Gena MARSHALL, DMSc, PA-C
Colleyville,TX
Summary
Strategic clinical leader and Physician Associate with a Doctor of Medical Science degree and 20+ years of experience spanning surgical practice and healthcare operations. Deep expertise in reimbursement strategy, payer policy, utilization management, and cross-functional business integration across Medicare, Medicaid, and Commercial markets, supported by a long-standing clinical foundation in orthopedic and plastic surgery. Extensive experience supporting market access strategy through payer insights, reimbursement analysis, utilization trends, and policy interpretation across Medicare, Medicaid, and Commercial markets. Known for translating medical and pharmaceutical claims review, claims analysis, utilization trends, pricing and reimbursement dynamics, reimbursement policy, and regulatory changes into executive-ready insights that improve market access, affordability, patient experience, and enterprise readiness. Payer-side experience provides a unique perspective on reimbursement, access, and policy dynamics directly translatable to pharmaceutical market access strategy.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Director, Medical Clinical Operations – UM Medical Strategy, Integration & Payer Insights
UnitedHealthcare – United Clinical Services Medical Strategy
09.2025 - Current
- Lead enterprise utilization management strategy and integration efforts supporting reimbursement, coverage determination, payment integrity, and operational alignment across Medicare, Medicaid, and Commercial lines of business.
- Provide subject matter expertise in utilization management, reimbursement policy, prior authorization, post-service review, and medical necessity criteria, translating findings into strategic recommendations for leadership.
- Perform claims-based analysis and translate utilization and reimbursement data into actionable insights to support strategic decision-making, market access strategy, and enterprise readiness.
- Analyze claims review outcomes, utilization patterns, operational trends, and payer behavior to identify opportunities, threats, affordability considerations, access barriers, and policy impact.
- Evaluate scenarios and assess potential impact of reimbursement, policy, and operational changes to inform strategy, implementation planning, and enterprise strategy.
- Monitor and interpret regulatory, legislative, and payer policy trends to anticipate impact on reimbursement, access, and operational strategy.
- Identify cost drivers, utilization patterns, and reimbursement trends to understand financial impact and support affordability and access strategies.
- Serve as a primary strategic liaison across clinical operations, Health Care Economics, legal, regulatory/compliance, and business teams to align financial, clinical, and operational priorities.
- Assess operational feasibility of new initiatives and modernization efforts, advising leadership on implementation strategy, enterprise readiness, and potential business impact.
- Distill complex operational and reimbursement information into executive-ready updates and present key priorities to leadership and business stakeholders, including governance and JOC forums.
- Led successful implementation of a claims review departmental transition through staffing design, leadership structure, workflow integration, and automation.
- Spearheaded modernization strategies incorporating technology, automation, and AI to improve scalability, efficiency, and process performance.
- Reduced prior authorization requirements across payers, including pediatric populations, to improve patient access, reduce administrative burden, and support more timely care delivery.
- Manage Network Termination team
Director, Medical Clinical Operations
UnitedHealth Group – Optum Medical Claims Review
09.2017 - 09.2025
- Directed medical claims review operations involving clinical review, reimbursement determinations, payment integrity, and medical necessity oversight across multiple lines of business.
- Directed claims-based reimbursement analytics and trend analysis supporting complex medical necessity determinations, quality oversight, and strategic decision-making.
- Led multidisciplinary teams of physicians, physician associates, and nurses, including 19 direct reports, while driving quality, process standardization, and clinical policy implementation.
- Served as clinical liaison and project manager for global clinical efficiency and quality initiatives, supporting enterprise process improvements and operational consistency.
- Managed automation and workflow enablement initiatives, including clinical review tools and routing solutions designed to improve efficiency, alignment, and review quality.
- Partnered with specialty pharmacy stakeholders on review of high-dollar injectable drug claims to support reimbursement accuracy, cost management, and clinical oversight.
- Presented data, reimbursement trends, policy considerations, and process recommendations in executive and JOC settings to support strategic decision-making and stakeholder alignment.
- Developed onboarding and educational programs for physician associates and led internal presentations on clinical operations, quality, and team effectiveness.
Physician Associate – Orthopedic, Plastic, Reconstructive & General Surgery
Combined Clinical, Surgical, and Leadership Experience
Sugar Land
01.2001 - 01.2017
- More than 20 years of clinical and surgical experience as a Physician Associate across orthopedic, plastic, reconstructive, bariatric, general surgery, and trauma care settings.
- Performed surgical first assist, inpatient and outpatient management, consultation support, and complex clinical care delivery.
- Worked extensively in coding, reimbursement documentation, peer-to-peer review, predeterminations, provider education, and letters of medical necessity.
- Managed clinic operations, staffing, training, and workflow development while supporting physician practices with quality, education, and patient access initiatives.
Education
Doctor of Medical Science (DMSc), Summa Cum Laude -
Northern Arizona University
Flagstaff, AZ01-2026
Master of Science, Physician Assistant Studies, Summa Cum Laude -
University of Nebraska
Lincoln2004
Bachelor of Science, Physician Assistant Studies -
University of North Texas Health Science Center
Fort Worth, TX2001
Bachelor of Science, Occupational Therapy -
Texas Tech University Health Science Center
Lubbock1998
Skills
- Market Access Strategy & Payer Insights
- Claims Analytics & Utilization Trend Analysis
- Pricing and Reimbursement Dynamics
- Utilization Management & Prior Authorization
- Executive Communication & Presentations
- Scenario Analysis & Strategic Recommendations
- Reimbursement Policy & Coverage Strategy
- Medical Policy Impact & Enterprise Strategy
- Health Care Economics Collaboration
- Policy, Regulatory & Compliance Alignment
- Cross-Functional Stakeholder Leadership
- Process Optimization, Automation & AI Integration
Accomplishments
- Led a successful departmental transition for claims review within a four-month period by establishing staffing structure, leadership alignment, and automated workflows after multiple prior failed attempts from previous leaders.
- Significantly reduced prior authorization requirements across multiple payers, including pediatrics, to improve patient experience and support more timely delivery of care.
- Integrated technology, automation, and AI into modernization strategy to improve workflow efficiency, scalability, data visibility, and operational performance.
- Recognized with both an individual UHG Sages of Clinical Services Award and a collaborative Sages team award for quality on a global team.
- Drove clinical strategy and solutions to save the company over 40 million dollars since 1/26.
Certification
- Physician Assistant License – Texas 2001- present
- Physician Assistant License – New Mexico 2024- present
- Physician Assistant License – Arizona 2024- present
- Board Certification – National Commission on Certification of Physician Assistants (NCCPA) 2001- present
- Occupational Therapist, Registered- Texas 1998- present
LEADERSHIP DEVELOPMENT
- UHC Clinical Executive Leadership Program (NPS; Accelerating Change and Transitions)
- UHC Emerging Leaders Program
- Business of Healthcare Certification – Strategic Thinking
Timeline
Director, Medical Clinical Operations – UM Medical Strategy, Integration & Payer Insights
UnitedHealthcare – United Clinical Services Medical Strategy
09.2025 - Current
Director, Medical Clinical Operations
UnitedHealth Group – Optum Medical Claims Review
09.2017 - 09.2025
Physician Associate – Orthopedic, Plastic, Reconstructive & General Surgery
Combined Clinical, Surgical, and Leadership Experience
01.2001 - 01.2017
Doctor of Medical Science (DMSc), Summa Cum Laude -
Northern Arizona University
Master of Science, Physician Assistant Studies, Summa Cum Laude -
University of Nebraska
Bachelor of Science, Physician Assistant Studies -
University of North Texas Health Science Center
Bachelor of Science, Occupational Therapy -
Texas Tech University Health Science Center