Tom has over 28 years of healthcare experience including programming and application support. He has audited millions of claims in his career including medical, dental and pharmacy claims for self-funded employers. He has also managed claims and eligibility datasets, query development, report development, customized benefits analysis, third-party administrator site visits, provider contract analysis and collections tracking. Tom graduated from the University of Tennessee, Knoxville with a bachelor’s degree in mathematics.
My healthcare career spans more than 28 years with the first eight of those working for a payer, experiencing all facets related to healthcare claims administration from both end user and programmer/analyst perspectives. Bringing that experience and knowledge to healthcare claims auditing allowed me to quickly adapt, learning industry intricacies and providing varied IT support to the audit firm. After a brief recoil back to the healthcare IT world from the provider’s aspect, I came back home as an auditor with JGI in 2017, having previously audited claims for John Graham. I provide a level of knowledge, experience and expertise on almost every attribute in the realm of a healthcare claims audit. This allows me to fill various needs within JGI from loading and scrubbing data, sampling claims, managing a site visit, to presenting an audit report. The diversity of work required for a JGI claims audit is both challenging and rewarding and allows for constant learning and maintenance of a multifaceted skillset.