I started out in nursing school. Then music pulled me to Nashville, and I spent about three years touring. When I came off the road, I found my way back to healthcare, this time on the business side. In 2011 I started at Community Health Systems as a contractor and went full time in 2013. That's where I learned how a hospital actually gets paid.
A lot of the work I was handed ran on manual workarounds, so I taught myself to code and started fixing them. In 2016 I started Paradexo to do that same work for other healthcare organizations, and it's still running today. From there I worked in Parallon's Physician Services Group at HCA, on the physician side of the revenue cycle. Along the way I cofounded two more companies: a travel business in Peru that still operates today, and a healthcare cybersecurity company, still in stealth, where I ran operations as COO.
I've spent 15 years in the revenue cycle, most of it in the plumbing:
Through all of it I kept seeing the same thing: a claim comes back denied and nobody has time to work it. Every system I touched and every role I held, it came back to denials.
AppealsOne is the company I was always going to start. The piece below is how I think about the problem.
Why healthcare costs what it costs, from someone who has spent 15 years in the front and back office, and what we can actually do about the part I understand.
A correct prior authorization turned into a $150,000 denial, and the bill went to the patient. Six months later she owed nothing. Most people never get there.
Denial prevention has gotten better and all of it should be done. But a clean claim can still be denied, and most organizations are underbuilt for what happens after the denial lands.
I try to find the actual problem underneath the one everyone is complaining about, and I would rather fix the structure than wait for the right person to show up and run it. I do business the same way: say what I think, show my work, and serve the people in front of me.