PAUL D.

WILLIAMS, DO

Harrisburg, Pennsylvania 17111
H (717) 540-0700
C (717) 574-4960
padofp@hotmail.com

SUMMARY

A top-performing and versatile physician with extensive experience in review of outpatient services, specialized
radiological procedures, injectable medications, drug utilization policy, quality management, and medical policy
review. Possesses expertise in data abstraction/analysis and writing recommendations. A dynamic communicator
who utilizes excellent interpersonal skills to tactfully conduct hospital care reviews. Performs second-level appeals
for a wide variety of insurance products. A forward-thinking leader who guides the development of innovative
medical solutions and promotes policies that maximize an organizations growth and profits. In addition, has over
23 years of clinical medicine experience in a variety of settings, including private office, occupational health centers,
urgent care facilities, extended care facilities, and prisons.

EXPERIENCE

ACCRETIVE HEALTH, Chicago, Illinois
Physician Advisor, 2010-2013

Held responsibility for accessing variety of hospital electronic medical records, performing data abstraction and analysis, and writing
recommendations regarding hospital admission and outpatient observation status. Conducted business calls with health plan medical
directors regarding hospital admission denials. Drafted letters of appeal for cases being sent on for further review.

Trained and experienced in the Centers for Medicare and Medicaid Services 2 Midnight Rule regarding hospital admissions.
Familiar with a variety of hospital electronic medical records and telecommuting.
Familiar with Milliman and Interqual Utilization Criteria.

CAPITAL BLUECROSS, Harrisburg, Pennsylvania
Associate Medical Director and Chairperson of Pharmacy and Therapeutics, 2003-2008

Oversaw pre-authorization reviews for DME, outpatient services, injectable medications, specialized radiological procedures, air
ambulance requests, and transplantation services. Performed second-level appeals for entire complement of Capital Blue Cross
insurance products, including traditional indemnity, managed care, Federal Employees Health Program, and Capitals Senior Blue
managed Medicare product.

Completed concurrent care reviews for acute care hospitals, skilled nursing facilities, rehabilitation hospitals, and long-term
acute care hospitals, using Interqual and Milliman Utilization Review Guidelines.
Participated in quality management activities and fraud and abuse reviews. Reviewed medical policies as necessary. Served
as lead medical director for Federal Employees Health Program (FEP). Participated in NCQA plan, URAC accreditation
reviews, and FEP program surveys.
Held responsibility, along with pharmacy director, for developing yearly formula for drug utilization policies. Worked on team
designing special injectable drug strategy to ensure access to medications as specialty pharmacy became larger area of cost.

PRIVATE PRACTICE EXPERIENCE

HOUCKS ROAD FAMILY PRACTICE, Harrisburg, Pennsylvania, 1990-2014. Served as physician in general family practice office
providing full range of primary care services, including in-patient hospital and long-term facility care. Revitalized and remodeled the
office and grew the practice over the last 23 years. Successfully implemented electronic medical records and met Centers for
Medicare and Medicaid Services Meaningful Use requirements for 2012 and 2013. Maintains active staff privileges Department of
Family Medicine - PINNACLEHEALTH SYSTEM.


Paul D. Williams, Page 2
OTHER EXPERIENCE

KEYSTONE PEER REVIEW ORGANIZATION, Harrisburg, Pennsylvania, Utilization Review Physician, 1991-2014.
FEDERAL OCCUPATIONAL HEALTH SERVICE REGION III, Harrisburg, Pennsylvania, Physician, 1995-2003, 2008-2014.
VISITING NURSES ASSOCIATION OF CENTRAL PENNSYLVANIA HOSPICE, Harrisburg, Pennsylvania, Medical Director,
1995-2014.
MEDICAL REVIEW, Harrisburg, Pennsylvania, Private Consultant/Medical Expert, 1990-2014.
PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE, Harrisburg, Pennsylvania, Medical Consultant, Office of Outpatient
Operations and Medical Assistance, 1995-1998.
THE POLYCLINIC MEDICAL CENTER, Harrisburg, Pennsylvania, Family Practice, 1987-1990.
THE METHODIST HOSPITAL, Brooklyn, New York, Rotating Internship, 1986-1987.

EDUCATION

THE PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE, Philadelphia, Pennsylvania, Doctor of Osteopathy, 1986
TRENTON STATE COLLEGE, Trenton, New Jersey, B.S., Biology, 1982

LICENSURE

Commonwealth of Pennsylvania, OS-006314-L

CERTIFICATIONS

Diplomate, American Board of Quality Assurance and Utilization Review Physicians, 1994-2014
Diplomate, American Board of Family Medicine #66331, 1990, 1996, 2002, 2008
Diplomate, National Board of Osteopathic Medical Examiners #13429, 1986
Federal Emergency Management Agency National Emergency Incident Command Management
Federal Motor Carrier Safety Administration - Certified medical examiner # 1743402960

PROFESSIONAL DEVELOPMENT

Fundamentals of Management for Family Physicians, 1998

AFFILIATIONS

Pinnacle Health Systems-Pinnacle Health Hospitals
American Academy of Family Physicians-Pennsylvania Academy of Family Physicians
American College of Physician Executives
American Osteopathic Association
American Board of Quality Assurance and Utilization Review Physicians
National Association of Managed Care Physicians
Sigma Xi
Pennsylvania Department of Public Welfare - Office of Medical Assistance Credentialing Committee

COMPUTER SKILLS

Microsoft Office Suite

SECURITY CLEARANCE

Level 3 Security Clearance - United States Government