Deborah A. Berger

About Deborah A. Berger

Physician and business executive with eighteen years of experience in the business sector of healthcare. Experience is rooted in payment integrity, data and analytics, a passion to improve healthcare delivery, the patient experience, and operational workflow through technology and innovation. Extensive experience helping public and private healthcare systems achieve strategic and financial success through product development, quality improvement, operational performance and strategic planning. Decisive leader with broad base experience leading multidisciplinary teams to promote cultural change and elevate leadership performance utilizing change management, Lean and Six Sigma expertise. Influential leader with a track record for excellent communication skills, ability to develop powerful trusted advisor relationships, and strong analytical and strategic rigor.Specialties: Communication, Business Strategy and Development, Operational Process Improvement, Change Acceleration and Acceptance, Project Management and Execution, Facilitation

Experience

1. Medical Director, Payment Integrity

   Cotiviti

   Jan 2017 — Present · Chicago, IL, US

   Cotiviti - acquired by Verscend Technologies, August 2018)Medical Director, Payment IntegrityAs a Medical Director with Cotiviti’s Payment Accuracy team, support Health Plan clients to work more effectively across their payment accuracy silos through deployment of best-practice clinical and coding payment policies, ensuring compliance to avert or recover incorrect payments. Deeply rooted knowledge in both outpatient and inpatient coding: Current Procedural Terminology (CPT), ICD-10-CM and ICD-10-PCS codes.Take accountability to validate that claims are supported by clinical and coding documentation to determine reimbursement thresholds, clinical appropriateness, and proper claim payment.Responsible for quality audit assessments for DRG and APC validation which includes clinical and coding accuracy, proper sequencing, and compliance with new and existing coding regulations and guidelines.Integral to evaluating and validating the development of medical policy in collaboration with the research, concept development and data analytics teams.Provide clinical leadership to new product development associated with cross claim (hospital and professional) clinical and coding reviews. Create, develop and support a team of data analysts, auditors, medical directors and content developers to ideate, and innovate new content. In a collaborative effort the team has produced over 35 clinical and coding rules with an estimated value totaling over $5M.Tasked with leading several internal quality performance initiatives with the objective to reduce the number of total appeals, increase audit staff productivity and reduce the number of medical director-to-medical director conversations that occur in regard to appealed claims.

Education

• Resurrection Medical Center

  Transitional Year Residency Program

• Loyola University Chicago Stritch School of Medicine

  Diagnostic Radiology Residency Program

• Miami University

  Bachelor of Arts - BA, Pre-Medicine/Pre-Medical Studies; Sociology

• The University of Chicago Pritzker School of Medicine

  Diagnostic Radiology Fellowship Program, Mammography

• Chicago Medical School

  Master of Science - MS, Cell Physiology

• Chicago Medical School

  Doctor of Medicine - MD