Health/Hospital Administration, Health Insurance &
Health Plan Expert and Consultant
Areas of Expertise:
- Standards of Care
- Health Insurance
- Health Insurer-Provider Relations
- Managed Healthcare (HMO, PPO)
- TPA (Third Party Administrator)
- National Accreditation Guidelines
- Medicare / Medicaid
- Medicare Advantage
- Physician / Hospital Joint Ventures (PHO's)
- Industry Standards Adherence
- Utilization Review
- Provider Credentialing and Contracting
- Provider and Member Communications
- Patient Benefits Determination and Grievance and Appeal Procedures, including External Review
- Financial Reimbursement Models
- Compensation and Capitation
- Due Process Requirements
- Case Management
- Bad Faith Claims
- Analysis and Evaluation of Administrative Events
- Research of Relevant Literature
- Interpretation of Provider and Member Contracts
- Developing Deposition Strategy and Questions
- Preparation of a Defensible Report
- Articulation of Complex Matters