations. Closely liaised with OR administrators to ensure high standards, practice efficiencies and continuous improvements. Organized and delivered extensive CME lectures and credit courses for nursing and medical staff. • Conceived and established the Monitored Surgical Care Area, a 12-bed observation unit for providing post-operative care for OSA patients. • Organized and administered the first-ever multi-specialty conference on OSA at state-level to increase screening awareness pre-operatively. • Concurrently served as Race Physician at Pike’s Peak International Raceway (1998-2001) and Director of Surgical Services at Printer’s Parkway. • Acted as Principal Investigator with “Prospect,” a clinical study to assess the adequacy and effectiveness of home OSA diagnosis; also authored and introduced a system-wide OSA screening and management protocol. • Regular participant in successful biannual JCAHO improvement and standardization inspections. • Active member of the Memorial Hospital Monitoring and Evaluation Committee (1994-2011), Anesthesia Resident Review (2009-2011), Pro-Temp Committee – Sentinel Events (1997-2011) and Obstructive Sleep Apnea Policy and Risk Mitigation Committee (1998-2011). Show less