Appeals Expert Witnesses

Sarasota, Florida

Life Care Planning, Medical Management - Rehabilitation, Orthopedic, Catastrophic /Complex/Chronic Disease, Developmental Disability, Adult, Pediatric, Workers Comp, Liability, Data Analysis, Medical File Review, Bill Review, Medical Cost Projections, Medicare Secondary Payer, Case Management, Disputes, Denials, Appeals, Nurse Consulting

Seasoned, results-oriented, and versatile clinician and former insurance executive; offering extensive experience in Life Care Planning, Expert Testimony, leadership and all facets of complex medical claims integrating technology, evidenced-based clinical and technical processes, quality assurance, and case management, Possesses articulate communication skills, both verbal and written. Entrepreneur/ Innovator at the Intersection of Healthcare, Insurance and Technology, InsurTech/ HealthTech REGISTERED NURSE (RN) – STATE OF FLORIDA CERTIFIED REHABILITATION REGISTERED NURSE (CRRN) CERTIFIED CASE MANAGER (CCM) CERTIFIED LIFE CARE PLANNER (CLCP) MEDICARE SET ASIDE CONSULTANT CERTIFIED (MSCC) Sigma Theta Tau International Nurses Honor Society (STTI) International Association of Rehabilitation Professionals (IARP) Case Management Society of America (CMSA) Association of Rehabilitation Nurses (ARN), Health Policy Committee Member National Association of Professional Women—2013 Profess...

Yanceyville, North Carolina

HMO, Emergency Medicine - MA, Medicare Advantage, Medicare Operations, Prior Authorization, PA, Appeals, Managed Care, Prior Authorization, Utilization Review, Utilization Management, Senior Care, Emergency Medicine

As a clinical and administrative physician, my career has focused on ensuring treatment decisions and actions are completely and properly documented in the medical record. It was an honor to establish our multi-state physician group governance structures (peer review, credentialing, quality assurance and utilization management committees) and the needed feedback loops. This work stands the test of time and ensures that the medical records supplied would meet quality assurance outcomes, payment standards, and medical treatment standards at the time care was rendered. Tradewinds Healthcare Consulting, LLC 2025 - present - private consulting group providing: - expert opinion through high quality research, analysis and distilled documentation where clinical outcome(s) are in question and relevant standards are at issue - provide expert insight and support in navigating the complex Medicare Advantage industry and consistent medical decision making process...