Frank L Brown, Jr, MD, FACP, FRSM, FCP(E)
Bluffton, South Carolina
Medical Management, Insurance
Accountable Care Organizations, ACO, Health Insurance, Managed Care, Grievances, Peer Review, Pharmacology, Provider Credentialing, Medical Necessity, Medicare, Medicaid, Formulary, Healthcare Fraud & Abuse, Medical Billing, Medical Utilization, Utilization Review, Health Plan Benefits, Qui Tam
Senior physician executive in the health insurance industry. Certified as Health Insurance Executive. National insurance companies worked for include Oxford Healthplans, Blue Cross & Blue Shield, Wellpoint, Anthem, and Cigna. Responsibilities have included case management, fraud and abuse, physician credentialing, peer review, physician grievances & appeals, patient grievance & appeals, and patient safety. Board certified in both internal medicine, and emergency medicine. Holder of multiple patents. Experienced public speaker. Chief Medical Correspondent WVGB-FM in Beaufort, South Carolina. Yale educated, NIH trained.
Conducted over 5,000 physician credentialing reviews; over 5,000 medical necessity/utilization management reviews; patient & physician appeals, & hearings; and over 2,000 committee and in-person patient grievance & appeal reviews. Served as an Examiner for the Malcolm Baldrige National Quality Award, as well as the National Committee for Quality Assurance.