Co-Founder, Chairman at Verisys Corporation

• Jun 2021 - Present

Chief Executive Officer and Co-Founder at Verisys Corporation

• Jun 2017 - Aug 2021

As CEO of Verisys, I led the company into new territory within the health care sector, as well as the use of data science and technology to accelerate the management and delivery of health care by materially contributing to the ability for real-time transparency to transactions, individuals and entities. Verisys serves the largest retail pharmacy interests with its products and services.I am passionate about helping lead innovation and technology for higher interoperability critical to elevating quality, safety, and transparency for the health care consumer.Having invested wholeheartedly in products and content that facilitate not only a compliant culture in health care but provide innovation towards streamlining best practices that serve and protect the health care consumer. Show less

Chief Operating Officer, Co-Founder, Verisys Corporation

• Jun 2007 - Jan 2017

Delivering since 1992, Verisys Corporation and its flagship product, FACIS®, has been exclusively serving the health care sector. Verisys is made up of a team of specialists in health care regulatory compliance, risk management, data acquisition and management, data quality assurance and IT. Verisys acquires, aggregates and publishes data electronically from thousands of primary sources, both federal and state, to surface an historical and current view of a health care provider. Verisys obtains primary source content on persons, professionals and business entities relative to licensing, sanctions, exclusions, debarments, disciplinary actions, DEA registrant, SSA - Master File, NPI, UPIN, Abuse Registries and other key data sets and links them, clustering and house-holding, and then matches Verisys content to client input using proprietary entity resolution technologies. The Verisys team handles millions of transactions annually across the health care system, including hospitals, hospital systems, health care provider systems (IPAs), pharmacies, pharmaceutical manufacturers, medical equipment manufacturers (DME), payers, managed care organizations, medical malpractice carriers, background screening companies and credentialing organizations. Verisys provides information to help its clients assure regulatory compliance, manage legal and financial risk and protect their reputation. We help organizations know that their: employees (people), providers (licensed professionals, internal and external), and vendors (businesses) that they engage with are not high-risk individuals or entities. Verisys Corporation is NCQA Certified for the following verification services: professional licensure, DEA registrant, medical board sanctions, Medicare/Medicaid sanctions and ongoing monitoring of sanctions. Verisys is a fully accredited Credentials Verification Organization (CVO) by URAC. Show less

Vice President, Insurance and Health Care, Risk and Information Group

• Oct 2004 - May 2007

Market planning and strategy for the health care and property and casualty insurance solution set for LexisNexis Risk and Information Group. Responsible for product development and management for the health care and insurance verticals, including revenue goals. Market planning and strategy for the health care and property and casualty insurance solution set for LexisNexis Risk and Information Group. Responsible for product development and management for the health care and insurance verticals, including revenue goals.

Vice President

• Nov 2001 - Oct 2004

Product Development and Post-Development Business Leader - Proprietary initiatives related to medical bill repricer (a group health, auto, workers’ compensation repricer), medical bill imaging and medical provider data informatics. Product Development and Post-Development Business Leader - Proprietary initiatives related to medical bill repricer (a group health, auto, workers’ compensation repricer), medical bill imaging and medical provider data informatics.

Vice President

• Nov 2000 - Nov 2001

Acquired by Concentra. Responsible for two technology/business initiatives focused on the insurance sector: Web RePrice - a rule driven (validation, coding, UCR repricing, fee schedule repricing, frequency and duration, utilization) medical bill review software and MedFlow/WebFlow – a paperless medical bill (HCFA1500/UB-92) and medical records rule and state driven document imaging, management and workflow software with a Web-based user interface (WebFlow). Responsible for provider waste, abuse and fraud detection (informatics) team (ESP - a prospective fraud detection and profiling software tool). Managed software quality assurance team. Responsible for back-end analytics and reporting and jurisdictional and regulatory compliance (HIPAA and jurisdictional requirements). Data Security Officer for NHR, Inc. National Consolidation/Re-branding/Marketing Initiative – Marketing officer at NHR, managed Creative Services group at NHR and Concentra. Show less

Senior Vice President

• May 1999 - Nov 2000

Directed client and project management. Software was designed to drive profit improvement employing data analysis and incorporating modeling and predictive technologies. Developed Axios analytic strategies and data marts focused on delivering value in the areas of coding practices and provider behaviors, including; waste, abuse and fraud, medical outcomes (both MMIS Management and Administrative Reporting Subsystem (MARS) and Surveillance and Utilization Review Subsystem (SURS)), disease management, managed care issues, case management issues (frequency and duration and utilization) and profitability. Managed multiple projects of high complexity and diversity across multiple clients and environments. Developed sales, marketing and business development strategies for prospective clients as well as act as technical lead on sales and marketing calls. Represented company at presentations, industry meetings and conferences, including public speaking/writing (articles, White Papers). Show less

Manager

• Sep 1998 - May 1999

DT Health Systems, Deloitee Consulting: • Client project and client relationship management for the firm’s healthcare and health care fraud and abuse practice. Developed and designed analytical products and solutions for clients, primary product was Detect, later known as ClaimsMiner. Responsible for computational intelligence design, algorithmic and statistical analytics and programming/coding requirements. Developed sales, marketing and business development strategies for prospective clients. Strategic business planning for fraud and abuse practice. Business intelligence, competitive analysis and market analysis. Represented Deloitte at presentations, industry meetings and conferences, including public speaking/writing (articles and white papers). Show less

Vice President

• Aug 1993 - Aug 1998

Corporate Vice President, Claims/Special Investigations Unit/Litigation Unit. Developed, sponsored and/or taught ongoing training programs for claims and SIU.Developed learning organization model and core competency models for claims and SIU organizations driving organization toward behavior/goal based performance (rather than process driven). Strategically involved in company-wide information technology planning, fraud prediction and identification software development, successful platform transition and on-going data warehouse implementation effort. Researched, developed and handled nationwide regulatory compliance function, including state compliance plan filings, and established and nurtured industry, DOI and law enforcement contacts and relationships. Show less

Director

• 1992 - 1993

Developed (researched, built and implemented business plan), led and managed a nationwide multi-jurisdictional Special Investigations Unit to fight workers' compensation fraud (claimant, medical provider, premium and vendor fraud). Led, mentored, trained, and managed a 40+ team of supervisors, investigators and claims staff. Produced multi-million dollar savings within six months with a positive return on investment. Company reported savings of $12 for every $1 invested. Directed civil and criminal prosecutions with multiple arrests and favorable verdicts. Handled customer service issues, public relations, claims/SIU related governmental affairs and regulatory compliance duties. Show less