Contact this Consultant
- Phone: 512-709-7088
Profession: Physician (MD or DO)
Current ABMS or AOA Board Specialty and Subspecialty Certification(s): Family Medicine/Family Practice
Licenses: California, New York, North Carolina, Texas, and Virginia
Additional Information: Several years of utilization/case review experience as both a reviewer for health plans and as an independent reviewer. File review experience includes: medical necessity reviews, inpatient care, outpatient services (pharmaceutical, imaging, DME, lab services), billing and coding, chart auditing. Experience with reviews using guidelines (MCG, Interqual, AIM, internal guidelines, etc) as well reviews using medical literature and medical society guidelines. Additional experience in health plan audits/surveys. Additional training and experience with Billing and Coding procedures.
Education: Doctor of Osteopathic Medicine-University of North Texas Health Science Center and Masters of Business Administration-University of Massachusetts - Amherst
Years in Practice: 6 to 15 years
Number of file reviews previously performed: 100+ file reviews
Average monthly hours in direct patient care: 11 to 40 hours