HMO Expert Witnesses in Texas

McKinney, Texas

Medical Billing, Insurance - Managed Care, HMO, PPO, Medicare, Medicaid, Reasonable Value, Audit, Hospital, ERISA, Usual and Customary, Reimbursement Disputes, Claims Denials, Athena Billing, Out-of-Network, Balance Billing, Fee Schedule Analysis, Expert Testimony, Medical Necessity, Multi-State, Healthcare Reimbursement

I have over 35 years of experience in medical billing, reimbursement, and managed care systems, with expertise spanning provider operations, payer methodologies, and claims adjudication practices. My work focuses on evaluating medical billing accuracy, reimbursement methodologies, usual and customary charges, and payer denial practices. Practice includes multi-state reimbursement analysis, with extensive experience in California managed care systems, including HMO, IPA, and risk-based reimbursement structures, as well as Medicare Advantage and national payer methodologies. I have served in multiple roles, including claims examiner, billing manager, revenue cycle executive, and founder of a national medical billing and audit firm. This multidisciplinary experience allows me to analyze disputes from both the provider and payer perspectives. Experience includes analyzing billing system workflows and claims processing issues across platforms such as Athenahealth. My expert work includ...