*****, Product Director, CompProjections Medicare Set-Aside Division, 2007 - Present

 Responsible for operational research, start-up, organization and ongoing operations of new Medicare Set-Aside Unit, CompProjections

 Preparation of MSAs for clients, including abstraction/summarization of medical records, future medical service forecasting and fee schedule/UCR pricing of same

 Design and creation of automated pricing system for medical cost projections to ensure consistent use and updating of the applicable fee schedule and UCR values within the MSA process

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***** Consulting Group, Managed Care Consultant, six years
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 Led Occupational Health Revenue Improvement Initiative for California’s largest Worker’s Compensation medical services provider with the goal of recouping substantial lost revenues for this product line

 Provided expert subject matter guidance to a large nationwide HMO in the conceptualization and development of a product designed to provide lifetime future medical treatment cost estimates based on patient demographics and diagnoses utilizing a large, nationwide database

 Conducted seminars on the process and steps involved in the Medicare Set-Aside process, CMS regulatory requirements, and tips for complying with the same.

 Evaluated Kaiser Permanente’s EOB Unit operations and provided input resulting in enhanced data capture and reporting capabilities.

 Created and conducted a training program educating a large HMO’s physician and billing staff on coding and documentation under the CA OMFS and CMS guidelines.

 Represented a large HMO in an ongoing project concerning outpatient surgery reimbursement, including negotiations with a large carrier and provision of expert testimony at a CHSWC public hearing.

 Analyzed the billing practices, procedures and receivables for Occupational Health Services for a large HMO in Northern California, including the creation of a Policies & Procedures manual and a series of statewide training sessions resulting in potential revenue increases exceeding $10 million annually.

 Managed project team in the design and development of an Online Provider Profiling & Analysis tool for Risk Data Corporation.

 Created a medical service/charge database representing 30% of the state's 1996 W/C activity and provided analysis of the fiscal impact of proposed OMFS changes to the CA W/C Institute (CWCI).

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First Health Priority Services (Coventry Health Care), Sr. Vice President - Operations, two years
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 Expanded internal production capacity, including staffing and systems, to support increase in monthly revenue from $250k to $2.2 million over a period of seven months.

 Successfully implemented two systems applications, @Task and Allegro, to support production requirements.

 Oversaw the creation of multiple proprietary systems and workflows enhancing products offerings and streamlining of workflows.
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Fair, Isaac and Company, Vice President - Business Unit Operations/ Insurance Service Bureau, two years
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 Managed service bureau medical bill review and repricing operations for a staff of 180 located at three branch offices generating $25 million in annual revenue

 Assisted in refinement of the design and implementation of new medical bill review system, including image-based front-end processing, resulting in productivity enhancements of 20%.

 Explored and implemented outsourcing and off-shoring work through vendor partners and subsidiaries.
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Health Net Plus, Vice President - Leased Provider Networks, two years
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 Managed PPO network operations supporting $45 million in annual revenue, including rate management and loading, provider contracting and credentialing, and provider relations for network issues.

 Negotiated agreements with twelve leased networks increasing revenues by over $5 million annually.

 Assisted in the direction and management of company operations leading to an increase of $15 million in revenue over annual projections and directly benefiting the company’s bottom-line in the pursuant sale.
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Fremont Compensation Insurance Group, Vice President - Managed Care, three years
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 Managed a nationwide team of managed care staff providing case management, network contracting and medical cost management services in 41 states.

 Negotiated favorable managed care contracts with select vendors in multiple states for the provision of outsourced bill review and case management services.

 Successfully transitioned an in-house bill review operation to outside vendors, with an estimated cost savings of over $12.00 per bill and increased review savings.
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Beech Street Corporation, ten years
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Vice President - Product Management, 2 years
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 Designed and implemented standardized benchmarking and productivity analysis throughout the company.

 Developed strategic plans for primary products and regularly briefed Board of Directors on growth objectives.

 Managed project team responsible for development of 24-hr Care program, integrating Group Health, Workers' Comp and Disability Management.
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Vice President - Workers Compensation Operations, two years
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 Managed departmental operations for a staff of over 250 employees performing medical bill review and repricing, generating over $16 million in annual revenue, with an operating budget of $7.8 million.

 Sustained a 30% growth rate for two consecutive years, resulting in a departmental profit margin of over 50%.
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Business Systems Consultant - Workers Compensation, two years
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 Managed a team of systems analysts/programmers designing a state-of-the-art medical bill review system, including on-line utilization review employing normative treatment patterns for monitoring provider compliance; successfully completed project in nine months including the conversion of all bill review business from an HP COBOL legacy system to an IBM/AS400 system utilizing Synon code-generation software.
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Vice President/Director - Medical Bill Review, four years
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 Managed departmental operations for staff performing medical bill review for a client base consisting of large self-insured public agencies and employers generating $3 million in annual revenue

 Assisted in client services and sales in marketing of bill review product line
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Medata, *****, Seven years
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 Positions here included Production Team Leader, Hearing Representative, Provider Relations Representative, Medical/Legal Review Specialist, Technical Specialist, and Billing Analyst.

California State University, Long Beach, CA , Major: Political Science, 1976 – 1979

Western State University of Law, Fullerton, CA, Legal Studies, 1984 – 1985

National Alliance of Medicare Set-Aside Professionals (NAMSAP), Communications Committee
Chairman, Evaluation & Management Subcommittee,
OMFS Task Force, Industrial Medical Council, California Department of Workers' Compensation

Presenter, WorkCompCentral, Medicare Set-Asides Seminar
Co-Author, SIIA Magazine, "One Size Does Not Fit All - What You Don't Know About Medicare Set-Asides Can Hurt You"
Featured Speaker, California Self-Insurers Association, Annual Meeting
Featured Speaker, "Announcing A Truce" seminars, CWCI & CSIMS