Healthcare Operations Consultant · MD, MSc, CPC, CRC, CDEO

Most primary care practices don't fail because of bad medicine.
They fail because operations were never made explicit.

By the time it shows up in revenue — through denials, documentation gaps, or broken handoffs — the damage is already compounding. I help organizations fix it at the source.

Book a Free 30-Min Call See How I Work

18+

Years in Healthcare

$1.8M

Revenue Recovered

62%

Avg. Appeal Reduction

"When I reviewed their approach, they were fighting denials after they happened. Hiring people to appeal. Writing letters to payers. Playing defense. The problem: they were treating symptoms, not causes."

HCC Coding & Billing Clinical Documentation Revenue Cycle Risk Adjustment CDI Programs Value-Based Care HCC Coding Workflow Design

The Pattern I Keep Seeing

The same failures repeat across care settings.

Early-stage and scaling primary care organizations share a predictable set of operational blind spots. The good news: they're fixable — but only if addressed before growth amplifies them.

Inconsistent intake and documentation standards that live in people's heads, not in systems
Revenue leakage that starts long before a claim is ever submitted
Unclear ownership of clinical workflows and handoffs between teams
Telehealth encounters capturing 15–25% fewer HCC codes than in-person visits — silently
CDI programs treated as a department rather than a process woven into daily care
Risk adjustment strategies that can't survive a CMS audit
Denial rates above 10% being treated as a billing problem when they're actually a documentation problem

How I Work

Four ways to engage, one outcome: operations that hold up.

I work with a small number of organizations at a time to ensure every engagement gets the depth it deserves. Each offer is designed to be a contained commitment that delivers measurable results.

Operational Readiness Assessment

For primary care startups · 6–24 months post-launch

A 2-week diagnostic engagement. I audit your intake workflows, documentation standards, coding alignment, and revenue cycle handoffs — then deliver a prioritized gap report and 30-day action plan.

End-to-end workflow review
Documentation & coding gap analysis
Prioritized findings report
90-minute strategy debrief
30-day action roadmap

$2,500 – $3,500 · Fixed fee

Fractional Clinical Operations

For scaling health plans & primary care groups

Monthly retainer engagement. I serve as your embedded clinical operations and CDI advisor — reviewing workflows, supporting risk adjustment strategy, and providing on-demand expertise without the full-time cost.

10–15 hours/month dedicated support
Workflow design & SOP development
CDI program oversight
Risk adjustment strategy
Provider education & alignment

$3,000 – $4,500 · Monthly retainer

CDI & Revenue Cycle Program Design

For organizations with documentation or denial problems

A 4–6 week project engagement. I design or redesign your CDI process, build your provider education framework, create coding alignment workflows, and deliver a measurement dashboard you can actually use.

Current-state process assessment
CDI program design & SOPs
Provider education curriculum
KPI framework & dashboard
Implementation handoff support

$6,000 – $9,000 · Project fee

Medical Coding & Billing Services

For independent practices · IPAs · MA Organizations

Physician-led coding and billing oversight — from HCC gap closure and chart reviews to coding audits, coder training, and prior authorization documentation strategy. Accurate coding is the foundation of every revenue outcome.

HCC coding review & gap closure
Coding compliance audits (ICD-10-CM, CPT, HCC)
Prior auth documentation strategy
Coder training & QA oversight
RADV audit preparation & support

Custom scope · Contact for pricing

Start with a free 30-min call →

Results

What changes when operations are made explicit.

Revenue Cycle · Risk Adjustment

A virtual-first primary care organization, 18 months post-launch, with 12 providers across multiple states — denial rate at 18%, spending $240K annually on appeal specialists.

The organization was treating denials as a billing problem and hiring more staff to fight them downstream. After reviewing their workflows, the root cause was clear: documentation failures at the point of care, not billing errors. I redesigned their CDI process to be concurrent with encounters, introduced real-time claim scrubbing before submission, and built payer-specific documentation checklists. The metric shifted from "how fast can we appeal" to "how many denials did we prevent."

18% → 9%

Denial rate

62%

Appeal workload reduction

54 → 41

Days in AR

$1.8M

Net revenue recovered annually

Medicare Advantage · HCC Capture

A Medicare Advantage organization with RAF scores running 12% below benchmark across their provider network — significant risk adjustment revenue being left uncaptured.

Inconsistent HCC capture across the network was traced to documentation habits — specifically, providers not assessing and documenting chronic conditions outside the primary reason for visit. I redesigned their concurrent CDI workflow, built payer-specific documentation templates that prompted condition assessment during encounters, and created a provider education program aligned with risk adjustment logic. The program was subsequently audit-ready and passed its first CMS review without findings.

+12%

RAF score improvement

Zero

CMS audit findings

100%

Provider network adoption

ACA Health Plan · Operational Scaling

A national ACA health plan scaling large-scale clinical and documentation programs supporting ACA populations — programs were unstable, lacking clear ownership and consistent execution standards.

I led the stabilization and scaling of these programs through end-to-end workflow redesign, working cross-functionally with Data and Engineering to improve program visibility and support automation. I established clear performance standards and prioritization frameworks, ensuring alignment with quality, compliance, and regulatory requirements throughout. The result was a repeatable operating model that held up under regulatory scrutiny.

Stable

Program execution

Automated

Key reporting workflows

Compliant

Regulatory alignment maintained

Free Resource

Prior Authorization Intelligence Brief

Primary Care Edition · Q1 2026 · Data sourced from KFF, AMA & HHS OIG

Free Download

How to read the new CMS public payer data — and what to do with it.

As of March 31, 2026, CMS now requires payers to publicly post their prior authorization denial rates, appeal overturn rates, and decision timelines. Most practices don't know this data exists — or what to do with it. This brief closes that gap.

53M

MA PA requests in 2024

80.7%

Appeals overturned

12.8%

UHC denial rate

94%

Physicians report PA delays care

Download Free Brief No cost · Instant PDF download

Payer-Specific Workflow Framework A step-by-step PA strategy built around denial rates and appeal overturn data — tailored to your top payers.

Major Payers Profiled UnitedHealthcare, CVS/Aetna, Humana, Elevance, Cigna, and Centene — denial rates, appeal data, and key watch items.

Denial Category Checklists Most common denied service types and most common denial reasons in primary care — with prevention strategies.

Need a version built for your practice — your payer mix, your specialty, your denial history? Book a Free Consultation →

New Release

Opening a Primary Care Practice:
The Operational Playbook.

Most physicians opening a primary care practice know medicine.
What they don't have is a system.

This playbook is the operational brain of a well-run primary care practice — written by a physician with 18+ years of healthcare operations experience. Every SOP, checklist, and template is built from real operational work, not theory.

What's Inside — 7 Operational Sections

Practice model definition and operating guardrails
Entity formation, payer sequencing, and credentialing control
Front desk as a revenue function — rules, scripts, reconciliation
Clinical documentation standards built for operations
Billing and cash flow oversight — founder-level weekly framework
Staffing, role clarity, and escalation rules
First 90-day operating rhythm — weekly and monthly cadence

This Is For You If

You are opening an independent primary care practice
You are an MSO-backed founder in pre-launch or year one
You want fewer expensive surprises and more predictable operations

Opening a Primary Care Practice — The Operational Playbook

$97

⚡ Use code FOUNDING for $79 — first 50 copies only

Get the Playbook — $97

Instant download · PDF + Excel Bonus Toolkit included
Use code FOUNDING at checkout for $79

Bonus Digital Toolkit Included

Pre-Launch Financial Model
Credentialing Timeline Tracker
EMR Selection Framework

About

I've seen the same failures repeat themselves across care settings.

I'm a physician with 18+ years of healthcare experience, spanning clinical practice and operations, with deep expertise in clinical documentation, data quality, and revenue cycle foundations within the U.S. healthcare system.

My work sits at the intersection of clinical reality and operational execution. I help organizations translate strategy into day-to-day processes that actually work — improving workflows, clarifying ownership, and fixing the handoffs between clinical, operational, and billing teams that quietly drive cost, risk, and clinician burnout.

I've built departments and programs from scratch at organizations including Firefly Health, Sidecar Health, and Ultimate Health Plans — always with the same focus: making operations explicit before growth amplifies the gaps that already exist.

MD — Clinical practice, diagnostic radiology residency
MSc — Healthcare Management & Clinical Direction, VIU Spain
CPC, CRC, CDEO — AAPC Certified Professional Coder, Risk Adjustment Coder & Documentation Expert
Bilingual — English / Spanish

"I'm especially interested in collaborating with founders, hospital innovators, and consulting teams who care about making healthcare technology and operations work beyond the pilot phase."

I've worked across the full spectrum of healthcare operations: as a payer-side risk adjustment manager, as a provider-side revenue cycle leader, as a CDI architect, and as a clinical AI trainer. That range of perspective is what allows me to see the same problem from every angle and fix it at the source.

I currently work with a small number of organizations at a time. If you're building, implementing, or scaling healthcare solutions and want them to hold up in the real world, I'd welcome a conversation.

Schedule a Conversation

Most primary care practices don't fail because of bad medicine. They fail because operations were never made explicit.