Strategic Advisory & Insurance Advocacy
Bridging the gap between complex insurance denials and successful claim resolutions through strategy, education, and clarity.
The American healthcare billing system is designed to be difficult. Most policyholders lose not because they are wrong, but because they lack the specific framework required to win an appeal. I provide the high-level strategy and technical guidance necessary to navigate these disputes with precision.
Areas of Expertise
My work focuses on the intersection of medical necessity, coding accuracy, and contractual obligations. I advise on:
- Complex Denial Analysis: Identifying the "root cause" of a rejection, whether it is a coding error, a plan exclusion, or a lack of clinical documentation.
- Appeal Architecture: Structuring arguments that align with ERISA regulations and state-specific insurance laws.
- Provider-Payer Disputes: Navigating the friction between hospital billing departments and insurance adjusters.
- Resource Navigation: Helping individuals and organizations identify the specific tools, advocates, or legal resources needed for their unique case.
How I Help
I do not offer high-volume claims management or billing services. Instead, I provide targeted expertise for those who need a roadmap to handle their own disputes or a strategy to scale their own advocacy efforts.
1. Strategy Consultations
A focused session to review your specific denial, identify the strongest path forward, and outline the exact evidence required to overturn the decision.
2. Organizational Guidance
For businesses or advocacy groups looking to build internal systems for managing medical claim disputes more effectively.
3. Educational Workshops
Deep-dive sessions on the mechanics of the "Appeals Engine"—how to read an EOB, understand medical policy, and write letters that adjusters cannot ignore.
The Ideal Fit
My consulting is best suited for those who value guidance over execution. I am a fit for:
- Individuals facing high-value denials who need a clear, professional strategy before filing their final appeal.
- Medical Advocates looking to sharpen their technical understanding of specific billing and coding hurdles.
- Benefit Managers seeking to better protect their employees from unfair claim rejections.
Transparency & Compliance: I am a strategist and advocate, not an attorney or a clinical provider. My guidance is educational and strategic in nature. I do not provide legal or medical advice, nor do I guarantee specific financial outcomes from insurance carriers.
To maintain your authority while protecting your time, the language at the end of the page needs to be firm but helpful. By positioning the templates as the primary solution, you frame your personal consulting as an "exception" rather than the rule.
Here is the updated Next Steps section for the page:
Next Steps
My goal is to provide the most effective path to a resolution with the least amount of friction.
Start with Proven Frameworks
In almost all cases, the most efficient way to resolve a denial is through a structured, evidence-based appeal. To make this accessible, I have codified my strategies into professional Appeal Template Libraries at ClaimsValidated.com.
I typically refer individuals and organizations to these resources first, as they contain the exact logic and formatting I use in my own strategic work.
Rare Project Inquiries
I maintain a very limited schedule for custom advisory work and rarely take on individual cases or one-off projects. I only consider engagements where high-level strategy or organizational systems-building is required.
If you believe your situation requires a custom strategic consultation rather than a self-paced resource, you may submit a brief inquiry below.