Welcome to my channel! My goal is to provide interesting and informative content about medicine and U.S. healthcare in a concise format.
I have several decades of experience in the U.S. healthcare sector as a board-certified (in internal medicine) licensed physician (M.D.), focusing on payer administrative healthcare. I've worked as a medical director for the largest private health insurance company in the U.S., handling Medicare, Medicaid, and commercial (private coverage) health insurance. I also spent over 21 years as a physician medical consultant for California's Medicaid program ("Medi-Cal").
I have experience in:
- Internal Medicine
- healthcare
- private and governmental health insurer systems
- quality of care assessment
- medical appeals and grievances
- Medicare
- Medicaid
- medical claims review
- medical utilization management
- medical auditing
- clinical documentation improvement
- medical service coding
- healthcare fraud, waste, and abuse