Profession: Physician (MD or DO) and Pharmacology

Current ABMS or AOA Board Specialty and Subspecialty Certification(s): Internal Medicine

Licenses: Kentucky, North Carolina, Pennsylvania, and Virginia

Additional Information: Experienced senior physician executive in the health insurance industry. Yale-educated, NIH-trained. Certified as Health Insurance Executive. National insurance companies worked for include Blue Cross & Blue Shield, Wellpoint, Anthem, and Cigna. Conducted over 2,000 committee and in-person patient grievance & appeal reviews. Conducted over 5,000 utilization/medical necessity reviews. Conducted over 500 physician appeal hearings; and 100 physician coding audits. Served as an examiner for the Malcolm Baldrige National Quality Award and the National Committee for Quality Assurance.

Education: MD-Yale University School of Medicine, MBA-Virginia Commonwealth University, and BSC, Pharmacy-Howard University College of Pharmacy

Years in Practice: 16+ years

Number of file reviews previously performed: 100+ file reviews

Average monthly hours in direct patient care: Not currently practicing