Merwin David · CRCR, CSMC
Revenue cycle operations leader with 14+ years building and scaling high-performance teams across Primary care, Surgery, Radiology, Labs, Optometry, Behavioral health, Therapy and multispecialty. I bridge operations and engineering, turn manual judgment into tooling, and stop denials at the source.
About
I have spent my career building and scaling revenue cycle operations in complex, multi-client environments, leading cross-functional teams of more than 100 people and carrying P&L accountability. My edge is bridging operations and technology: I work directly with engineering to turn manual judgment into tooling, design KPI frameworks that make performance visible, and use automation and data to drive measurable, durable gains. I am just as comfortable in a regulated compliance setting, in front of a client, or inside a product roadmap conversation.
Core competencies
Experience
Featured work
A loop on real-time payer data that monitors denials and ranks them, so recurring patterns get traced back and fixed at the front end instead of worked one claim at a time.
The product requirements, development guide, and knowledge base that let engineering build an engine to resolve backend issues automatically, cutting manual intervention.
An AI knowledge graph mapping diagnosis and procedure codes, laying the groundwork for more accurate coverage and denial predictions at the point of order.
Commercial payer medical policies ingested into a structured database of covered and non-covered CPT and ICD codes, wired into a tool that gives the physician a real-time coverage read at the point of order, so non-covered services are caught before the claim goes out.
A payer-by-payer database of CPT frequency and same-day billing limits, surfaced at order entry so over-frequency, duplicate, and standing-order denials are prevented before submission.
A PHI-free, encrypted tracker that surfaces authorizations before they expire or run out of units, with calendar reminders, so reauthorizations happen on time and care never goes out unauthorized.
Every denial is sorted into one of three buckets, front end, medical necessity, and payer behavior, and worked the right way for its type. The pattern that emerges points straight back to better front-end fixes, so the same denial stops recurring.
Tightening the note at the source, cleaner coding structure, stronger medical records, and clearer medical-necessity support, so claims go out defensible the first time and survive payer review.
Toolbox & credentials