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Accept Decline Skip to main content Toggle navigation * HOME * PREVIOUS SPEAKERS * PREVIOUS PARTNERS * COMMUNITY * GET INVOLVED * MEDIA KIT * REGISTER YOUR INTEREST * HEADLINE PARTNER * PLATINUM PARTNER * * GOLD PARTNERS * * * * View All Partners 2ND ANNUAL HEALTHCARE PAYMENT AND REVENUE INTEGRITY EAST | MAY 22-23 Delivering scalable and flexible solutions which ensure accuracy and integrity of claims, nurture payer-provider relationships and support the transition to value-based payments REGISTER YOUR INTEREST 2024 THANK YOU TO EVERYONE THAT JOINED US IN BOSTON The Healthcare Payment and Revenue Integrity Congress connects leading figures in PI and RI/RCM to encourage information sharing, discuss the latest solutions being leveraged to ensure the integrity of claims, nurture payer-providers relationships and support the transition to value-based payments. Health plans use this forum to strengthen, redefine, or establish their own payment integrity strategies by analyzing case studies from industry peers and joining interactive discussions that span the entire claims continuum. It also empowers providers to make revenue cycle decisions with confidence by leveraging intelligent automation, optimizing RCM based on value, and effectively communicating concerns around emerging payment initiatives. PHOTO GALLERY VIEW ALL PHOTOS HERE * * * * * * * * * * * * * * 210.1 HPRI WELCOME VIDEO (1) Video of 210.1 HPRI Welcome Video (1) OUR COMMUNITY OF PAYERS * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * WOULD YOU LIKE TO PRESENT AT THE UPCOMING EVENT? Showcase your work to our audience of 150+ payment integrity leaders. If you would be interested in learning about the speaking opportunities available, please email Matthew.Oxley@kisacoresearch.com PAYERS PROVIDERS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. > It's a unique forum that brings together providers, payors, vendors and > regulators for collaboration, education and information sharing. UnitedHealth > It was a seamless process and the intimate meeting space was ideal to allow > for more collaboration Health Care Services Corporation > The quality of the event, sessions, speakers and Health Plan attendees scored > high Performant Corp > Great job putting on your inaugural show. I'm certain that the show will > continue to grow and get even better in the future. MedReview > I think the conference has good potential going forward. It fits a niche in > the industry. ClaimLogiq > This conference filled the much needed gap in focusing on Payment Integrity > issues and initiatives Blue Cross and Blue Shield of North Carolina > We finally have a PI conference! EXL > This PI conference was wonderful. We’d rank it 10/10 with representation from > all across the industry Carelon > This was the most meaningful industry event of the year for Payment Integrity > professionals Advanced Medical Solutions It was a great opportunity to hear from many subject matter experts over a wide topic of subjects specific to Payment/Revenue Integrity Devoted Health HOW TO GET INVOLVED PARTNER WITH US Partner with us to elevate your brand, and make valuable new connections. Subject to availability, we offer opportunities for thought leadership, branding, and facilitated networking. Please contact our Partnerships Director, Harry Ludbrook, for more info. GET IN TOUCH PAYERS AND PROVIDERS ATTEND FOR FREE Step into interactive discussions and engaging presentations on the key challenges and opportunities presented by payment companies. To deliver maximum value for our community, all payers and providers are eligible for complimentary passes. CLAIM YOUR FREE PASS OUR COMMUNITY FEATURED SPEAKERS JENNIFER DUPEE Director, Audit & Vulnerabilities Group, Center for Program Integrity CMS Jennifer Dupee, Director. Audits & Vulnerabilities Group. Center for Program Integrity Full bio JENNIFER DUPEE Director, Audit & Vulnerabilities Group, Center for Program Integrity CMS JENNIFER DUPEE Director, Audit & Vulnerabilities Group, Center for Program Integrity CMS Jennifer Dupee, Director. Audits & Vulnerabilities Group. Center for Program Integrity In her role as the Director of the Audits and Vulnerabilities Group, Ms. Dupee identifies and develops comprehensive mitigation strategies addressing program integrity risks for all of CMS' programs, provides oversight of Medicare Part C and Part D plans and the Federally Facilitated Exchanges, and implements CMS’ Comprehensive Medicaid Integrity Plan. Prior to her current role at CPI, Ms. Dupee worked on such initiatives as the improper payment rate measurement for the Medicare fee-for-service program, Open Payments, and the Healthcare Fraud Prevention Partnership. Ms. Dupee also completed a Congressional detail with the House Committee on Ways and Means, responsible for a portfolio of Medicare fee-for-service and program integrity issues. Ms. Dupee has a Bachelor of Science Degree in Nursing from the University of Wisconsin, a Master of Science in Nursing and a Master of Business Administration from Johns Hopkins University, and a Juris Doctor Degree with a Health Law Certificate from the University of Maryland. MONIQUE PIERCE Payment Integrity Leader Devoted Health Monique is a Strategic Executive Healthcare Leader with proven ability to develop solutions and maximize the benefits of Payment Integrity programs. She is known for having excellent domain knowledge and being driven, high performing, and having a deep dedication to recruiting and developing top talent. Full bio MONIQUE PIERCE Payment Integrity Leader Devoted Health MONIQUE PIERCE Payment Integrity Leader Devoted Health Monique is a Strategic Executive Healthcare Leader with proven ability to develop solutions and maximize the benefits of Payment Integrity programs. She is known for having excellent domain knowledge and being driven, high performing, and having a deep dedication to recruiting and developing top talent. Monique started her Payment Integrity career at Oxford HealthPlans in the COB and Subrogation Department after spending time in Payment Policy. When United Healthcare acquired many health plans in the early 2000s like Oxford, Monique was tagged as part of the Optum team to integrate the processes and people into the COB systems that she had built at Oxford. She led systems development, quality, reporting, operations, vendor management and was responsible for creating innovative proactive programs that more than doubled savings to $1.4B in three years. Monique developed a successful program that reduced interest expense on late claims for UHC, assisted a communication company to develop COB tools and assisted in strategic system projects before joining SCIO Health Analytics in 2014 to develop new products - specifically prepayment programs. In 2015 she became the product owner of SCIOMine, the company’s internal audit application and managed the roadmap. Monique also owned strategic direction for operational metrics and reporting including executive scorecards. Monique was promoted to VP of Business Opportunities and Client Engagement where she improved Audit Recovery TAT by 39% and reduced client implementations TAT by 11% and the Level of Effort by 18% while increasing the count of implementation projects by 126%. In 2020 Monique joined Devoted Health, a startup company with the goal of building the first ever integrated Payment Integrity Program. The company has one system, great data, and a great mission; to change health care by treating every member as if they are family. In her spare time, Monique volunteers her time in the community on the Board of Directors of SCARE NH and works in her family business LARP Portal with her husband Rick. PHILLIP CHURCHILL Assistant General Counsel Blue Cross Blue Shield of Michigan PHILLIP CHURCHILL Assistant General Counsel Blue Cross Blue Shield of Michigan PHILLIP CHURCHILL Assistant General Counsel Blue Cross Blue Shield of Michigan DAVE CARDELLE Chief Strategy Officer AMS DAVE CARDELLE Chief Strategy Officer AMS DAVE CARDELLE Chief Strategy Officer AMS CONOR MCCAULEY Director, Payment Integrity Clinical Capabilites Highmark Health My name is Conor McCauley. I am the Director of Payment Integrity Clinical Capabilities at Highmark. Being a Critical Care nurse, it is easy to see there are issues surrounding healthcare funding. Inserting clinical insights into reimbursement methodologies can lead to affordability and improved patient outcomes. Clinicians are well positioned to make a difference here. My passion is developing an engaged team, effective processes, and surrounding clinicians with the right technology, data, and market insights so they can work at the top of their licensure. Full bio CONOR MCCAULEY Director, Payment Integrity Clinical Capabilites Highmark Health CONOR MCCAULEY Director, Payment Integrity Clinical Capabilites Highmark Health My name is Conor McCauley. I am the Director of Payment Integrity Clinical Capabilities at Highmark. Being a Critical Care nurse, it is easy to see there are issues surrounding healthcare funding. Inserting clinical insights into reimbursement methodologies can lead to affordability and improved patient outcomes. Clinicians are well positioned to make a difference here. My passion is developing an engaged team, effective processes, and surrounding clinicians with the right technology, data, and market insights so they can work at the top of their licensure. ANDREA BEATRICE Director of Payment Integrity and FWA Health New England ANDREA BEATRICE Director of Payment Integrity and FWA Health New England ANDREA BEATRICE Director of Payment Integrity and FWA Health New England View all speakers AGENDA HIGHLIGHTS -------------------------------------------------------------------------------- Printable version CMS CENTER FOR PROGRAM INTEGRITY (CPI) UPDATES - This session will be focused on providing an insider’s view of CPI and CPI’s 2023 priorities - We will cover the use of the Government Accountability Office Fraud Risk Management Framework to develop anti-fraud strategies and react to emerging threats, updates on our Marketplace fraud work, and opportunities for private-public collaboration. AUTHOR: JENNIFER DUPEE Director, Audit & Vulnerabilities Group, Center for Program Integrity CMS Jennifer Dupee, Director. Audits & Vulnerabilities Group. Center for Program Integrity In her role as the Director of the Audits and Vulnerabilities Group, Ms. Dupee identifies and develops comprehensive mitigation strategies addressing program integrity risks for all of CMS' programs, provides oversight of Medicare Part C and Part D plans and the Federally Facilitated Exchanges, and implements CMS’ Comprehensive Medicaid Integrity Plan. Prior to her current role at CPI, Ms. Dupee worked on such initiatives as the improper payment rate measurement for the Medicare fee-for-service program, Open Payments, and the Healthcare Fraud Prevention Partnership. Ms. Dupee also completed a Congressional detail with the House Committee on Ways and Means, responsible for a portfolio of Medicare fee-for-service and program integrity issues. Ms. Dupee has a Bachelor of Science Degree in Nursing from the University of Wisconsin, a Master of Science in Nursing and a Master of Business Administration from Johns Hopkins University, and a Juris Doctor Degree with a Health Law Certificate from the University of Maryland. ... read more JENNIFER DUPEE Director, Audit & Vulnerabilities Group, Center for Program Integrity CMS Jennifer Dupee, Director. Audits & Vulnerabilities Group. Center for Program Integrity In her role as the Director of the Audits and Vulnerabilities Group, Ms. Dupee identifies and develops comprehensive mitigation strategies addressing program integrity risks for all of CMS' programs, provides oversight of Medicare Part C and Part D plans and the Federally Facilitated Exchanges, and implements CMS’ Comprehensive Medicaid Integrity Plan. Prior to her current role at CPI, Ms. Dupee worked on such initiatives as the improper payment rate measurement for the Medicare fee-for-service program, Open Payments, and the Healthcare Fraud Prevention Partnership. Ms. Dupee also completed a Congressional detail with the House Committee on Ways and Means, responsible for a portfolio of Medicare fee-for-service and program integrity issues. Ms. Dupee has a Bachelor of Science Degree in Nursing from the University of Wisconsin, a Master of Science in Nursing and a Master of Business Administration from Johns Hopkins University, and a Juris Doctor Degree with a Health Law Certificate from the University of Maryland. DEVELOPING A PAYMENT INTEGRITY PROGRAM FROM THE GROUND UP * Developing a Payment Integrity Program from the ground up for a brand new Medicare Advantage Health Plan * Covering both the opportunities and the challenges of building and effectively managing PI programs that prevent, avoid, or recover billing errors, payment errors and other party liability errors * Listing of suggestions/ advice from our success, and lessons learned AUTHOR: MONIQUE PIERCE Payment Integrity Leader Devoted Health Monique is a Strategic Executive Healthcare Leader with proven ability to develop solutions and maximize the benefits of Payment Integrity programs. She is known for having excellent domain knowledge and being driven, high performing, and having a deep dedication to recruiting and developing top talent. Monique started her Payment Integrity career at Oxford HealthPlans in the COB and Subrogation Department after spending time in Payment Policy. When United Healthcare acquired many health plans in the early 2000s like Oxford, Monique was tagged as part of the Optum team to integrate the processes and people into the COB systems that she had built at Oxford. She led systems development, quality, reporting, operations, vendor management and was responsible for creating innovative proactive programs that more than doubled savings to $1.4B in three years. Monique developed a successful program that reduced interest expense on late claims for UHC, assisted a communication company to develop COB tools and assisted in strategic system projects before joining SCIO Health Analytics in 2014 to develop new products - specifically prepayment programs. In 2015 she became the product owner of SCIOMine, the company’s internal audit application and managed the roadmap. Monique also owned strategic direction for operational metrics and reporting including executive scorecards. Monique was promoted to VP of Business Opportunities and Client Engagement where she improved Audit Recovery TAT by 39% and reduced client implementations TAT by 11% and the Level of Effort by 18% while increasing the count of implementation projects by 126%. In 2020 Monique joined Devoted Health, a startup company with the goal of building the first ever integrated Payment Integrity Program. The company has one system, great data, and a great mission; to change health care by treating every member as if they are family. In her spare time, Monique volunteers her time in the community on the Board of Directors of SCARE NH and works in her family business LARP Portal with her husband Rick. ... read more MONIQUE PIERCE Payment Integrity Leader Devoted Health Monique is a Strategic Executive Healthcare Leader with proven ability to develop solutions and maximize the benefits of Payment Integrity programs. She is known for having excellent domain knowledge and being driven, high performing, and having a deep dedication to recruiting and developing top talent. Monique started her Payment Integrity career at Oxford HealthPlans in the COB and Subrogation Department after spending time in Payment Policy. When United Healthcare acquired many health plans in the early 2000s like Oxford, Monique was tagged as part of the Optum team to integrate the processes and people into the COB systems that she had built at Oxford. She led systems development, quality, reporting, operations, vendor management and was responsible for creating innovative proactive programs that more than doubled savings to $1.4B in three years. Monique developed a successful program that reduced interest expense on late claims for UHC, assisted a communication company to develop COB tools and assisted in strategic system projects before joining SCIO Health Analytics in 2014 to develop new products - specifically prepayment programs. In 2015 she became the product owner of SCIOMine, the company’s internal audit application and managed the roadmap. Monique also owned strategic direction for operational metrics and reporting including executive scorecards. Monique was promoted to VP of Business Opportunities and Client Engagement where she improved Audit Recovery TAT by 39% and reduced client implementations TAT by 11% and the Level of Effort by 18% while increasing the count of implementation projects by 126%. In 2020 Monique joined Devoted Health, a startup company with the goal of building the first ever integrated Payment Integrity Program. The company has one system, great data, and a great mission; to change health care by treating every member as if they are family. In her spare time, Monique volunteers her time in the community on the Board of Directors of SCARE NH and works in her family business LARP Portal with her husband Rick. CLAIMS AUDIT – THE INDIANA JONES OF PAYMENT INTEGRITY? - How does Claim Audit fit into the overall savings goals from PI? - Archaeology amongst savings drivers? High $ treasures? - Claim Audit Digs & Research – driving process improvement, not just savings. - Do underpayments matter? - How to keep finding treasure: - Partnering with other departments as a true “Partner” not an “Auditor.” - It will all be in a museum (creating reference materials). AUTHOR: TOM MARTIN AVP, Payment Integrity Molina Healthcare ... read more TOM MARTIN AVP, Payment Integrity Molina Healthcare 2023 PARTNERS HEADLINE PARTNER * PLATINUM PARTNER * * GOLD PARTNERS * * * * * View all partners OUR COMMUNITY * * * * * * * * * * * * * * * * * * * * * Step into interactive discussions and engaging presentations on the key challenges and opportunities presented by payment companies today: OUR PARTNERS 2 Main Event Days 35+ Industry Leading Speakers 180+ Industry Experts 15+ Dedicated Networking Hours OUR SELECTION COMITTEE AUTHOR: BRANNON MORISOLI Director SWK Holdings Mr. Morisoli joined SWK Holdings as a Senior Analyst in March 2016. Prior to joining SWK, he was an Investment Analyst and Portfolio Manager for a family office that invested in equities, fixed income, real estate, and alternative investments. Prior to that, he was an Investment Analyst for Presidium Group, a real estate private equity firm, where he played an integral role in closing over $100mm in transactions. Mr. Morisoli began his career at Neurografix, a startup medical technology company in Santa Monica, CA that was doing groundbreaking work in the MRI imaging of peripheral nerves. While with Neurografix, he was published in two leading neurology journals. Brannon graduated from UCLA with a B.S., was awarded a fellowship and graduated from the University of Notre Dame with an M.B.A, and was awarded a Samson Fellowship from the University of Wisconsin Law School, where he graduated with a J.D. Mr. Morisoli is an inactive member of the State Bar of Wisconsin ... read more BRANNON MORISOLI Director SWK Holdings Mr. Morisoli joined SWK Holdings as a Senior Analyst in March 2016. Prior to joining SWK, he was an Investment Analyst and Portfolio Manager for a family office that invested in equities, fixed income, real estate, and alternative investments. Prior to that, he was an Investment Analyst for Presidium Group, a real estate private equity firm, where he played an integral role in closing over $100mm in transactions. Mr. Morisoli began his career at Neurografix, a startup medical technology company in Santa Monica, CA that was doing groundbreaking work in the MRI imaging of peripheral nerves. While with Neurografix, he was published in two leading neurology journals. Brannon graduated from UCLA with a B.S., was awarded a fellowship and graduated from the University of Notre Dame with an M.B.A, and was awarded a Samson Fellowship from the University of Wisconsin Law School, where he graduated with a J.D. Mr. Morisoli is an inactive member of the State Bar of Wisconsin AUTHOR: THOMAS BUSBY Vice President Outcome Capital Thomas Busby is a Vice President and has been with Outcome Capital since 2015. He focuses on medical technology, digital health and life science services segments with particular interest in innovative life science companies that deliver patient impact by leveraging novel approaches. Thomas is driven by the desire to identify disruptive technologies and services that require unique strategic thought and assistance to realize their full market potential. Thomas has been published in leading life science journals Life Science Leader and The Pharma Letter, and also serves on the board of HealthTech Build, a Boston-based digital health innovation group. Prior to his career in life-science investment banking, Thomas pursued his passion for the public service and non-profit sectors working in a variety of leadership and management positions, and at one time held a Massachusetts teaching license. Thomas completed his MBA at Suffolk University’s Sawyer Business School on full academic scholarship where he was President of the school’s Graduate Business Association and class speaker at graduation. Prior, he completed a BS in Philosophy with Honors from Suffolk’s College of Arts & Sciences. Committed to giving back, Thomas is currently the President of the College of Arts & Sciences Alumni Board of Directors. Thomas is a FINRA Registered Securities Representative holding his Series 79 and 63. ... read more THOMAS BUSBY Vice President Outcome Capital Thomas Busby is a Vice President and has been with Outcome Capital since 2015. He focuses on medical technology, digital health and life science services segments with particular interest in innovative life science companies that deliver patient impact by leveraging novel approaches. Thomas is driven by the desire to identify disruptive technologies and services that require unique strategic thought and assistance to realize their full market potential. Thomas has been published in leading life science journals Life Science Leader and The Pharma Letter, and also serves on the board of HealthTech Build, a Boston-based digital health innovation group. Prior to his career in life-science investment banking, Thomas pursued his passion for the public service and non-profit sectors working in a variety of leadership and management positions, and at one time held a Massachusetts teaching license. Thomas completed his MBA at Suffolk University’s Sawyer Business School on full academic scholarship where he was President of the school’s Graduate Business Association and class speaker at graduation. Prior, he completed a BS in Philosophy with Honors from Suffolk’s College of Arts & Sciences. Committed to giving back, Thomas is currently the President of the College of Arts & Sciences Alumni Board of Directors. Thomas is a FINRA Registered Securities Representative holding his Series 79 and 63. AUTHOR: ROBERT CROUSORE Managing Partner Health Frontier Ventures Robert has 28 years of experience in the health care products and services industry. Crousore is a serial entrepreneur with multiple successful product and services company exits. His experience spans the entire business enterprise including Sales, Marketing, Operations, Product Innovation and, most recently M & A. Highlights Include: * Has successfully managed a global commercial organization in the wound care business. * Has a number of patent credits for products in the wound care industry. * Sits on multiple boards of healthcare technology companies. * His passion is creating meaningful changes in patient care by combining great products with great teams that are focused on empowering improved clinical and financial outcomes. ... read more ROBERT CROUSORE Managing Partner Health Frontier Ventures Robert has 28 years of experience in the health care products and services industry. Crousore is a serial entrepreneur with multiple successful product and services company exits. His experience spans the entire business enterprise including Sales, Marketing, Operations, Product Innovation and, most recently M & A. Highlights Include: * Has successfully managed a global commercial organization in the wound care business. * Has a number of patent credits for products in the wound care industry. * Sits on multiple boards of healthcare technology companies. * His passion is creating meaningful changes in patient care by combining great products with great teams that are focused on empowering improved clinical and financial outcomes. AUTHOR: BRANNON MORISOLI Director SWK Holdings Mr. Morisoli joined SWK Holdings as a Senior Analyst in March 2016. Prior to joining SWK, he was an Investment Analyst and Portfolio Manager for a family office that invested in equities, fixed income, real estate, and alternative investments. Prior to that, he was an Investment Analyst for Presidium Group, a real estate private equity firm, where he played an integral role in closing over $100mm in transactions. Mr. Morisoli began his career at Neurografix, a startup medical technology company in Santa Monica, CA that was doing groundbreaking work in the MRI imaging of peripheral nerves. While with Neurografix, he was published in two leading neurology journals. Brannon graduated from UCLA with a B.S., was awarded a fellowship and graduated from the University of Notre Dame with an M.B.A, and was awarded a Samson Fellowship from the University of Wisconsin Law School, where he graduated with a J.D. Mr. Morisoli is an inactive member of the State Bar of Wisconsin ... read more BRANNON MORISOLI Director SWK Holdings Mr. Morisoli joined SWK Holdings as a Senior Analyst in March 2016. Prior to joining SWK, he was an Investment Analyst and Portfolio Manager for a family office that invested in equities, fixed income, real estate, and alternative investments. Prior to that, he was an Investment Analyst for Presidium Group, a real estate private equity firm, where he played an integral role in closing over $100mm in transactions. Mr. Morisoli began his career at Neurografix, a startup medical technology company in Santa Monica, CA that was doing groundbreaking work in the MRI imaging of peripheral nerves. While with Neurografix, he was published in two leading neurology journals. Brannon graduated from UCLA with a B.S., was awarded a fellowship and graduated from the University of Notre Dame with an M.B.A, and was awarded a Samson Fellowship from the University of Wisconsin Law School, where he graduated with a J.D. Mr. Morisoli is an inactive member of the State Bar of Wisconsin AUTHOR: THOMAS BUSBY Vice President Outcome Capital Thomas Busby is a Vice President and has been with Outcome Capital since 2015. He focuses on medical technology, digital health and life science services segments with particular interest in innovative life science companies that deliver patient impact by leveraging novel approaches. Thomas is driven by the desire to identify disruptive technologies and services that require unique strategic thought and assistance to realize their full market potential. Thomas has been published in leading life science journals Life Science Leader and The Pharma Letter, and also serves on the board of HealthTech Build, a Boston-based digital health innovation group. Prior to his career in life-science investment banking, Thomas pursued his passion for the public service and non-profit sectors working in a variety of leadership and management positions, and at one time held a Massachusetts teaching license. Thomas completed his MBA at Suffolk University’s Sawyer Business School on full academic scholarship where he was President of the school’s Graduate Business Association and class speaker at graduation. Prior, he completed a BS in Philosophy with Honors from Suffolk’s College of Arts & Sciences. Committed to giving back, Thomas is currently the President of the College of Arts & Sciences Alumni Board of Directors. Thomas is a FINRA Registered Securities Representative holding his Series 79 and 63. ... read more THOMAS BUSBY Vice President Outcome Capital Thomas Busby is a Vice President and has been with Outcome Capital since 2015. He focuses on medical technology, digital health and life science services segments with particular interest in innovative life science companies that deliver patient impact by leveraging novel approaches. Thomas is driven by the desire to identify disruptive technologies and services that require unique strategic thought and assistance to realize their full market potential. Thomas has been published in leading life science journals Life Science Leader and The Pharma Letter, and also serves on the board of HealthTech Build, a Boston-based digital health innovation group. Prior to his career in life-science investment banking, Thomas pursued his passion for the public service and non-profit sectors working in a variety of leadership and management positions, and at one time held a Massachusetts teaching license. Thomas completed his MBA at Suffolk University’s Sawyer Business School on full academic scholarship where he was President of the school’s Graduate Business Association and class speaker at graduation. Prior, he completed a BS in Philosophy with Honors from Suffolk’s College of Arts & Sciences. Committed to giving back, Thomas is currently the President of the College of Arts & Sciences Alumni Board of Directors. Thomas is a FINRA Registered Securities Representative holding his Series 79 and 63. AUTHOR: ROBERT CROUSORE Managing Partner Health Frontier Ventures Robert has 28 years of experience in the health care products and services industry. Crousore is a serial entrepreneur with multiple successful product and services company exits. His experience spans the entire business enterprise including Sales, Marketing, Operations, Product Innovation and, most recently M & A. Highlights Include: * Has successfully managed a global commercial organization in the wound care business. * Has a number of patent credits for products in the wound care industry. * Sits on multiple boards of healthcare technology companies. * His passion is creating meaningful changes in patient care by combining great products with great teams that are focused on empowering improved clinical and financial outcomes. ... read more ROBERT CROUSORE Managing Partner Health Frontier Ventures Robert has 28 years of experience in the health care products and services industry. Crousore is a serial entrepreneur with multiple successful product and services company exits. His experience spans the entire business enterprise including Sales, Marketing, Operations, Product Innovation and, most recently M & A. Highlights Include: * Has successfully managed a global commercial organization in the wound care business. * Has a number of patent credits for products in the wound care industry. * Sits on multiple boards of healthcare technology companies. * His passion is creating meaningful changes in patient care by combining great products with great teams that are focused on empowering improved clinical and financial outcomes. SPEAKERS JENNIFER DUPEE Director, Audit & Vulnerabilities Group, Center for Program Integrity CMS Jennifer Dupee, Director. Audits & Vulnerabilities Group. Center for Program Integrity Full bio JENNIFER DUPEE Director, Audit & Vulnerabilities Group, Center for Program Integrity CMS JENNIFER DUPEE Director, Audit & Vulnerabilities Group, Center for Program Integrity CMS Jennifer Dupee, Director. Audits & Vulnerabilities Group. Center for Program Integrity In her role as the Director of the Audits and Vulnerabilities Group, Ms. Dupee identifies and develops comprehensive mitigation strategies addressing program integrity risks for all of CMS' programs, provides oversight of Medicare Part C and Part D plans and the Federally Facilitated Exchanges, and implements CMS’ Comprehensive Medicaid Integrity Plan. Prior to her current role at CPI, Ms. Dupee worked on such initiatives as the improper payment rate measurement for the Medicare fee-for-service program, Open Payments, and the Healthcare Fraud Prevention Partnership. Ms. Dupee also completed a Congressional detail with the House Committee on Ways and Means, responsible for a portfolio of Medicare fee-for-service and program integrity issues. Ms. Dupee has a Bachelor of Science Degree in Nursing from the University of Wisconsin, a Master of Science in Nursing and a Master of Business Administration from Johns Hopkins University, and a Juris Doctor Degree with a Health Law Certificate from the University of Maryland. MONIQUE PIERCE Payment Integrity Leader Devoted Health Monique is a Strategic Executive Healthcare Leader with proven ability to develop solutions and maximize the benefits of Payment Integrity programs. She is known for having excellent domain knowledge and being driven, high performing, and having a deep dedication to recruiting and developing top talent. Full bio MONIQUE PIERCE Payment Integrity Leader Devoted Health MONIQUE PIERCE Payment Integrity Leader Devoted Health Monique is a Strategic Executive Healthcare Leader with proven ability to develop solutions and maximize the benefits of Payment Integrity programs. She is known for having excellent domain knowledge and being driven, high performing, and having a deep dedication to recruiting and developing top talent. Monique started her Payment Integrity career at Oxford HealthPlans in the COB and Subrogation Department after spending time in Payment Policy. When United Healthcare acquired many health plans in the early 2000s like Oxford, Monique was tagged as part of the Optum team to integrate the processes and people into the COB systems that she had built at Oxford. She led systems development, quality, reporting, operations, vendor management and was responsible for creating innovative proactive programs that more than doubled savings to $1.4B in three years. Monique developed a successful program that reduced interest expense on late claims for UHC, assisted a communication company to develop COB tools and assisted in strategic system projects before joining SCIO Health Analytics in 2014 to develop new products - specifically prepayment programs. In 2015 she became the product owner of SCIOMine, the company’s internal audit application and managed the roadmap. Monique also owned strategic direction for operational metrics and reporting including executive scorecards. Monique was promoted to VP of Business Opportunities and Client Engagement where she improved Audit Recovery TAT by 39% and reduced client implementations TAT by 11% and the Level of Effort by 18% while increasing the count of implementation projects by 126%. In 2020 Monique joined Devoted Health, a startup company with the goal of building the first ever integrated Payment Integrity Program. The company has one system, great data, and a great mission; to change health care by treating every member as if they are family. In her spare time, Monique volunteers her time in the community on the Board of Directors of SCARE NH and works in her family business LARP Portal with her husband Rick. PHILLIP CHURCHILL Assistant General Counsel Blue Cross Blue Shield of Michigan Full bio PHILLIP CHURCHILL Assistant General Counsel Blue Cross Blue Shield of Michigan PHILLIP CHURCHILL Assistant General Counsel Blue Cross Blue Shield of Michigan DAVE CARDELLE Chief Strategy Officer AMS Full bio DAVE CARDELLE Chief Strategy Officer AMS DAVE CARDELLE Chief Strategy Officer AMS CONOR MCCAULEY Director, Payment Integrity Clinical Capabilites Highmark Health My name is Conor McCauley. I am the Director of Payment Integrity Clinical Capabilities at Highmark. Being a Critical Care nurse, it is easy to see there are issues surrounding healthcare funding. Inserting clinical insights into reimbursement methodologies can lead to affordability and improved patient outcomes. Clinicians are well positioned to make a difference here. My passion is developing an engaged team, effective processes, and surrounding clinicians with the right technology, data, and market insights so they can work at the top of their licensure. Full bio CONOR MCCAULEY Director, Payment Integrity Clinical Capabilites Highmark Health CONOR MCCAULEY Director, Payment Integrity Clinical Capabilites Highmark Health My name is Conor McCauley. I am the Director of Payment Integrity Clinical Capabilities at Highmark. Being a Critical Care nurse, it is easy to see there are issues surrounding healthcare funding. Inserting clinical insights into reimbursement methodologies can lead to affordability and improved patient outcomes. Clinicians are well positioned to make a difference here. My passion is developing an engaged team, effective processes, and surrounding clinicians with the right technology, data, and market insights so they can work at the top of their licensure. ANDREA BEATRICE Director of Payment Integrity and FWA Health New England Full bio ANDREA BEATRICE Director of Payment Integrity and FWA Health New England ANDREA BEATRICE Director of Payment Integrity and FWA Health New England MAHI RAYASAM PhD., Partner McKinsey Mahi Rayasam is a Partner in McKinsey’s Healthcare practice and leads a large analytics team focused on Healthcare Affordability, Quality and Outcomes. Mahi serves payers, healthcare technology & services companies and private equity institutions on topics related to transformations, operations and innovation. Specifically, Mahi has extensive experience in serving payers across 30 states on topics including Payment Integrity, FW&A, Medical Management and Out-of-Network cost management. Full bio MAHI RAYASAM PhD., Partner McKinsey MAHI RAYASAM PhD., Partner McKinsey Mahi Rayasam is a Partner in McKinsey’s Healthcare practice and leads a large analytics team focused on Healthcare Affordability, Quality and Outcomes. Mahi serves payers, healthcare technology & services companies and private equity institutions on topics related to transformations, operations and innovation. Specifically, Mahi has extensive experience in serving payers across 30 states on topics including Payment Integrity, FW&A, Medical Management and Out-of-Network cost management. Mahi also leads the development of McKinsey’s knowledge and product development efforts on AI/ML/NLP and other transformative technologies for healthcare. POOJA SINGH Partner McKinsey Pooja Singh is a Partner in McKinsey’s Healthcare practice and a leader in the domain focused on Healthcare Affordability, Quality and Outcomes. Pooja serves payers, healthcare technology & services companies and private equity institutions on topics related to transformations, operations and innovation. Specifically, Pooja has extensive experience in serving payers on topics including Payment Integrity, FW&A, Medical Management, Care Management and Network management. Full bio POOJA SINGH Partner McKinsey POOJA SINGH Partner McKinsey Pooja Singh is a Partner in McKinsey’s Healthcare practice and a leader in the domain focused on Healthcare Affordability, Quality and Outcomes. Pooja serves payers, healthcare technology & services companies and private equity institutions on topics related to transformations, operations and innovation. Specifically, Pooja has extensive experience in serving payers on topics including Payment Integrity, FW&A, Medical Management, Care Management and Network management. VLADIMIR-DUCARMEL JOSEPH CDI Program Manager Lahey Hospital & Medical Center Vladimir-Ducarmel Joseph is the CDI Program Manager at Lahey Hospital & Medical Center, where he spearheads a dedicated team of CDI professional experts to optimize clinical documentation best practices. With almost a decade in CDI leadership across diverse healthcare environments, Vladimir-Ducarmel holds a Master of Health Administration from George Washington University and is ECFMG-certified as a foreign-trained physician. His expertise encompasses physician leadership, team dynamics, CDI provider education, and program management. Full bio VLADIMIR-DUCARMEL JOSEPH CDI Program Manager Lahey Hospital & Medical Center VLADIMIR-DUCARMEL JOSEPH CDI Program Manager Lahey Hospital & Medical Center Vladimir-Ducarmel Joseph is the CDI Program Manager at Lahey Hospital & Medical Center, where he spearheads a dedicated team of CDI professional experts to optimize clinical documentation best practices. With almost a decade in CDI leadership across diverse healthcare environments, Vladimir-Ducarmel holds a Master of Health Administration from George Washington University and is ECFMG-certified as a foreign-trained physician. His expertise encompasses physician leadership, team dynamics, CDI provider education, and program management. A fervent advocate for healthcare excellence, Vladimir-Ducarmel is adept at bridging the gap between clinical and administrative roles. He is proficient in various healthcare-oriented analytical and business tools, leveraging them to drive impactful CDI outcomes. STUART EPLING Assistant Director, Office of Program Integrity West Virginia STUART EPLING Assistant Director, Office of Program Integrity West Virginia STUART EPLING Assistant Director, Office of Program Integrity West Virginia MICHAEL TAYLOR Senior Fraud Analyst, Medicaid Fraud Control Unit West Virginia MICHAEL TAYLOR Senior Fraud Analyst, Medicaid Fraud Control Unit West Virginia MICHAEL TAYLOR Senior Fraud Analyst, Medicaid Fraud Control Unit West Virginia DALE CARR Director Missouri Medicaid Audit and Compliance (MMAC) Dale Carr currently serves as Director of the Missouri Medicaid Audit & Compliance (MMAC) unit, which has overall responsibility for Medicaid program integrity efforts. Dale has worked for the State of Missouri since 2011. Director Carr was previously a Police Officer in Fallon, NV; an Investigator for the U.S. Office of Special Counsel; and a Supervisory Special Agent with the Coast Guard Investigative Service. Dale holds a Bachelor’s degree in Administration of Criminal Justice and is a graduate of the 158th Session of the FBI National Academy. Full bio DALE CARR Director Missouri Medicaid Audit and Compliance (MMAC) DALE CARR Director Missouri Medicaid Audit and Compliance (MMAC) Dale Carr currently serves as Director of the Missouri Medicaid Audit & Compliance (MMAC) unit, which has overall responsibility for Medicaid program integrity efforts. Dale has worked for the State of Missouri since 2011. Director Carr was previously a Police Officer in Fallon, NV; an Investigator for the U.S. Office of Special Counsel; and a Supervisory Special Agent with the Coast Guard Investigative Service. Dale holds a Bachelor’s degree in Administration of Criminal Justice and is a graduate of the 158th Session of the FBI National Academy. LACEY CROWL Director, Claims Operations Longevity Health Plan Lacey Crowl is the Director of Claims Operations for Longevity Health Plan, responsible for the accuracy of claims processing focused on Medicare members. Lacey has experience in the Commercial, Medicare and Medicaid environments, developing prospective and retrospective payment integrity solutions for both clinical and claim coding reviews. She has operated within various claims processing platforms to develop, code and implement new audit concepts while operating within the Managed Care space. Full bio LACEY CROWL Director, Claims Operations Longevity Health Plan LACEY CROWL Director, Claims Operations Longevity Health Plan Lacey Crowl is the Director of Claims Operations for Longevity Health Plan, responsible for the accuracy of claims processing focused on Medicare members. Lacey has experience in the Commercial, Medicare and Medicaid environments, developing prospective and retrospective payment integrity solutions for both clinical and claim coding reviews. She has operated within various claims processing platforms to develop, code and implement new audit concepts while operating within the Managed Care space. NIOBIS QUEIRO CEO The Queiro Group Niobis (Nio) Queiro is the founder of The Queiro Group offering transformation, integration, advisory and leadership development services. Nio formerly was the SVP of Revenue Cycle Tufts Medicine, in Boston Massachusetts. Full bio NIOBIS QUEIRO CEO The Queiro Group NIOBIS QUEIRO CEO The Queiro Group Niobis (Nio) Queiro is the founder of The Queiro Group offering transformation, integration, advisory and leadership development services. Nio formerly was the SVP of Revenue Cycle Tufts Medicine, in Boston Massachusetts. She brings vast experience in both the hospital and physician revenue cycle industry. Nio uses her expertise in Lean and Six Sigma to drive change across diverse healthcare delivery channels, hence, bridging the chasm between finance and clinical care. As a change agent she has been able assist health systems transition to an integrated revenue cycle that met or exceeded HFMA KPI standards. Nio has presented in front of Congress as an industry expert for the digitization of the military service men medical records as the lead of a proof-of-concept project that is now the standard healthcare data exchange for the military. Nio was named as one of the top 25 Innovators of 2021 by Modern Healthcare. Niobis continues her dedication to education as an adjunct Professor with Tufts University’s Masters in Public Health program and as a Professional Coach, business advisor. For fun its all about family and spoiling her grandson, Cylas. DUTCH NOSS Chief Operating Officer Precision GX Dutch Noss, COO of PrecisionGx is a highly versed Operations leader with 20+ years in Payment Integrity, Revenue Cycle Management, and Product Development. Dutch is an expert in the operational use of Artificial Intelligence, Machine Learning, Predictive Analysis, and Gaming Theory. Dutch’s specialties span both clinical and non-clinical audits including Contract Compliance, Duplicate Payments, IBill & DRG Review, COB, TPL, Retro-term, FWA and RAC audits in pre and post pay settings for Commercial, Medicare, and Medicaid payers.” Full bio DUTCH NOSS Chief Operating Officer Precision GX DUTCH NOSS Chief Operating Officer Precision GX Dutch Noss, COO of PrecisionGx is a highly versed Operations leader with 20+ years in Payment Integrity, Revenue Cycle Management, and Product Development. Dutch is an expert in the operational use of Artificial Intelligence, Machine Learning, Predictive Analysis, and Gaming Theory. Dutch’s specialties span both clinical and non-clinical audits including Contract Compliance, Duplicate Payments, IBill & DRG Review, COB, TPL, Retro-term, FWA and RAC audits in pre and post pay settings for Commercial, Medicare, and Medicaid payers.” RITESH RAMESH Chief Executive Officer MDAudit RITESH RAMESH Chief Executive Officer MDAudit RITESH RAMESH Chief Executive Officer MDAudit ANKUR VERMA Vice President, Healthcare Everest ANKUR VERMA Vice President, Healthcare Everest ANKUR VERMA Vice President, Healthcare Everest AARON BROWDER President Carelon Subrogation Aaron Browder is Staff Vice President, Elevance Health and President, Carelon Subrogation, formerly Meridian Resource Company (Meridian), where he and his team are responsible for overseeing the successful implementation and execution of our clients’ end-to-end subrogation programs. With a nearly 20-year career in subrogation, Aaron possesses a deep knowledge of healthcare subrogation. He has held a wide range of management positions throughout his tenure at Meridian, most recently serving as Staff Vice President. Full bio AARON BROWDER President Carelon Subrogation AARON BROWDER President Carelon Subrogation Aaron Browder is Staff Vice President, Elevance Health and President, Carelon Subrogation, formerly Meridian Resource Company (Meridian), where he and his team are responsible for overseeing the successful implementation and execution of our clients’ end-to-end subrogation programs. With a nearly 20-year career in subrogation, Aaron possesses a deep knowledge of healthcare subrogation. He has held a wide range of management positions throughout his tenure at Meridian, most recently serving as Staff Vice President. Prior to joining Meridian, Aaron gained experience in the financial services and insurance industries with Arthur Andersen, LLP/KPMG, LLP, and Travelers Property Casualty. Aaron holds a Bachelor of Arts degree from Indiana University and a Master of Business Administration from Butler University. He served on the Board of Directors for the National Association of Subrogation Professionals and has been a national presenter and author on issues related to subrogation. KYLE PANKEY Sales & Growth Leader Carelon Subrogation KYLE PANKEY Sales & Growth Leader Carelon Subrogation KYLE PANKEY Sales & Growth Leader Carelon Subrogation MORGAN TACKETT Vice President Product CAQH Morgan Tackett is Vice President Product at CAQH. Over the last nine years, he has worked to build the portfolio of member and provider data solutions that CAQH offers to the industry. Prior to joining CAQH, Morgan spent 18 years at Blue Cross and Blue Shield of North Carolina, where he led teams in Member Service Operations, EDI Services, and Network Management. Morgan holds an MPH from the University of North Carolina at Chapel Hill. Full bio MORGAN TACKETT Vice President Product CAQH MORGAN TACKETT Vice President Product CAQH Morgan Tackett is Vice President Product at CAQH. Over the last nine years, he has worked to build the portfolio of member and provider data solutions that CAQH offers to the industry. Prior to joining CAQH, Morgan spent 18 years at Blue Cross and Blue Shield of North Carolina, where he led teams in Member Service Operations, EDI Services, and Network Management. Morgan holds an MPH from the University of North Carolina at Chapel Hill. KAREN WEINTRAUB Executive Vice President HEALTHCARE FRAUD SHIELD KAREN WEINTRAUB Executive Vice President HEALTHCARE FRAUD SHIELD KAREN WEINTRAUB Executive Vice President HEALTHCARE FRAUD SHIELD KATHY GONZALES-BYRD Chief Strategy Officer MedReview Kathy Gonzales is the Chief of Staff, collaborating with the CEO and other senior leaders on revenue growth, process improvement and organizational effectiveness. Kathy oversees new client implementations and operations for key strategic accounts; manages the organization’s strategic planning process; and oversees interdepartmental accountability processes to ensure operational efficiency. Full bio KATHY GONZALES-BYRD Chief Strategy Officer MedReview KATHY GONZALES-BYRD Chief Strategy Officer MedReview Kathy Gonzales is the Chief of Staff, collaborating with the CEO and other senior leaders on revenue growth, process improvement and organizational effectiveness. Kathy oversees new client implementations and operations for key strategic accounts; manages the organization’s strategic planning process; and oversees interdepartmental accountability processes to ensure operational efficiency. Before joining MedReview’s senior leadership team, Kathy served as Vice President, Payment Recovery for Cotiviti, Inc. overseeing claim audit operations and client management for Blue Cross Blue Shield accounts. She also has a long-standing consulting career, which include leadership roles in healthcare revenue cycle and organization effectiveness with Accenture and Ernst & Young. Kathy has a bachelor’s degree in psychology from West Chester University of Pennsylvania, and a master’s degree in business administration (MBA) and Health Care Administration and Finance from Widener University. WILLIAM O'NEILL Vice President – Product Management, Payment Integrity EXL WILLIAM O'NEILL Vice President – Product Management, Payment Integrity EXL WILLIAM O'NEILL Vice President – Product Management, Payment Integrity EXL SHERRI RICHARDSON Strategy, Growth and Program Director Carelon SHERRI RICHARDSON Strategy, Growth and Program Director Carelon SHERRI RICHARDSON Strategy, Growth and Program Director Carelon TONI CASE Vice President, National Sales CERIS TONI CASE Vice President, National Sales CERIS TONI CASE Vice President, National Sales CERIS RAJEEV RONANKI Chief Executive Officer Lyric RAJEEV RONANKI Chief Executive Officer Lyric RAJEEV RONANKI Chief Executive Officer Lyric TIMOTHY WILSON Senior Vice President of Population Health Management P3 Health Partners TIMOTHY WILSON Senior Vice President of Population Health Management P3 Health Partners TIMOTHY WILSON Senior Vice President of Population Health Management P3 Health Partners MICHAEL BROWN Data Mining Expert MedReview MICHAEL BROWN Data Mining Expert MedReview MICHAEL BROWN Data Mining Expert MedReview KATREECE BAKER VP of Clinical Operations DRG Claims Management KATREECE BAKER VP of Clinical Operations DRG Claims Management KATREECE BAKER VP of Clinical Operations DRG Claims Management BOB STARMAN SVP Payment Integrity Solutions Sagility BOB STARMAN SVP Payment Integrity Solutions Sagility BOB STARMAN SVP Payment Integrity Solutions Sagility + See More AGENDA -------------------------------------------------------------------------------- Printable version CMS CENTER FOR PROGRAM INTEGRITY (CPI) UPDATES - This session will be focused on providing an insider’s view of CPI and CPI’s 2023 priorities - We will cover the use of the Government Accountability Office Fraud Risk Management Framework to develop anti-fraud strategies and react to emerging threats, updates on our Marketplace fraud work, and opportunities for private-public collaboration. AUTHOR: JENNIFER DUPEE Director, Audit & Vulnerabilities Group, Center for Program Integrity CMS Jennifer Dupee, Director. Audits & Vulnerabilities Group. Center for Program Integrity In her role as the Director of the Audits and Vulnerabilities Group, Ms. Dupee identifies and develops comprehensive mitigation strategies addressing program integrity risks for all of CMS' programs, provides oversight of Medicare Part C and Part D plans and the Federally Facilitated Exchanges, and implements CMS’ Comprehensive Medicaid Integrity Plan. Prior to her current role at CPI, Ms. Dupee worked on such initiatives as the improper payment rate measurement for the Medicare fee-for-service program, Open Payments, and the Healthcare Fraud Prevention Partnership. Ms. Dupee also completed a Congressional detail with the House Committee on Ways and Means, responsible for a portfolio of Medicare fee-for-service and program integrity issues. Ms. Dupee has a Bachelor of Science Degree in Nursing from the University of Wisconsin, a Master of Science in Nursing and a Master of Business Administration from Johns Hopkins University, and a Juris Doctor Degree with a Health Law Certificate from the University of Maryland. ... read more JENNIFER DUPEE Director, Audit & Vulnerabilities Group, Center for Program Integrity CMS Jennifer Dupee, Director. Audits & Vulnerabilities Group. Center for Program Integrity In her role as the Director of the Audits and Vulnerabilities Group, Ms. Dupee identifies and develops comprehensive mitigation strategies addressing program integrity risks for all of CMS' programs, provides oversight of Medicare Part C and Part D plans and the Federally Facilitated Exchanges, and implements CMS’ Comprehensive Medicaid Integrity Plan. Prior to her current role at CPI, Ms. Dupee worked on such initiatives as the improper payment rate measurement for the Medicare fee-for-service program, Open Payments, and the Healthcare Fraud Prevention Partnership. Ms. Dupee also completed a Congressional detail with the House Committee on Ways and Means, responsible for a portfolio of Medicare fee-for-service and program integrity issues. Ms. Dupee has a Bachelor of Science Degree in Nursing from the University of Wisconsin, a Master of Science in Nursing and a Master of Business Administration from Johns Hopkins University, and a Juris Doctor Degree with a Health Law Certificate from the University of Maryland. DEVELOPING A PAYMENT INTEGRITY PROGRAM FROM THE GROUND UP * Developing a Payment Integrity Program from the ground up for a brand new Medicare Advantage Health Plan * Covering both the opportunities and the challenges of building and effectively managing PI programs that prevent, avoid, or recover billing errors, payment errors and other party liability errors * Listing of suggestions/ advice from our success, and lessons learned AUTHOR: MONIQUE PIERCE Payment Integrity Leader Devoted Health Monique is a Strategic Executive Healthcare Leader with proven ability to develop solutions and maximize the benefits of Payment Integrity programs. She is known for having excellent domain knowledge and being driven, high performing, and having a deep dedication to recruiting and developing top talent. Monique started her Payment Integrity career at Oxford HealthPlans in the COB and Subrogation Department after spending time in Payment Policy. When United Healthcare acquired many health plans in the early 2000s like Oxford, Monique was tagged as part of the Optum team to integrate the processes and people into the COB systems that she had built at Oxford. She led systems development, quality, reporting, operations, vendor management and was responsible for creating innovative proactive programs that more than doubled savings to $1.4B in three years. Monique developed a successful program that reduced interest expense on late claims for UHC, assisted a communication company to develop COB tools and assisted in strategic system projects before joining SCIO Health Analytics in 2014 to develop new products - specifically prepayment programs. In 2015 she became the product owner of SCIOMine, the company’s internal audit application and managed the roadmap. Monique also owned strategic direction for operational metrics and reporting including executive scorecards. Monique was promoted to VP of Business Opportunities and Client Engagement where she improved Audit Recovery TAT by 39% and reduced client implementations TAT by 11% and the Level of Effort by 18% while increasing the count of implementation projects by 126%. In 2020 Monique joined Devoted Health, a startup company with the goal of building the first ever integrated Payment Integrity Program. The company has one system, great data, and a great mission; to change health care by treating every member as if they are family. In her spare time, Monique volunteers her time in the community on the Board of Directors of SCARE NH and works in her family business LARP Portal with her husband Rick. ... read more MONIQUE PIERCE Payment Integrity Leader Devoted Health Monique is a Strategic Executive Healthcare Leader with proven ability to develop solutions and maximize the benefits of Payment Integrity programs. She is known for having excellent domain knowledge and being driven, high performing, and having a deep dedication to recruiting and developing top talent. Monique started her Payment Integrity career at Oxford HealthPlans in the COB and Subrogation Department after spending time in Payment Policy. When United Healthcare acquired many health plans in the early 2000s like Oxford, Monique was tagged as part of the Optum team to integrate the processes and people into the COB systems that she had built at Oxford. She led systems development, quality, reporting, operations, vendor management and was responsible for creating innovative proactive programs that more than doubled savings to $1.4B in three years. Monique developed a successful program that reduced interest expense on late claims for UHC, assisted a communication company to develop COB tools and assisted in strategic system projects before joining SCIO Health Analytics in 2014 to develop new products - specifically prepayment programs. In 2015 she became the product owner of SCIOMine, the company’s internal audit application and managed the roadmap. Monique also owned strategic direction for operational metrics and reporting including executive scorecards. Monique was promoted to VP of Business Opportunities and Client Engagement where she improved Audit Recovery TAT by 39% and reduced client implementations TAT by 11% and the Level of Effort by 18% while increasing the count of implementation projects by 126%. In 2020 Monique joined Devoted Health, a startup company with the goal of building the first ever integrated Payment Integrity Program. The company has one system, great data, and a great mission; to change health care by treating every member as if they are family. In her spare time, Monique volunteers her time in the community on the Board of Directors of SCARE NH and works in her family business LARP Portal with her husband Rick. CLAIMS AUDIT – THE INDIANA JONES OF PAYMENT INTEGRITY? - How does Claim Audit fit into the overall savings goals from PI? - Archaeology amongst savings drivers? High $ treasures? - Claim Audit Digs & Research – driving process improvement, not just savings. - Do underpayments matter? - How to keep finding treasure: - Partnering with other departments as a true “Partner” not an “Auditor.” - It will all be in a museum (creating reference materials). AUTHOR: TOM MARTIN AVP, Payment Integrity Molina Healthcare ... read more TOM MARTIN AVP, Payment Integrity Molina Healthcare DOWNLOAD YOUR COPY OF THE AGENDA REGISTRATION Monday, October 30, 2023 to Thursday, May 23, 2024 Healthcare Payers and Providers COMPLIMENTARY PASS + Register Now An organization that determine service prices, collect payments, and handle claims A legal entity, or sub-set of a legal entity, which may contract for the provision of health care Monday, October 30, 2023 to Thursday, May 23, 2024 Vendors/ Service Providers $4,999 + Register Now Preparing registration... HEADLINE PARTNER * AMS INTELLIGENT ANALYTICS WEBSITE: HTTPS://WWW.MDSTRAT.COM/ Please visit our website for more information. PLATINUM PARTNER * * EXL WEBSITE: HTTPS://WWW.EXLSERVICE.COM/ Please visit our website for more information. PRECISIONGX WEBSITE: HTTPS://PRECISION-GX.COM/ PrecisionGx is an automated claims intelligence solution designed for healthcare payers to identify and recover millions in overpaid, incorrect, or fraudulent payments each year. The PrecisionGx technology advantage is our customer's business advantage. Coupled with decades of subject matter expertise in data mining and audit, our claims-native AI engine enables payers to reduce vendor spend and identify more refunds earlier in the recovery lifecycle. These advantages allow us to outperform legacy vendors in payment recoveries and create transformative, AI-enabled prevention for the 75% of incorrect payments that existing vendors can’t address today. GOLD PARTNERS * * * * * CARELON WEBSITE: HTTPS://WWW.CARELON.COM/ Please visit our website for more information. DRG CLAIMS WEBSITE: HTTPS://WWW.DRGCLAIMS.COM/ Please visit our website for more information. HEALTHCARE FRAUD SHIELD WEBSITE: HTTPS://WWW.HCFRAUDSHIELD.COM/ Healthcare Fraud Shield specializes in fraud, waste, and abuse detection and payment integrity for healthcare payers nationally by efficiently stopping claims prior to payment using utilizing post-payment advanced analytics and artificial intelligence insights. We save health plans millions annually incremental to existing pre-payment processes using our unique and proven approach. FWAShield™ offers the combination of targeted rules, artificial intelligence, shared analytics across multiple payers resulting in higher ROI (up to 20:1) compared to other vendors. FWAShield™ software platform was developed by industry leading healthcare subject matter experts and is a component of over 50+ clients’ including 16 Blue plans Payment Integrity/SIU departments. Our client satisfaction rating is exceptional with a net promoter score of 97 and client retention rate over 95%. FWAShield™ – is a fully integrated platform consisting of PreShield™ (pre-payment), AIShield™ (AI), PostShield™ (post-payment), RxShield™ (pharmacy analytics), Shared Analytics™, QueryShield™ (ad hoc query and reporting tool) and CaseShield™ (case management). LYRIC WEBSITE: HTTPS://WWW.LYRICHEALTH.COM/ Please visit our website for more information. MEDREVIEW WEBSITE: HTTPS://WWW.MEDREVIEW.US/ Headquartered in the financial district of New York City and serving all U.S. states and territories, MedReview has been a leading provider of payment integrity, utilization management and quality surveillance services for more than 40 years. A physician-led organization with a passion for ensuring that health care claims fairly represent the care provided, MedReview provides timely independent hospital billing audits and clinical validation reviews on behalf of health plans, government agencies and Taft-Hartley organizations, saving millions of dollars for its clients each year. SILVER PARTNERS * * * * CAQH WEBSITE: HTTPS://WWW.CAQH.ORG/ Please visit our website for more information. CERIS HEALTH WEBSITE: HTTPS://WWW.CERIS.COM/ Please visit our website for more information. CLAIMLOGIQ WEBSITE: HTTPS://WWW.CLAIMLOGIQ.COM/ While the everchanging healthcare landscape can be challenging to navigate, ClaimLogiq’s advanced technology, streamlined processes, intelligent automation, and improved methods for data extraction to generate actionable clinical insights enables health plans across the country to gain control of payment integrity and risk adjustment programs. ClaimLogiq’s proprietary platform and scalable technology enhanced by industry-leading OCR and NLP technology are primary drivers for the delivery of accurate and consistent cost savings, efficient turnaround times, and coding results. The flexibility of the healthcare technology company’s engagement models allows health plans to achieve their goals and solve even the most complex healthcare data challenges no matter where they are in their program journey. As a collaborative partner, ClaimLogiq enables technology-based solutions and supplements existing resources and program capabilities as plans insource more work around their payment integrity and risk adjustment programs. SAGILITY WEBSITE: HTTPS://SAGILITYHEALTH.COM/ Please visit our website for more information. EXHIBITORS * * * * * * * 6 DEGREES HEALTH WEBSITE: HTTPS://WWW.6DEGREESHEALTH.COM/ 6 Degrees Health is on a mission to reduce the cost of healthcare. We take a service-first approach to our Clean Claim Reviews to ensure accuracy in billing and fair payments. Using our extensive cost containment experience, clinical expertise, and next-generation, purpose-built software, we deliver remarkable savings for health plans. Our proprietary review process leverages CMS and other industry standard guidelines to evaluate every line item and identify billing errors and inconsistencies. These pre-pay clinical reviews are completed by our team of highly trained and experienced registered nurses to ensure each billed line item is appropriate for reimbursement. This detailed review removes erroneous line items and verifies billing accuracy. Our comprehensive process manages claims during the review stage, as well as through payment and appeals resolution. Our white glove service on appeals allows us to maintain an uphold rate of 97 %, so your savings are secure. ADVENT HEALTH PARTNERS WEBSITE: HTTPS://ADVENTHP.COM/ Advent Health Partners is the leader in workflow agnostic technology applications across the various payer and provider payment and revenue integrity programs. Payers and providers recognize the need for Plug and Play technology to achieve healthy financials and solve manual challenges around clinical and coding activities. Advent Health Partners technology incorporates AI extractions and models paired with an intuitive interface to ingest and normalize unstructured documentation and data to drive consistent, accurate, and improved clinical and coding determinations across numerous use cases within the payer and provider reimbursement integrity space. FATHOM HEALTH WEBSITE: HTTPS://WWW.FATHOMHEALTH.COM/ Fathom is the leader in autonomous medical coding, applying cutting-edge deep learning and natural language processing (NLP) to produce complete coding results for patient encounters with zero human intervention. We deliver the highest automation rates and the broadest specialty coverage. Our AI technology reduces costs, increases accuracy, strengthens revenue capture, and shortens turnaround times from days to minutes. We carry out a risk-free trial to demonstrate our coding quality before your organization ever pays us a dollar. Fathom’s clients include leading health systems, physician groups, and revenue cycle management companies. Following our $46M Series B in November 2022, we are backed by world-class investors including Lightspeed and Alkeon Capital as well as leading health systems and healthcare executives including Cedars-Sinai, Vituity's Inflect Health, and Jonathan Bush. PENSTOCK GROUP WEBSITE: HTTPS://WWW.PENSTOCKGROUP.COM/ Penstock is a service partner and SaaS builder for forward-thinking health plans and providers, empowering recovery, audit and regulatory teams to get accuracy right from the start—when it matters most. Our mission is to create lasting systemic change that removes wasted spend from our healthcare system, returning dollars to payers, lowering the cost of care and improving access for all. Penstock is powered by industry veterans who are some of the most sought-after payment integrity and regulatory experts in the industry. Our business model is rooted in transparency and the drive to reinstate true integrity in payment integrity—even if it defies traditional business sense. Our audit workflow SaaS platform, ClearBridge gives health plans the tools and insights they need to identify overpayments, correct them and implement their own edits with ease, ensuring correct payments and mitigating future discrepancies. When you partner with Penstock, you reclaim time and control with an end-to-end partnership that beautifully and seamlessly connects human and machine intelligence—to prevent recurring issues at the source. PHIA GROUP WEBSITE: HTTPS://WWW.PHIAGROUP.COM/ The Phia Group, LLC is an experienced provider of healthcare cost containment techniques offering comprehensive consulting services, legal expertise, plan document drafting, subrogation and overpayment recovery, claim negotiation, and plan defense designed to control costs and protect plan assets. RIALTIC WEBSITE: HTTPS://WWW.RIALTIC.IO/ Rialtic is a modern healthcare technology platform focused on payment accuracy. Built by a team of seasoned industry veterans, Rialtic addresses the most important areas of the payment process. Payment policies are highly configurable and customizable: insurers can edit or build their own bespoke policies, while providers can analyze potential reimbursement levels. Robust analytics features across claims, lines of business, payments, and policies provides insightful business intelligence to users. By continuously sourcing, ingesting, and structuring healthcare payment policy documents and data, customers can confidently make up-to-date decisions. Keeping security and compliance top of mind, Rialtic empowers healthcare organizations to work off the same platform with rigorous security controls, a standard in enterprise software. ZOLL WEBSITE: HTTPS://WWW.ZOLLDATA.COM/ Please visit our website for more information. MEDIA PARTNERS * * * HEALTHCARE IT TODAY WEBSITE: HTTPS://WWW.HEALTHCAREITTODAY.COM/ Please visit our website for more information. HEALTHTECH MAGAZINES WEBSITE: HTTPS://WWW.HEALTHTECHMAGAZINES.COM/ LinkedIn: https://www.linkedin.com/company/health-tech-magazines/ Twitter: https://twitter.com/HTMagazines Description: HealthTech Magazines is a Wilmington-based award-winning publication that offers robust platform for healthcare technology professionals to express their views and exchange knowledge on emerging technologies that are transforming the healthcare industry. MANAGED HEALTHCARE EXECUTIVE WEBSITE: HTTPS://WWW.MANAGEDHEALTHCAREEXECUTIVE.COM/ Managed Healthcare Executive® covers the cost and delivery of healthcare. We provide insight, information and analysis on developments in value-based care, cost effectiveness research and programs, pharmacy benefit management and population health. We publish a monthly print publication and maintain a news-driven website. PARTNER WITH US Based on your objectives, we can create bespoke packages designed specifically for you – from presenting your expertise on the main stage, to hosting a private dinner. You can partner with us showcase your brand and make valuable new connections. Opportunities predominantly lie in 3 main categories: Thought Leadership, Branding & Networking. To discuss your objectives and partnership opportunities please contact Harry Ludbrook, Sales Director harry.ludbrook@kisacoresearch.com REGISTER YOUR INTEREST Interested in a media partnership? We'd love to hear from you and how we can support one another to connect with the industry. Contact Jodie Purser, Marketing Manager, jodie.purser@kisacoresearch.com PARTNER WITH US Based on your objectives, we can create bespoke packages designed specifically for you – from presenting your expertise on the main stage, hosting private dinners, to showcasing your brand and making valuable new connections. Opportunities predominantly lie in 3 main categories: Thought Leadership, Branding, and Networking. To discuss your objectives and partnership opportunities please contact partner@kisacoresearch.com. Interested in a media partnership? We'd love to hear from you and how we can support one another to connect with the industry. Contact marketing@kisacoresearch.com. DELIVERING SCALABLE AND FLEXIBLE SOLUTIONS WHICH ENSURE ACCURACY AND INTEGRITY OF CLAIMS The Healthcare Payments and Revenue Integrity Congress is the only summit focused on addressing healthcare waste and ensuring that claims are paid correctly, reflecting current healthcare needs. You will join key decision-makers, within health insurers and providers, who are responsible for payment and revenue integrity, value-based payment, and networking relations. At a time when both payers and providers are evaluating and streamlining internal payment and revenue integrity processes, this networking conference has been established to breakdown silos, by promoting discussion between clinical, coding, revenue cycle and payment departments to facilitate the development of efficient, value-based healthcare systems. RESOURCES HPRI EAST 2023 POST EVENT REPORT INTERVIEW: DALE CARR, DIRECTOR OF MISSOURI MEDICAID AUDIT & COMPLIANCE AMS PARTNERS WITH MDAUDIT COMMUNITY BROCHURE DOWNLOAD RESOURCE VENUE THE COLONNADE BOSTON 120 HUNTINGTON AVE BOSTON, MA 02116 We're excited to welcome you to The Colonnade Boston for the Healthcare Payment & Revenue Integrity Summit East! To book your room at a discounted rate, please use this link here. MEDIA KIT For more information on webinars, roundtables, content marketing packages, interviews and marketing solutions opportunities, download the Media Kit. DOWNLOAD THE MEDIA KIT If you have any questions, please contact Harry Ludbrook, Sales Director, harry.ludbrook@kisacoresearch.com. ABOUT KISACO RESEARCH Kisaco Research produces, designs and hosts B2B industry conferences, exhibitions and communities – focused on a specialized selection of topic areas. Meet industry peers that will help build a career-changing network for life. Learn from the mistakes of your peers as much as their successes—ambitious industry stalwarts who are happy to share not just what has made them successful so far but also their plans for future proofing their companies. Note down the inspired insight that will form the foundation for future strategies and roadmaps, both at our events and through our online communities. Invest both in your company growth and your own personal development by signing up to one of our events and get started. WE'D LOVE TO HEAR FROM YOU. Contact us at +44 (0)20 3696 2920 and email events@kisacoresearch.com, or let us know what subject area you're interested in below. 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