Speaker Hall of Fame | Kisaco Research

Speaker Hall of Fame

3rd Annual Healthcare Payment & Revenue Integrity Congress Nashville | February 5-6 2025
5-6 February, 2025
Nashville

Meet our Health Plan & Provider Experts

 

Dr Priscilla Alfaro, MD, FAAP, CPC, CPMA, COC, CIC, CFE

VP Payment Integrity
Blue Cross NC

Dr Priscilla Alfaro, MD, FAAP, CPC, CPMA, COC, CIC, CFE

VP Payment Integrity
Blue Cross NC

Dr Priscilla Alfaro, MD, FAAP, CPC, CPMA, COC, CIC, CFE

VP Payment Integrity
Blue Cross NC
 

Novelette Wallace, MPH, PMP, CSSBB

Head of Payment Integrity
Johns Hopkins Healthcare

Novelette Wallace is a distinguished Payment Integrity Leader with a rich background spanning over 30 years in the healthcare industry. Her extensive experience includes leadership roles within payment integrity, where she has played pivotal roles in both payment integrity vendor organizations and health plans. Throughout her career, Novelette has demonstrated a remarkable ability to build and lead Payment Integrity departments from their inception.

Novelette Wallace, MPH, PMP, CSSBB

Head of Payment Integrity
Johns Hopkins Healthcare

Novelette Wallace, MPH, PMP, CSSBB

Head of Payment Integrity
Johns Hopkins Healthcare

Novelette Wallace is a distinguished Payment Integrity Leader with a rich background spanning over 30 years in the healthcare industry. Her extensive experience includes leadership roles within payment integrity, where she has played pivotal roles in both payment integrity vendor organizations and health plans. Throughout her career, Novelette has demonstrated a remarkable ability to build and lead Payment Integrity departments from their inception. Her expertise has been instrumental in establishing robust processes and strategies to identify and recover inaccuracies in claims, contributing significantly to cost of care savings for health plans year after year.

Novelette has held key leadership positions with industry-leading organizations, including Performant Corp, United Healthcare, and Aetna (previously Coventry). In each role, she has consistently delivered results by optimizing payment integrity processes and driving operational excellence. Currently serving as the Assistant Vice President (AVP) of Payment Integrity for Johns Hopkins Health Plans, Novelette continues to bring her wealth of knowledge and leadership acumen to the forefront. Her dedication to achieving and surpassing cost of care savings goals exemplifies her commitment to advancing the financial health and efficiency of healthcare organizations.

With a proven track record of success and a comprehensive understanding of payment integrity within the healthcare landscape, Novelette Wallace stands as a respected leader in the industry, contributing significantly to the success of the organizations she serve

 

Rae A. McIntee, DDS, MD, MBA, FACS, CPE

Medical Director Payment Integrity and Special Investigations
Blue Cross and Blue Shield of Louisiana

Rae A. McIntee, DDS, MD, MBA, FACS, CPE

Medical Director Payment Integrity and Special Investigations
Blue Cross and Blue Shield of Louisiana

Rae A. McIntee, DDS, MD, MBA, FACS, CPE

Medical Director Payment Integrity and Special Investigations
Blue Cross and Blue Shield of Louisiana
 

Monique Pierce

Head of Payment Integrity
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 Pierce

Head of Payment Integrity
Devoted Health

Monique Pierce

Head of Payment Integrity
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.

 

Lacey Crowl

VP of Health Plan 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.

Lacey Crowl

VP of Health Plan Operations
Longevity Health Plan

Lacey Crowl

VP of Health Plan 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.

 

Lawrence M. Simon, MD, MBA, FACS

Interim Senior Medical Director
Blue Cross and Blue Shield of Louisiana (BCBSLA)

Dr.

Lawrence M. Simon, MD, MBA, FACS

Interim Senior Medical Director
Blue Cross and Blue Shield of Louisiana (BCBSLA)

Lawrence M. Simon, MD, MBA, FACS

Interim Senior Medical Director
Blue Cross and Blue Shield of Louisiana (BCBSLA)

Dr. Larry Simon is the Interim Senior Medical Director and Managing Medical Director for Medical Policy and Medical Appeals for Blue Cross and Blue Shield of Louisiana (BCBSLA), where he also serves as the Medical Director for Coding and Reimbursement and Chair of the Credentialing and Medical Quality Management Committees.  He is a member of the AMA CPT Editorial Panel, serving on the Executive Committee and as Co-Chair of the Molecular Pathology Advisory Group and Genomic Sequencing Procedures Workgroup.  He also chairs the Medical Director’s Forum for both the Louisiana Association of Health Plans and the National Anti-Fraud Advisory Board of the Blue Cross and Blue Shield Association.  Prior to joining BCBSLA, Dr. Simon served in numerous leadership roles for the American Academy of Otolaryngology, the American Medical Association, the American College of Surgeons, and the Louisiana State Medical Society. 

Dr. Simon is an alumnus of Louisiana State University, Baylor College of Medicine, Rady Children’s Hospital, and the BI Moody College of Business Administration at the University of Louisiana.  A diplomate of the American Board of Otolaryngology and a Fellow of the American College of Surgeons, Dr. Simon has over 15 years of experience in Health Policy and Healthcare Reform, and he has presented over 170 lectures and seminars on these topics. 

A Rotarian, an animal rescuer, a member of multiple civic boards, and a patron of the arts, Dr. Simon enjoys spending his time outside of work serving his community, helping the animal shelters and abandoned dogs of Louisiana, and travelling and enjoying life with his wife and their family and friends.

 

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.

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.

 

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.

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.

 

Michael Devine

Director Special Investigations Unit
L.A Care

Michael Devine

Director Special Investigations Unit
L.A Care

Michael Devine

Director Special Investigations Unit
L.A Care
 

Danielle Nelson

FWA Program Manager
PacificSource Health Plan

Danielle M. Nelson graduated from the University of Missouri with a Bachelor of Science in Criminology and Criminal Justice. In 2017, she received a Master of Arts in Management and Leadership from Webster University.

Danielle Nelson

FWA Program Manager
PacificSource Health Plan

Danielle Nelson

FWA Program Manager
PacificSource Health Plan

Danielle M. Nelson graduated from the University of Missouri with a Bachelor of Science in Criminology and Criminal Justice. In 2017, she received a Master of Arts in Management and Leadership from Webster University.

Prior to joining for PacificSource Health Plans (PacificSource) as the Fraud, Waste and Abuse Program Manager in 2022, Ms. Nelson spent seven years working in Special Investigations Units (SIU) of varying sizes at both for-profit and not-for profit organizations, allowing her to gain experience in investigating fraud for government-funded programs, ACA, FEHB, and commercial lines of business. Before moving into fraud investigations in health care, Ms. Nelson spent 15 years in finance, working in consumer lending and back-office operations.

Ms. Nelson is a member of the Association of Certified Fraud Examiners, the St. Louis Chapter of ACFE, and National Health Care Anti-Fraud Association (NHCAA) and a participant with the Healthcare Fraud Prevention Partnership (HFPP).

 

Drew Satriano

Vice President of Payment Integrity
Highmark Health

Drew Satriano, a seasoned professional with an MBA, CPA, CFE, and JD, brings extensive expertise in payment integrity, accounting, auditing, and legal matters within regulated environments. Notably, he has spearheaded innovative initiatives resulting in a 968% increase in savings since 2014. His recent focus includes leveraging AI and technology for enhanced accuracy and efficiency in provider payment processes.

Drew Satriano

Vice President of Payment Integrity
Highmark Health

Drew Satriano

Vice President of Payment Integrity
Highmark Health

Drew Satriano, a seasoned professional with an MBA, CPA, CFE, and JD, brings extensive expertise in payment integrity, accounting, auditing, and legal matters within regulated environments. Notably, he has spearheaded innovative initiatives resulting in a 968% increase in savings since 2014. His recent focus includes leveraging AI and technology for enhanced accuracy and efficiency in provider payment processes.

 

Dr Michael Seavers

Vice-Chair of the Harrisburg University Faculty, Department Chair and Program Lead, and Assistant Professor of Healthcare Informatics
Harrisburg University

Dr. Michael Seavers is the Vice-Chair of the Harrisburg University Faculty, Department Chair and Program Lead, and Assistant Professor of Healthcare Informatics at Harrisburg University.  Dr. Seavers has a varied background in IT, business, and healthcare spanning many decades.  Dr. Seavers began as a programmer analyst at Shared Medical Systems and later at General Electric in their Aerospace Division.  Dr.

Dr Michael Seavers

Vice-Chair of the Harrisburg University Faculty, Department Chair and Program Lead, and Assistant Professor of Healthcare Informatics
Harrisburg University

Dr Michael Seavers

Vice-Chair of the Harrisburg University Faculty, Department Chair and Program Lead, and Assistant Professor of Healthcare Informatics
Harrisburg University

Dr. Michael Seavers is the Vice-Chair of the Harrisburg University Faculty, Department Chair and Program Lead, and Assistant Professor of Healthcare Informatics at Harrisburg University.  Dr. Seavers has a varied background in IT, business, and healthcare spanning many decades.  Dr. Seavers began as a programmer analyst at Shared Medical Systems and later at General Electric in their Aerospace Division.  Dr. Seavers then worked in IT management in the pick-pack-and-ship industry being employed at companies like Book-of-the-Month Club (Time Warner) and Hanover Direct during the .COM expansion.

As the .COM industry went bust, Dr. Seavers moved to the healthcare industry.  Dr. Seavers worked at Capital BlueCross for nearly two decades.  The first decade was as a Senior Manager in the IT department and the second decade as the Senior Director of Claims and later the Senior Director of Enrollment and Billing.  Dr. Seavers focus was automation of labor utilizing software robotics for healthcare. 

After a varied career background and various formal degrees, Dr. Seavers is very pleased to be teaching at Harrisburg University.

 

Cathy Newman

Managing Director Value-Based Strategy
Blue Cross Blue Shield of Rhode Island

Cathy Newman is the Managing Director of Value-Based strategy for Blue Cross Blue Shield of Rhode Island.  Her experience in the healthcare industry spans over twenty years working for both large integrated providers, small IPAs, and health plans.  In her ten years with Blue Cross, she has worked to advance value-based opportunities from pay for performance to full-risk global capitation models.  She is passionate about her work and has been able to develop more collaborative and meaningful relationships with providers throughout the state of Rhode Island.

Cathy Newman

Managing Director Value-Based Strategy
Blue Cross Blue Shield of Rhode Island

Cathy Newman

Managing Director Value-Based Strategy
Blue Cross Blue Shield of Rhode Island

Cathy Newman is the Managing Director of Value-Based strategy for Blue Cross Blue Shield of Rhode Island.  Her experience in the healthcare industry spans over twenty years working for both large integrated providers, small IPAs, and health plans.  In her ten years with Blue Cross, she has worked to advance value-based opportunities from pay for performance to full-risk global capitation models.  She is passionate about her work and has been able to develop more collaborative and meaningful relationships with providers throughout the state of Rhode Island.

 

Corella Lumpkins

Manager of Coding, Compliance and Provider Education
Loudoun Medical Group P.C.

Corella Lumpkins is the Manager of Coding, Compliance & Provider Education at Loudoun Medical Group (LMG) - one of the largest and most diverse physician-owned, multi-specialty Accountable Care Organizations in Northern Virginia/DC suburbs. As a subject matter expert, Corella has over 35 years of experience working in every area of the healthcare revenue cycle. Corella holds a bachelor’s degree and eleven certifications with an extensive background in auditing, billing, coding, implementing corporate compliance programs, CDI, education, denial and practice management.

Corella Lumpkins

Manager of Coding, Compliance and Provider Education
Loudoun Medical Group P.C.

Corella Lumpkins

Manager of Coding, Compliance and Provider Education
Loudoun Medical Group P.C.

Corella Lumpkins is the Manager of Coding, Compliance & Provider Education at Loudoun Medical Group (LMG) - one of the largest and most diverse physician-owned, multi-specialty Accountable Care Organizations in Northern Virginia/DC suburbs. As a subject matter expert, Corella has over 35 years of experience working in every area of the healthcare revenue cycle. Corella holds a bachelor’s degree and eleven certifications with an extensive background in auditing, billing, coding, implementing corporate compliance programs, CDI, education, denial and practice management. Prior to joining LMG, Corella has held leadership roles at Lifebridge, Medstar, Johns Hopkins and the University of Maryland health systems.

Corella is an author, adjunct faculty member and national speaker currently serving on both the AAPC National Advisory Board and Association of Clinical Documentation Integrity Specialists (ACDIS) Leadership Council. Corella works closely with providers in navigating patient-centric value-based care. 

 

David Flannery

Director of Telegenetics and Digital Genetics
Cleveland Clinic

David Flannery is a "pioneer" in telemedicine, having started telegenetics clinic in 1995 in Georgia. He’s currently the Director of Telegenetics and Digital Genetics at Cleveland Clinic. He has expertise with ICD-10 coding and CPT codes. He oversaw the revenue cycle management for the 300+ physician practice group at the Medical College of Georgia. He served on the American Medical Association's Digital Medicine Payment Advisory Group, developing new CPT codes for telemedicine and digital medicine.

David Flannery

Director of Telegenetics and Digital Genetics
Cleveland Clinic

David Flannery

Director of Telegenetics and Digital Genetics
Cleveland Clinic

David Flannery is a "pioneer" in telemedicine, having started telegenetics clinic in 1995 in Georgia. He’s currently the Director of Telegenetics and Digital Genetics at Cleveland Clinic. He has expertise with ICD-10 coding and CPT codes. He oversaw the revenue cycle management for the 300+ physician practice group at the Medical College of Georgia. He served on the American Medical Association's Digital Medicine Payment Advisory Group, developing new CPT codes for telemedicine and digital medicine.

 

Dr. Ahmad Kilani MD, MBA, MLS, MSIT, CHCQM-PHYADV, FACP, FACHE

Medical Director
Cleveland Clinic

Dr. Ahmad Kilani MD, MBA, MLS, MSIT, CHCQM-PHYADV, FACP, FACHE

Medical Director
Cleveland Clinic

Dr. Ahmad Kilani MD, MBA, MLS, MSIT, CHCQM-PHYADV, FACP, FACHE

Medical Director
Cleveland Clinic
 

Anthony Baize

Inspector General
Wisconsin Department of Health Services

Anthony Baize has been the Inspector General for the Wisconsin Department of Health Services since 2016.  He holds a master's degree in public administration from Indiana State University and a Certified Inspector General (CIG) credential from the Association of Inspectors General.  Prior to joining Wisconsin state government, Baize was the deputy director of audits and investigations for the Office of the Inspector General for the Kentucky Cabinet of Health and Family Services.

Anthony Baize

Inspector General
Wisconsin Department of Health Services

Anthony Baize

Inspector General
Wisconsin Department of Health Services

Anthony Baize has been the Inspector General for the Wisconsin Department of Health Services since 2016.  He holds a master's degree in public administration from Indiana State University and a Certified Inspector General (CIG) credential from the Association of Inspectors General.  Prior to joining Wisconsin state government, Baize was the deputy director of audits and investigations for the Office of the Inspector General for the Kentucky Cabinet of Health and Family Services.

 

Gregory Bryant

Chief Information Officer
Gov Juan F. Luis Hospital & Medical Center

Gregory Bryant

Chief Information Officer
Gov Juan F. Luis Hospital & Medical Center

Gregory Bryant

Chief Information Officer
Gov Juan F. Luis Hospital & Medical Center
 

Richelle Marting, JD, MHSA,RHIA,CPC,CEMC,CPMA

Director of Managed Care
North Kansas City Hospital

Richelle Marting, JD, MHSA,RHIA,CPC,CEMC,CPMA

Director of Managed Care
North Kansas City Hospital

Richelle Marting, JD, MHSA,RHIA,CPC,CEMC,CPMA

Director of Managed Care
North Kansas City Hospital
 

Dr Deepak Goyal, MD, MBBS, MBA, CPE, CHCQM, CMRP, CMPC

Executive Medical Director Revenue Cycle and Supply Chain
Monument Health

Dr Deepak Goyal, MD, MBBS, MBA, CPE, CHCQM, CMRP, CMPC

Executive Medical Director Revenue Cycle and Supply Chain
Monument Health

Dr Deepak Goyal, MD, MBBS, MBA, CPE, CHCQM, CMRP, CMPC

Executive Medical Director Revenue Cycle and Supply Chain
Monument Health
 

Dr Brad Archer

Chief Medical Officer
Monument Health

Dr Brad Archer

Chief Medical Officer
Monument Health

Dr Brad Archer

Chief Medical Officer
Monument Health
 

Kelly Bennett, JD, CFE, AHFI

Medicaid Program Integrity Chief
Agency for Health Care Administration

Kelly Bennett, JD, CFE, AHFI

Medicaid Program Integrity Chief
Agency for Health Care Administration

Kelly Bennett, JD, CFE, AHFI

Medicaid Program Integrity Chief
Agency for Health Care Administration
 

Jenny Raulerson, BSN, MSHI

Sr Clinical Consultant
Florida Blue

Jenny Raulerson, BSN, MSHI

Sr Clinical Consultant
Florida Blue

Jenny Raulerson, BSN, MSHI

Sr Clinical Consultant
Florida Blue
 

Kelly Springmann

Provider Enablement & Product Development
Florida Blue

Kelly Springmann

Provider Enablement & Product Development
Florida Blue

Kelly Springmann

Provider Enablement & Product Development
Florida Blue
 

Colleen Gianatasio

Director, Clinical Documentation Integrity and Coding Compliance
CDPHP

Colleen is a strategic clinical documentation, coding and compliance, and risk adjustment expert with 10+ years of experience driving increases in provider engagement. She has thoughtfully built clinical documentation improvement programs from scratch to target accurate risk scores, increases in provider satisfaction, and cost-savings.

Beyond her role at CDPHP, Colleen is also currently the president of the AAPC National Advisory Board.

Colleen Gianatasio

Director, Clinical Documentation Integrity and Coding Compliance
CDPHP

Colleen Gianatasio

Director, Clinical Documentation Integrity and Coding Compliance
CDPHP

Colleen is a strategic clinical documentation, coding and compliance, and risk adjustment expert with 10+ years of experience driving increases in provider engagement. She has thoughtfully built clinical documentation improvement programs from scratch to target accurate risk scores, increases in provider satisfaction, and cost-savings.

Beyond her role at CDPHP, Colleen is also currently the president of the AAPC National Advisory Board.

 

Mike Barrett

ex-VP of Strategy and Development
Centene Corp.

Mike Barrett

ex-VP of Strategy and Development
Centene Corp.

Mike Barrett

ex-VP of Strategy and Development
Centene Corp.
 

Frank Shipp

Executive Director
Johns Hopkins CIN

Frank E. Shipp currently serves as Executive Director of the Johns Hopkins Clinical Alliance, the clinically integrated network of Johns Hopkins Medicine. The network includes over 3,000 providers, consisting of both employed and independent practices.

Frank Shipp

Executive Director
Johns Hopkins CIN

Frank Shipp

Executive Director
Johns Hopkins CIN

Frank E. Shipp currently serves as Executive Director of the Johns Hopkins Clinical Alliance, the clinically integrated network of Johns Hopkins Medicine. The network includes over 3,000 providers, consisting of both employed and independent practices.

Frank transitioned to value-based care after 25 years of hospital-based operations experience in both community and academic health systems. During the past nine years, Frank has held executive positions in a Payor-Provider Organization in NYC and has built a highly successful CIN over a five-year period in Northern New Jersey. Frank speaks regular at national healthcare conferences regarding value-based care strategies and tactics.

Frank completed his MBA at Fairleigh Dickinson University, is a certified Fellow of the American College of Healthcare Executives and a trained Black Belt in Lean Six Sigma from Villanova University.

 

Vladimir-Ducarmel Joseph

CDI Program Manager
Beth Israel Lahey Health Hospital & Medical Center

Vladimir-Ducarmel Joseph is one of the Clinical Documentation Integrity Program Directors at Beth Israel Lahey Health, 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 his expertise encompasses physician leadership, team dynamics, CDI provider education, and program management.

Vladimir-Ducarmel Joseph

CDI Program Manager
Beth Israel Lahey Health Hospital & Medical Center

Vladimir-Ducarmel Joseph

CDI Program Manager
Beth Israel Lahey Health Hospital & Medical Center

Vladimir-Ducarmel Joseph is one of the Clinical Documentation Integrity Program Directors at Beth Israel Lahey Health, 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 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.

 

Thomas Everett

Subject Matter
Expert Independent

Thomas Everett

Subject Matter
Expert Independent

Thomas Everett

Subject Matter
Expert Independent
 

Ankur Verma

Vice President
Everest Group

Ankur Verma is a member of the Business Process Services team and assists clients on topics related to optimizing business process service delivery models, with an emphasis on Healthcare (payers and providers) and Life Sciences. Ankur’s responsibilities include assisting in managing Everest Group’s Healthcare and Life Sciences Outsourcing subscription offerings and providing outsourcing advisory services to clients on an ad hoc basis.

Ankur Verma

Vice President
Everest Group

Ankur Verma

Vice President
Everest Group

Ankur Verma is a member of the Business Process Services team and assists clients on topics related to optimizing business process service delivery models, with an emphasis on Healthcare (payers and providers) and Life Sciences. Ankur’s responsibilities include assisting in managing Everest Group’s Healthcare and Life Sciences Outsourcing subscription offerings and providing outsourcing advisory services to clients on an ad hoc basis.

Prior to joining Everest Group, Ankur was a Senior Analyst with The Smartcube. He holds a bachelor’s degree in technology from Netaji Subhas Institute of Technology, Delhi.

 

Lori Jensen

Director of Value Analysis
University of Utah Health

Lori Jensen

Director of Value Analysis
University of Utah Health

Lori Jensen

Director of Value Analysis
University of Utah Health
 

Janell Zuckerman

Director, Provider Network Development
Select Health

Janell Zuckerman has been at Select Health since 2021 as the Provider Network Development Director for Idaho. She leads the strategy and operations for network development including provider relations, contracting, and performance.  Her focus is on building partnerships with regional clinically integrated networks and hospitals, and improving interaction models between payers and providers.

Janell Zuckerman

Director, Provider Network Development
Select Health

Janell Zuckerman

Director, Provider Network Development
Select Health

Janell Zuckerman has been at Select Health since 2021 as the Provider Network Development Director for Idaho. She leads the strategy and operations for network development including provider relations, contracting, and performance.  Her focus is on building partnerships with regional clinically integrated networks and hospitals, and improving interaction models between payers and providers. She has successfully developed a direct Select Health network in Idaho and new clinically integrated network agreement, with new product launches across Southern Idaho for commercial and Medicare lines of business.

 

Janell has 15 years of experience in areas of acute care and ambulatory operations, clinically integrated networks, value-based care, and public health and policy, with time at St. Luke’s Health System and the YMCA. In 2023 she was an Idaho Business Review’s Women of the Year honoree. She is a board member and vocal artist with Opera Idaho and association member with HFMA and ACHE. She is a purpose-driven leader and serves as a connector across the health care ecosystem.

 

Janell is an Idaho native and lives with her husband and two children in Boise, Idaho.  She holds a B.A. in English from Tufts University and Masters in Health Administration from Ohio University.

 

Sean Ryder

Value Based Program Manager
Blue Cross Blue Shield of Arizona

Sean Ryder

Value Based Program Manager
Blue Cross Blue Shield of Arizona

Sean Ryder

Value Based Program Manager
Blue Cross Blue Shield of Arizona
 

Josh Miller

Director, Payment Integrity
Prominence

Josh Miller

Director, Payment Integrity
Prominence

Josh Miller

Director, Payment Integrity
Prominence
 

Stacy Reck

Director of Clinical Documentation Improvement and Utilization Review
Avera Health

Stacy Reck

Director of Clinical Documentation Improvement and Utilization Review
Avera Health

Stacy Reck

Director of Clinical Documentation Improvement and Utilization Review
Avera Health
 

Kay Larsen

Revenue Integrity Specialist
Adventist Health

Kay Larsen

Revenue Integrity Specialist
Adventist Health

Kay Larsen

Revenue Integrity Specialist
Adventist Health
 

Carl Reinhardt

Director of Special Investigations Unit – West
Anthem Blue Cross

Carl Reinhardt

Director of Special Investigations Unit – West
Anthem Blue Cross

Carl Reinhardt

Director of Special Investigations Unit – West
Anthem Blue Cross
 

Stina Redford

Director of Payment Innovation
Blue Cross of Idaho

Stina Redford

Director of Payment Innovation
Blue Cross of Idaho

Stina Redford

Director of Payment Innovation
Blue Cross of Idaho

Meet the Payment Integrity Vendor Gurus

 

Dave Cardelle

Chief Strategy Officer
AMS

Dave Cardelle

Chief Strategy Officer
AMS

Dave Cardelle

Chief Strategy Officer
AMS
 

Karen Weintraub

Executive Vice President
HEALTHCARE FRAUD SHIELD

With 25 years of data and 20 years of healthcare experience, Ms. Weintraub is currently responsible for the design and development of the company’s healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures. Prior to joining Healthcare Fraud Shield, managed SIUs on various healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity. Ms.

Karen Weintraub

Executive Vice President
HEALTHCARE FRAUD SHIELD

Karen Weintraub

Executive Vice President
HEALTHCARE FRAUD SHIELD

With 25 years of data and 20 years of healthcare experience, Ms. Weintraub is currently responsible for the design and development of the company’s healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures. Prior to joining Healthcare Fraud Shield, managed SIUs on various healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity. Ms. Weintraub received a BA in Criminal Justice from the University of Delaware and an MA in Criminal Justice from Rutgers University. Ms. Weintraub is a Certified Professional Coder for Payers (CPC-P), a Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders, a Certified Dental Coder (CDC) from the American Dental Association, and the founder of the Hamilton, NJ AAPC chapter. She is also an Accredited Healthcare Fraud Investigator (AHFI) from the National Healthcare Anti-Fraud Association (NHCAA). Ms. Weintraub Taught CPT Coding, Fraud & Audits, and Medical Billing, Laws and Ethics and the local community college. 

 

Karen Ballard

Director of Consulting Services
CGI

Karen Ballard is Director of Consulting Services, CGI, where she is responsible for managing the CGI ProperPay payment integrity platform. With a nearly 20-year career in the health payer space, Karen possesses a deep knowledge of claims processing, product management, payment integrity, and the Blue payer dynamic. Prior to joining CGI, Karen held a variety of positions in claims operations, BlueCard, and payment integrity during her 17-year tenure with Elevance Health (Anthem).

Karen Ballard

Director of Consulting Services
CGI

Karen Ballard

Director of Consulting Services
CGI

Karen Ballard is Director of Consulting Services, CGI, where she is responsible for managing the CGI ProperPay payment integrity platform. With a nearly 20-year career in the health payer space, Karen possesses a deep knowledge of claims processing, product management, payment integrity, and the Blue payer dynamic. Prior to joining CGI, Karen held a variety of positions in claims operations, BlueCard, and payment integrity during her 17-year tenure with Elevance Health (Anthem).

Karen holds a Bachelor of Arts and a Master of Business Administration from Southern New Hampshire University. She co-founded and previously co-facilitated the Blue PI Committee, comprised of payment integrity leaders from all 33 Blue Cross and Blue Shield plans and partnered with the Blue Cross and Blue Shield Association to drive change in the payment integrity space.

 

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.

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.

 

 

Mike Spellman

Senior Director, Consulting & Solution Design
Lyric

Mike Spellman

Senior Director, Consulting & Solution Design
Lyric

Mike Spellman

Senior Director, Consulting & Solution Design
Lyric
 

Cereasa Horner

Director of Policy and Payment Integrity
CERIS

Cereasa Horner, MHA, is the Director of Policy and Payment Integrity for CERIS, a CorVel company. Cereasa has been an integral part of the CERIS team since 2017, and throughout her tenure, she has consistently displayed a rare combination of leadership, innovation, and a deep understanding of the healthcare industry. Her dedication to the mission and values of CERIS Health has been evident in every aspect of her work. She has developed CERIS’ internal payment integrity program and partnered with health plans to create and implement reimbursement policies related to claim audits. 

Cereasa Horner

Director of Policy and Payment Integrity
CERIS

Cereasa Horner

Director of Policy and Payment Integrity
CERIS

Cereasa Horner, MHA, is the Director of Policy and Payment Integrity for CERIS, a CorVel company. Cereasa has been an integral part of the CERIS team since 2017, and throughout her tenure, she has consistently displayed a rare combination of leadership, innovation, and a deep understanding of the healthcare industry. Her dedication to the mission and values of CERIS Health has been evident in every aspect of her work. She has developed CERIS’ internal payment integrity program and partnered with health plans to create and implement reimbursement policies related to claim audits. 

 

Ted Pitynski

Chief Commercial Officer
MedReview

As the Chief Commercial Officer, Ted is responsible for the commercial growth of the company through his leadership of sales, marketing, and product management. Ted brings a wealth of knowledge from more than two decades of experience developing go-to-market strategies for selling complex healthcare solutions to payers, government agencies, benefit trusts and employers. Ted collaborates with sales teams, prospects, partners, and customers to capitalize on revenue-enhancing opportunities, setting new standards in the payment integrity industry.

Ted Pitynski

Chief Commercial Officer
MedReview

Ted Pitynski

Chief Commercial Officer
MedReview

As the Chief Commercial Officer, Ted is responsible for the commercial growth of the company through his leadership of sales, marketing, and product management. Ted brings a wealth of knowledge from more than two decades of experience developing go-to-market strategies for selling complex healthcare solutions to payers, government agencies, benefit trusts and employers. Ted collaborates with sales teams, prospects, partners, and customers to capitalize on revenue-enhancing opportunities, setting new standards in the payment integrity industry.

Prior to joining MedReview, Ted transitioned from the finance sector to healthcare with a fervent commitment to revolutionizing the healthcare landscape. He was previously the Vice President of Self-Insured Solutions and Partnerships for ArmadaHealth, where he developed and executed the company’s distribution strategy. Ted also spent eight years as the Director of Health Plan Partnerships for HealthMedia, a wholly owned subsidiary of Johnson & Johnson.

 

Clay Wilemon

Chief Executive Officer
4L Data Intelligence, Inc.

Clay serves as CEO at 4L Data Intelligence™. He has launched over 500 new healthcare brands and holds patents in artificial intelligence and medical technologies. Clay is on the Board of Directors at Octane, a Southern California non-profit economic development organization that has helped hundreds of technology and med-tech companies get started. He a graduate of Vanderbilt University. 

Clay Wilemon

Chief Executive Officer
4L Data Intelligence, Inc.

Clay Wilemon

Chief Executive Officer
4L Data Intelligence, Inc.

Clay serves as CEO at 4L Data Intelligence™. He has launched over 500 new healthcare brands and holds patents in artificial intelligence and medical technologies. Clay is on the Board of Directors at Octane, a Southern California non-profit economic development organization that has helped hundreds of technology and med-tech companies get started. He a graduate of Vanderbilt University. 

 

Greg Lyon

Senior Fraud Advisor
4L Data Intelligence, Inc.

Greg is a recognized anti-fraud expert with experience in Financial Services and Healthcare Payments that includes serving as Director of Fraud Prevention at United Healthcare. His guiding principle is, “The best way to fight fraud is to prevent it.” Greg is a graduate of Colgate University and is a Certified Financial Planner.

Greg Lyon

Senior Fraud Advisor
4L Data Intelligence, Inc.

Greg Lyon

Senior Fraud Advisor
4L Data Intelligence, Inc.

Greg is a recognized anti-fraud expert with experience in Financial Services and Healthcare Payments that includes serving as Director of Fraud Prevention at United Healthcare. His guiding principle is, “The best way to fight fraud is to prevent it.” Greg is a graduate of Colgate University and is a Certified Financial Planner.

 

David Ott

Director Consulting Payment Integrity
CGI

David Ott has over 28 years of experience in the healthcare and financial services industries. David has provided leadership and direction to department leaders and teams that support a variety of functions, including business development, payment integrity, claims processing, global project management and quality practices.

David Ott

Director Consulting Payment Integrity
CGI

David Ott

Director Consulting Payment Integrity
CGI

David Ott has over 28 years of experience in the healthcare and financial services industries. David has provided leadership and direction to department leaders and teams that support a variety of functions, including business development, payment integrity, claims processing, global project management and quality practices.

 

John-Michael Loke

SVP, Health Plan Strategy & Partnerships
AMS

John-Michael Loke

SVP, Health Plan Strategy & Partnerships
AMS

John-Michael Loke

SVP, Health Plan Strategy & Partnerships
AMS
 

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.

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.

 

 

Sherri Richardson

Strategy, Growth and Program Director
Carelon

As a strategic leader in Program Integrity Health Insurer industry and having mastered the world of “coordination of benefits”, Sherri is passionate about helping our customers and peers navigate the complex world of healthcare. With a proven track record of success in optimizing program efficiency and minimizing cost of care for Members who are eligible/entitled to two health coverages, Sherri is dedicated to ensuring the industry processes are focused on minimizing members out of pocket and provider/insurers administrative costs.

Sherri Richardson

Strategy, Growth and Program Director
Carelon

Sherri Richardson

Strategy, Growth and Program Director
Carelon

As a strategic leader in Program Integrity Health Insurer industry and having mastered the world of “coordination of benefits”, Sherri is passionate about helping our customers and peers navigate the complex world of healthcare. With a proven track record of success in optimizing program efficiency and minimizing cost of care for Members who are eligible/entitled to two health coverages, Sherri is dedicated to ensuring the industry processes are focused on minimizing members out of pocket and provider/insurers administrative costs.

Sherri has 30+ years Health Insurer Industry experience. Operational Excellence, mapping program Strategy is Her Leadership background includes leading highly productive operational teams and all functions of COB Operations within the Commercial, Medicare, Affordable Care Act, Medicaid, Subrogation and Senior market.

As an Elevance/Carelon Corporate Presenter, Sherri enjoys developing training and motivational material, as well as sharing her knowledge and best practices related to maximizing Health Coverage with members, groups, providers and other insurer peers.

Sherri’s experience in health insurance runs deeps, having the privilege of leadership at Elevance/Carelon for 30+ years, and mentoring from industry leaders. Sherri is a life-long learner and strongly encourages others to learn and grow through continued experiences and educational opportunities.

On a personal note; As a prior Fitness Trainer, Sherri enjoys Weight Training, Yoga, Aerial Silks, and Master Swimming.  Oftentimes joins the local 5K runs and loves to cook.   

 

Kyle Pankey

Sales & Growth Leader
Carelon Subrogation

Kyle Pankey has over two decades of experience working within the healthcare and payer operations, with over 10 years specifically tied in to the payment integrity space.   Kyle lives in Chattanooga, TN and has served as Carelon Subrogation’s growth leader since mid-2022.

Kyle Pankey

Sales & Growth Leader
Carelon Subrogation

Kyle Pankey

Sales & Growth Leader
Carelon Subrogation

Kyle Pankey has over two decades of experience working within the healthcare and payer operations, with over 10 years specifically tied in to the payment integrity space.   Kyle lives in Chattanooga, TN and has served as Carelon Subrogation’s growth leader since mid-2022.

 

Dr. Michael Menen

Chief Medical Officer
MedReview
•Former Chief Medical Officer at Optum
•Bachelor of Science degree in theoretical mathematics from the University of California, Riverside
•Doctor of Medicine degree from the Medical College of Wisconsin
•Board-certified invasive cardiologist and a fellow of the American College of Cardiology

Dr. Michael Menen

Chief Medical Officer
MedReview

Dr. Michael Menen

Chief Medical Officer
MedReview
•Former Chief Medical Officer at Optum
•Bachelor of Science degree in theoretical mathematics from the University of California, Riverside
•Doctor of Medicine degree from the Medical College of Wisconsin
•Board-certified invasive cardiologist and a fellow of the American College of Cardiology
 

Matt Ruyter

Senior Director of Product
Paradigm

Matt Ruyter

Senior Director of Product
Paradigm

Matt Ruyter

Senior Director of Product
Paradigm
 

Toni Case

Vice President, National Sales
CERIS

Toni Case

Vice President, National Sales
CERIS

Toni Case

Vice President, National Sales
CERIS
 

Alan Coulter

VP of Business Development
Performant

Alan Coulter

VP of Business Development
Performant

Alan Coulter

VP of Business Development
Performant
 

Ray Evans

Vice President of Healthcare Sales
CoventBridge Group

Ray Evans is a dynamic business development executive with extensive experience working within, and servicing healthcare organizations. He holds the position of Vice President of Healthcare Sales at CoventBridge Group where he utilizes his experience to share with the industry CoventBridge’s unmatched FWA investigative solutions. His goal is to work with health plans in protecting their organization from FWA through an experienced, flexible, and sensitive approach to minimizing provider abrasion, while still achieving organizational objectives.

Ray Evans

Vice President of Healthcare Sales
CoventBridge Group

Ray Evans

Vice President of Healthcare Sales
CoventBridge Group

Ray Evans is a dynamic business development executive with extensive experience working within, and servicing healthcare organizations. He holds the position of Vice President of Healthcare Sales at CoventBridge Group where he utilizes his experience to share with the industry CoventBridge’s unmatched FWA investigative solutions. His goal is to work with health plans in protecting their organization from FWA through an experienced, flexible, and sensitive approach to minimizing provider abrasion, while still achieving organizational objectives.

 

Amy Anzola, RN, MSN

VP, Clinical Operations
Apixio

Amy Anzola, RN, MSN

VP, Clinical Operations
Apixio

Amy Anzola, RN, MSN

VP, Clinical Operations
Apixio
 

Brad Ross

EVP, Payment Integrity
Apixio

Brad Ross

EVP, Payment Integrity
Apixio

Brad Ross

EVP, Payment Integrity
Apixio
 

Chandra Kuti

VP, Government Solutions Operations
CoventBridge Group

Chandra Kuti

VP, Government Solutions Operations
CoventBridge Group

Chandra Kuti

VP, Government Solutions Operations
CoventBridge Group
 

Ram Davaloor

Founder and COO
Claimshark

Ram Davaloor

Founder and COO
Claimshark

Ram Davaloor

Founder and COO
Claimshark
 

Rena Bielinski

VP Customer Success
Codoxo

Rena Bielinski

VP Customer Success
Codoxo

Rena Bielinski

VP Customer Success
Codoxo
 

Jesse Montgomery

VP of Analytics and Data Science
Codoxo

Jesse Montgomery

VP of Analytics and Data Science
Codoxo

Jesse Montgomery

VP of Analytics and Data Science
Codoxo

Other events you might be interested in:

3rd Annual Healthcare Payment & Revenue Integrity East

2nd Annual Healthcare Payment & Revenue Integrity Congress West