Auditor and Developer
Tom has been instrumental in auditing millions of claims in his career by utilizing high level programming and data analysis skills while applying extensive and detailed knowledge of the claims adjudication process. He has over twenty-five years of healthcare experience including programming and application support, with the majority dedicated to auditing medical, dental and pharmacy claims for self-funded employers. He has also supported the information technology structure of auditing firms and designed and validated related security policies and protocols. Such experience includes management of claims and eligibility datasets, query development, detailed analysis of results, creation of site visit sample and out-of-sample reports, customized benefits analysis from employer plan documents, third-party administrator site visits, provider contract analysis, collections tracking and audit report development. Additional knowledge and experience include pricing claims using publicly available CMS (Medicare) and TRICARE rates and methodologies. Tom is also a HITRUST Certified CSF Practitioner (CCSFP) which is utilized on HIPAA Privacy and Security issues for JGI. Tom graduated from the University of Tennessee, Knoxville with a Bachelor of Science in Mathematics.