Avery M.

A healthcare executive with over 20 years of experience in Care Management Operations both in payer and provider environment, leadership and operational experience in third party payer management and support. A significant 4 years recent experience in Business Process Outsourcing in the Philippines as VP Operations. Expertise in US - government sponsored programs in the areas of Medicare / Medicaid systems /Traditional Fee For Service Medicare, Medicare Advantage / Managed Care programs – Case management, Clinical Reimbursement, Utilization Management, Utilization Review, provider Denial and Appeals Management, PDPM, SNFPPS – RUG IV (Prospective Payment System) Revenue Cycle Management, Medicare Case Management administration, Continuous Quality Improvement (CQI) process, Quality and Process Excellence, QAPI, MDS (Minimum Data Set), Case Mix Maximization, Resource Utilization, Medicare SNF STAR rating program; has applied knowledge of Medicare Benefit Policy, CFR and California Title 22 regulations, Consolidated Billing, Costs analysis, Medical Review (RACs, ZPIC, MAC, Probe and MAC reviews, Denial management and Appeals process.