UR, Standard of Care, & Compliance Expert

Specialties & Experience of this Expert Witness

Additional Information

I am Dr. Alexander Kim, DO, MBA, FAAFP, CHCQM-PHYADV, ACPA-C , a dually board-certified physician in Family Medicine (ABFM and AOBFP) dedicated to providing objective, evidence-based analysis for complex medical-legal cases. My expertise is built upon extensive experience in clinical practice, healthcare operations, and utilization management, making me a valuable resource for attorneys. I hold specialized credentials, including certification in Healthcare Quality and Management (CHCQM-PHYADV) and Certified Expertise in Physician Advising, Utilization Review (UR), and Clinical Documentation Integrity (ACPA-C) , which inform my deep understanding of Medical Necessity and Regulatory Compliance. Specifically, I evaluate cases involving Inpatient vs. Observation Status, Admission/Discharge Criteria, the application of InterQual/Milliman standards , and adherence to CMS Regulations, including the Medicare Two-Midnight Rule. My background encompasses serving as a Physician Advisor to major healthcare systems, where I was the final authority on complex medical necessity denials and collaborated on process improvement to optimize resource utilization and mitigate risk. Clinically, my experience as an Attending Physician in remote telemedicine, Urgent Care, and Emergency Observation Units —as well as my role as a Medical Director where I directed operations and ensured strict adherence to the standard of care —provides a robust foundation for my Standard of Care Analysis across primary, urgent, and observational settings, all informed by active Peer Review experience. Furthermore, my MBA in Finance from Drexel University uniquely qualifies me for analysis of revenue cycle implications, resource utilization optimization, and operational efficiency. I maintain active medical licensure in multiple states, including Maine, New York, California, New Jersey, Colorado, Missouri, and Texas, demonstrating familiarity with diverse state medical standards , and my key skills include Chart Review and Expert Testimony.