Certified Medical Credentialing Specialist Expert Witness

Expert Witness No.2088

Education

1986 – 1987, St. Louis Community College, Business Administration Program, GPA of 3.62

St. Louis County Reserve Police Academy

Honors

1989 – 1992, Various Elected Officials in the National Association of Medical Staff Services, Missouri

1995 – Present, Chairman, Bylaws Committee - Greater St. Louis Chapter National Association of Medical Staff Services

1995 – Present, Reserve Police Officer for St. Louis County

2003 – Present, Missouri Medical Emergency Response System, Member of Disaster Team Credentialing Committee.

2004 – Present, Missouri Association Medical Staff Services Member, Nominating Committee

Experience

1998 - Present, A Medical Credentials Consulting Business, Missouri
Assist Attorneys with medical malpractice and personal injury cases to determine adequacy of medical personnel’s credentials, whether Hospital personnel adequately credentialed a practitioner before allowing them on staff, and other medical credential issues.  Also provide credentialing and re-credentialing services for independent companies.

1992 - 2000, Network Provider Coordinator, Anheuser-Busch Companies, Employee Assistance Program
Established a provider network coast-to-coast and negotiated rates with individuals, hospitals, and facilities (1,200 total).  Obtained signed contracts from each and negotiated contract language changes.  Responsible for credentialing and re-credentialing of each provider; including license checks and sanctions, malpractice suit reviews, degree and training verification, etc.  Ensure that National Committee on Quality Assurance (NCQA) standards are adhered to.  Gave credentialing presentation to 55 contractors in 1998 at Kingsmill Resort in Williamsburg, Virginia.

1985  - 1992, Medical Staff Coordinator - Jewish Hospital at Washington University Medical School. 
Responsible for accurate and thorough credentialing of each new physician (license sanctions; degrees; clinical competency; reviewed past malpractice suits, etc.).  Liaison between Chiefs of Service, Medical Staff, Legal Counsel, Risk Management and Administration.  Had outside contacts with circuit courts, HMOs, PPOs, Insurance Companies, Presidents and Clinical Service Directors of other Institutions.  Developed delineation of clinical privileges for 15 Departments.  Recommend to Administration; changes to the Hospital Policies & Procedures, Medical Staff Bylaws and Rules & Regulations of the Medical Staff.  Assure that the medical staff adheres to Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) requirements, Medical Staff Bylaws and Hospital policies.  Coordinated the reappointment process, suspensions and terminations (ensuring that Due Process was adhered to), and all privileges.

1982  - 1985, Administrative Assistant to Department Chief - Arrhythmia Service, Jewish Hospital at Washington University Medical School
Maintained a liaison between patients, 3 physicians, 3 nurses, and 1 technician; handled and followed-up with patient problem calls; coordinated patient follow-up system, prepared electrophysiology study reports, designed patient consent forms, coordinated research monitors' site visits; utilized the Medical Information System (MIS) for patient information and test results; prepared manuscripts, abstracts for medical journals, research forms, and grant proposals, processed travel arrangements and expense statements for 10 physicians

1978 - 1982, Office Manager and Sales Support - Tag Marketing, Inc,Recreational Land Developments and Time Sharing
Hired, trained and managed a 5-person office to set appointments by phone for customers to tour land developments; designed mail brochures for advertising; performed bookkeeping and payroll functions; compiled sales and monthly reports.

Certifications

Certified Provider Credentialing Specialist (CPCS)
Certified in 1999 by the National Association of Medical Staff Services (NAMSS) (Must re-certify every 3 years).  This certification exam covered Principles of Credentialing and Re-credentialing, JCAHO and NCQA Accreditation Standards and Surveys, Legal Principles of Credentialing, Health Care Definitions, and Management of Information.

Certified Professional Medical Services Management (CPMSM)
Certified in 1989 by the National Association of Medical Staff Services (NAMSS).  Must re-certify every 3 years. This certification exam covered Organization & Management, Principles of the Medical Staff, Medical Staff Law, Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and National Committee on Quality Assurance (NCQA) Standards, and Medical Terminology.

(NOTE:  These 2 Medical Staff Certificates are equivalent to an Associates of Arts Degree. A limited number of Universities now offer these Associate’s Programs but not until very recently.)

References

Available upon Request.