With 12 years in active medical practice, and 27 years in the managed care field, few medical professionals have the combined breadth of operational and policy management experience that Dr. Jim Cross has had. Jim has extensive experience in the development and implementation of clinical policies, as well as the acceptance of coding schemes and payment rules to establish and implement reimbursement rules for payers. He is known for his oversight of the Clinical Policy Bulletins at Aetna and his working knowledge of using vendors to implement coding/payment rules into various claim systems, working to bring clinical integrity and consistency to these reimbursement tools that are crucial to managing medical cost.
Jim’s background includes key leadership roles with several payer organizations including Travelers, MetraHealth, United Healthcare and Prudential Healthcare (acquired by Aetna). Before leaving Aetna in 2016, Dr. Cross was Vice President and Head of National Medical Policy and Operations, responsible for clinical policy and reimbursement/payment policy for the company and many national clinical programs.
Jim received his M.D. degree from the University of Minnesota Medical School and did his pediatrics residency there.