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Wednesday, 10 Sep, 202507:30am
Registration
Session Topics:Medical Cost Containment08:25amWelcome
Session Topics:Medical Cost ContainmentSession Type:General Session (Presentation)08:30am2026 Legislation Updates: From Compliance to Strategy
This session will explore the financial impact of federal legislation updates, such as upcoming price transparency rules, on both payment integrity and revenue cycle management programs. We’ll examine how these changes are expected to drive new cost pressures, reshape audit and payment practices, and create fresh challenges for both payers and providers. The discussion will also focus on collaborative strategies - how both sides can work together to ensure compliance, mitigate financial risk, and proactively adapt their programs to achieve better outcomes in a shifting regulatory landscape.
Session Topics:Medical Cost ContainmentSponsor(s):AMS Intelligent AnalyticsSpeaker(s):
Dave Cardelle
Chief Strategy OfficerAMS
Symone Rosales
Director of Revenue Cycle Regulatory ResearchSSM Health
Deborah Knight-Lauricia
Senior Director, Revenue Cycle Strategic InitiativesCleveland ClinicSession Type:General Session (Presentation)09:00amPresentation with Lyric
Sponsor(s):LyricSession Type:General Session (Presentation)09:30amCoffee Break
Session Topics:Medical Cost ContainmentSession Type:General Session (Presentation)09:35amFacilitated Meetings
Curated meetings based on your RCM/PI painpoints and investments -30 minutes each -3 meetings per registered individual -All those not scheduled to take meetings will be encouraged to take part in interactive sessions, competitions and activities in the exhibition room.
Session Topics:Medical Cost ContainmentSession Type:General Session (Presentation)10:10amFacilitated Meetings
Curated meetings based on your RCM/PI painpoints and investments -30 minutes each -3 meetings per registered individual -All those not scheduled to take meetings will be encouraged to take part in interactive sessions, competitions and activities in the exhibition room.
Session Topics:Medical Cost ContainmentSession Type:General Session (Presentation)10:40amSavings PMPM Benchmarking Initiative - Standard Definitions & Calculations
Industry benchmarks to measure the impact of payment integrity currently don't exist, making it challenging to optimize performance and areas of opportunity. Standards are extremely complicated due to varied member populations and an inconsistent approach to calculating metrics.In this groundbreaking panel discussion, learn how a Working Group of payer and vendor SMEs have been collaborating over the last six months to develop a standard approach to calculating savings PMPM across LOB and audit programs. This session will share standard definitions and calculations, so attendees can understand how to calculate and compare their savings PMPM.Session Topics:Payment IntegritySpeaker(s):Moderator
Natalie Clayton
Head of Market IntelligenceKisaco Research
Monique Pierce
Payment Solutions & OperationsCohere HealthMonique started her Payment Integrity career in COB at Oxford HealthPlans. After the merger with UnitedHealthcare, she led multiple teams and was responsible for creating innovative programs. Monique joined SCIO Health Analytics in 2014 and was responsible for system and process improvements before being promoted to VP of client engagement and business optimization In 2020, Monique joined start-up Devoted Health and created a full suite of programs from the ground up. Based on a passion for metrics and measuring performance, she centralized and standardized all programs reducing implementation time and maximizing savings. Today, Monique is driving opportunities to improve claim payment by designing and developing new prior auth and claim reconciliation products at Cohere Health.
Dr. Priscilla Alfaro, MD, FAAP, CPC, CPMA, COC, CIC, CFE, CRC
VP Payment IntegrityBlue Cross NCDr. Priscilla Alfaro is a seasoned healthcare professional with extensive experience in executive medical management, fraud prevention, and healthcare analytics. A certified medical coder, fraud examiner, and auditor, she has a proven track record of improving healthcare efficiency and preventing fraud, waste, and abuse across various roles and affiliations, including the Texas HHS and Anthem.
Karen Ballard
Director of Consulting ServicesCGIKaren 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.
Agenda Track No.:Track 1Session Type:TrackTackling Billing Complexities Head On
Diagnosis codes and modifiers aren’t just billing details—they tell the story that determines how your claims are paid. When these elements don’t align, hospitals face denials, delays, and compliance risks. This session will break down how to accurately connect coding choices with billing practices to ensure claims reflect true clinical intent, reduce audit exposure, and secure appropriate reimbursement.
Learning Objectives:- Recognize the most common coding and modifier missteps that lead to denials and learn how to avoid them through stronger documentation and coding practices.
- Implement strategies to bridge gaps between clinical, coding, and billing teams—ensuring consistent, compliant claims that tell the right story from documentation to payment.
Session Topics:Revenue Cycle ManagementSpeaker(s):
Stephanie Sjogren
Director, Coding and Provider ReimbursementEmblemHealth/ConnecticareStephanie Sjogren is a director of coding and provider reimbursement, working with payment integrity to ensure proper claims adjudication and to prevent fraud, waste, and abuse. Prior to joining ConnectiCare/EmblemHealth, she performed provider audits and education at a women’s healthcare group. Sjogren has also worked with physicians and staff to integrate and use electronic health record systems effectively and to stay in compliance with the Centers for Medicare & Medicaid Services’ rules and regulations. Her areas of specialty are payment integrity, auditing, and clinical documentation improvement.
Agenda Track No.:Track 2Session Type:General Session (Presentation)11:25amCoffee Break
Session Topics:Medical Cost ContainmentSession Type:General Session (Presentation)11:35amFacilitated Meetings
Curated meetings based on your RCM/PI painpoints and investments -30 minutes each -3 meetings per registered individual -All those not scheduled to take meetings will be encouraged to take part in interactive sessions, competitions and activities in the exhibition room.
Session Topics:Medical Cost ContainmentSession Type:General Session (Presentation)12:05pmThe Guide to Building Safe, Transparent, and Effective AI Partnerships
As AI use rapidly expands across health plan operations, understanding how these technologies will be governed is essential. In this session, experts will take a deeper dive into the current state of AI governance frameworks and the legislative landscape shaping their use. Health plan leaders will gain timely insights into what’s happening now—and what’s coming next—in AI oversight, helping them prepare their organizations for compliance, accountability, and responsible innovation.
Learning Objectives:- Learn how to assess, document, and monitor AI models used in claims review, fraud detection, and payment integrity to ensure they meet accountability, explainability, and compliance standards.
- Gain actionable insights into current and pending legislation on AI use in healthcare, and understand what steps your organization should take now to align with evolving regulatory expectations and avoid audit risks.
Sponsor(s):MachinifySpeaker(s):
Crystal Son
Executive Director of Enterprise Data Analytics SolutionsHCSCCrystal Son is an Executive Director of Enterprise Data Analytics Solutions at Healthcare Service Corporation (HCSC), the largest customer-owned health insurer in the United States. HCSC provides access to care nationwide through Blue Cross Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas as well as through its broad portfolio of companies. Crystal has 20 years of experience in deriving intelligence from data and mobilizing teams to action.
At HCSC, she leads the Strategic Initiatives & Partnerships team, which leads key programs such as Payment Integrity, Responsible AI and AI Literacy and Workforce Readiness. She is passionate about real-world applications of data-driven insights, storytelling through data, and building high-performance teams.
Prior to joining HCSC in October 2022, Crystal held several roles at previous organizations, including delivery of data science advisory services, management of healthcare and government customer portfolios, and the development and launch of several new products. She began her career in data as an epidemiologist, first for the City of New York, then with Memorial Sloan-Kettering Cancer Center but has called downtown Chicago home for the last 11 years.
Simi Binning
Responsible AI LeadHCSCSimi Binning is an accomplished healthcare professional with over a decade of experience in developing and executing successful strategies that drive business growth. Currently serving as a Responsible AI lead at HCSC, her focus is on AI governance and innovative problem solving.
Agenda Track No.:Track 1Session Type:TrackHow to Make Value-Based Care Work for You
As value-based care continues to reshape payment models, many health systems struggle to balance financial performance with care quality goals. This session will offer practical strategies to use denial data, coding insights, and care coordination metrics to strengthen value-based outcomes—without sacrificing revenue. This discussion will highlight how to engage teams, optimize processes, and identify sustainable financial opportunities within value-based contracts.
Learning Objectives:- Learn how to use denial patterns and audit insights to improve documentation, coding accuracy, and contract performance.
- Gain strategies to foster physician buy-in and leadership collaboration, finding “win-win” solutions that support both revenue integrity and value-based care success.
Session Topics:Revenue Cycle ManagementSpeaker(s):
Corella Lumpkins
Manager of Coding, Compliance and Provider EducationLoudoun 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.
Lourdes Centeno Fanjoy
Payment Policy ManagerMass General BrighamWith over 15 years of experience in revenue cycle management, compliance, payer policy advising, and executive presentations, Lourdes is a results-oriented leader dedicated to optimizing operational strategies and driving corporate success. Her resource allocation, process redesign, and capacity planning skills enable her to enhance profit margins and achieve strategic goals. Lourdes brings expertise in Medicare and Medicaid reimbursement policies, ensuring effective and compliant financial practices.
Agenda Track No.:Track 2Session Type:Track12:50pmLunch
Session Topics:Medical Cost ContainmentSession Type:General Session (Presentation)01:10pmFacilitated Meetings
Curated meetings based on your RCM/PI painpoints and investments -30 minutes each -3 meetings per registered individual -All those not scheduled to take meetings will be encouraged to take part in interactive sessions, competitions and activities in the exhibition room.
Session Topics:Medical Cost ContainmentSession Type:General Session (Presentation)01:45pmFacilitated Meetings
Curated meetings based on your RCM/PI painpoints and investments -30 minutes each -3 meetings per registered individual -All those not scheduled to take meetings will be encouraged to take part in interactive sessions, competitions and activities in the exhibition room.
Session Topics:Medical Cost ContainmentSession Type:General Session (Presentation)02:15pmPayer-Provider Roundtables
Engage in focused, small-group discussions where payers and providers connect over specific topics, share perspectives, and explore solutions from both sides—offering a balanced, holistic view of key challenges and opportunities.- Price Transparency 4 Years In: Navigating Compliance, Challenges, and Opportunities for Providers and PayersJoin us for a dynamic roundtable at the Healthcare Payment and Revenue Integrity Congress, where providers and payers will explore the impact of price transparency. Led by Dave Cardelle (SIIA Price Transparency Committee), the session will examine key challenges and strategies around the CMS Final Rule on Hospital Price Transparency and TiC MRFs, four years on. Discussion topics include compliance, penalties, costs, rate setting, contract negotiations, and using transparency data for analysis. Don’t miss this chance to share insights and shape the future of price transparency.Dave Cardelle, Chief Strategy Officer, AMS
- Payment Integrity 101Join us for Payment Integrity 101 at the Healthcare Payment and Revenue Integrity Congress, a foundational session designed for those new to or expanding their role in payment integrity. This session will break down the key components of payment integrity, from pre-pay to post-pay strategies, common fraud, waste, and abuse (FWA) schemes, to how plans and providers can align on reducing improper payments. Whether you're building a team, refining your approach, or just starting out, this session offers a practical roadmap and terminology primer to help you navigate the space with confidence.Charlie Jensen, Head of Payment Integrity Strategy, Blue Cross Blue Shield, Illinois
Session Topics:Medical Cost ContainmentSponsor(s):MachinifyAMS Intelligent AnalyticsSpeaker(s):
Maya Turner
Owner/Executive Managing DirectorTurner Expert ConsultingDave Cardelle
Chief Strategy OfficerAMS
Charlie Jensen
Head of Payment Integrity StrategyBlue Cross Blue Shield, IllinoisSession Type:General Session (Presentation)03:00pmCoffee Break
Session Topics:Medical Cost ContainmentSession Type:General Session (Presentation)03:05pmFacilitated Meetings
Curated meetings based on your RCM/PI painpoints and investments -30 minutes each -3 meetings per registered individual -All those not scheduled to take meetings will be encouraged to take part in interactive sessions, competitions and activities in the exhibition room.
Session Topics:Medical Cost ContainmentSession Type:General Session (Presentation)03:40pmFacilitated Meetings
Curated meetings based on your RCM/PI painpoints and investments -30 minutes each -3 meetings per registered individual -All those not scheduled to take meetings will be encouraged to take part in interactive sessions, competitions and activities in the exhibition room.
Session Topics:Medical Cost ContainmentSession Type:General Session (Presentation)04:15pmEmerging and Evolving Fraud Trends
As fraud schemes become increasingly complex, healthcare organizations must stay ahead of evolving threats that impact both clinical and financial integrity. This session will explore the latest fraud trends across the healthcare landscape - from billing manipulation and phantom providers to evolving schemes in hospice, home health, telehealth, and behavioral health. Join industry leaders as they share real-world examples, warning signs to watch for, and proactive strategies for detecting, preventing, and responding to fraud across care settings.
Session Topics:Payment IntegritySponsor(s):Healthcare Fraud ShieldSpeaker(s):
Michael Devine
Director Special Investigations UnitL.A Care
Peter Monson
SIU DirectorUCare HP
Mandi Heiple
Director of Payment IntegrityMedica
Karen Weintraub
Executive Vice PresidentHEALTHCARE FRAUD SHIELDWith 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.
Agenda Track No.:Track 1Session Type:TrackAgentic AI or Just Another Bot? Cutting Through the Healthcare Automation Hype
Not all automation is created equal. This session helps healthcare leaders cut through the noise and get real about what “agentic” means in practice. If you’ve been burned by bots that couldn’t scale—or are evaluating solutions now—this talk will help you make smarter choices.Learning Objectives:Distinguish between RPA, chatbots, and agentic AILearn how agentic systems adapt, escalate, and self-manageDiscover where agentic AI delivers outsized value in RCMGet a checklist for evaluating automation depth and riskSponsor(s):MagicalSpeaker(s):
Vanessa Moldovan, CRCR, CPC, CPB, CPMA, CPPM, CPC-I
Head of RCM StrategyMagical
Raffaello d'Amor
Head of ProductMagicalAgenda Track No.:Track 2Session Type:General Session (Presentation)Transforming Payment Integrity through Payment Precision
As the healthcare landscape evolves, the future of payment integrity depends on stronger, more transparent relationships between payers and providers. This session will explore how shifting from adversarial audits to aligned, data-driven collaboration can lead to more sustainable results. Using real case examples, we’ll discuss how leaders are redesigning their PI strategies to prioritize trust, accuracy, and efficiency.
Sponsor(s):OptumSpeaker(s):
Tisha Holden
Market PresidentOptumServing as Market President at Optum, Tisha has spent more than 25 years at the forefront of health plan innovation, helping clients build strategic, comprehensive programs to address their toughest challenges and achieve financial health and operational excellence at scale.
Agenda Track No.:Track 1Session Type:General Session (Presentation)What Denials Are Really Telling You (and How to Fix It)
Denial management isn’t just about fighting back—it’s about understanding why denials happen and fixing the root causes upstream. This session will focus on how hospitals and health systems can use audit findings and denial data to identify coding gaps, documentation weaknesses, and process breakdowns that lead to preventable denials. Learn how to close these gaps through stronger internal collaboration across revenue cycle, coding, and clinical teams, while also using data-driven insights to foster more productive payer relationships.
Learning Objectives:- Learn how to analyze denial patterns and audit results to uncover documentation, coding, and process issues—enabling proactive prevention rather than reactive rework.
- Discover best practices for improving internal workflows, fostering collaboration between clinical and revenue cycle teams, and ensuring that claims reflect accurate, defensible coding and clear clinical intent.
Session Topics:Revenue Cycle ManagementSpeaker(s):
Betye Ochoa
Director, Revenue Cycle RedesignNorthShore University HealthSystem
Kimberly D Conner
Subject Matter ExpertIndependentAgenda Track No.:Track 2Session Type:Track05:30pmDrinks Reception | Sponsored by Katch
Session Type:General Session (Presentation) -
Thursday, 11 Sep, 202507:30am
Registration
Session Topics:Medical Cost Containment08:25amWelcome to Day 2
Session Type:General Session (Presentation)08:30amPayer-Provider Panel: Improving Relationships Through Trust and Collaboration
Payer-provider abrasion remains one of the biggest barriers to efficient payment, timely care, and operational success. Too often, denials, delayed payments, and prior authorization disputes stem from misaligned expectations, incomplete data, and unclear communication—not true disagreement. This session will offer a candid, solutions-focused discussion on what payers really need from providers, what providers can do upfront to reduce friction, and how both sides can work together to minimize rework, prevent avoidable denials, and create shared wins.
Learning Objectives:- Gain clear insights into how providers can proactively align documentation, coding, and authorization workflows to meet payer requirements and reduce denials and appeals.
- Learn practical approaches to improve data sharing, reduce ambiguity in clinical and billing documentation, and foster payer-provider partnerships that lead to faster resolutions and fewer administrative burdens.
- Explore strategies to move beyond transactional interactions and build trust-based partnerships between payers and providers—focusing on shared goals like timely care, accurate payment, and operational efficiency.
Session Topics:Medical Cost ContainmentSpeaker(s):Moderator
Sarah Armstrong
CEOTrend Health PartnersSarah is, above all else, a passionate leader of people. With a career spanning over two decades, her journey began as a financial analyst at a small community hospital in Kentucky, where she developed a profound appreciation for the pivotal role of people in healthcare, both in the clinic and in the back office. This early experience ignited her passion for enhancing Revenue Cycle performance and fostering leadership talents that resonate with the values of collaboration and efficiency.
Her leadership at TREND is deeply influenced by her comprehensive background, championing a culture of inclusivity and collaboration. By valuing each team member's contribution, Sarah drives innovations that not only challenge the conventional adversarial healthcare models but also promote a cooperative and efficient environment that benefits all stakeholders.
She leads with a commitment to transparency, cooperation over competition, and a deep-seated belief in empowering her team. Under her leadership, TREND is pioneering a new era of healthcare solutions that prioritize accuracy, fairness, and collaborative problem-solving, all aimed at improving outcomes for patients and providers alike.
Sarah's leadership is characterized by her ability to bridge traditional divides within the industry, advocating for a paradigm shift from adversarial dynamics to cooperative partnerships. Her strategic vision is supported by her unwavering dedication to TREND's ideals, both internally and externally, driving TREND Health Partners to challenge the status quo and lead American healthcare into a more efficient and equitable future.
Panelists
Jonique Dietzen
Payment Integrity DirectorCareOregonWith over 18 years of experience in healthcare billing and finance, I am a certified professional coder dedicated to ensuring accurate claims and proper reimbursement for providers. Having worked extensively on the provider side in finance and revenue cycle, I bring wealth of knowledge to the table, particularly in processing and payment integrity.
Throughout my career, I have gained a comprehensive understanding of billing challenges from both perspectives. This unique insight drives my commitment to improving billing practices and advocating for provider education. I continue to leverage my expertise to enhance billing processes and support providers in navigating the complexities of healthcare finance.Mandi Heiple
Director of Payment IntegrityMedica
Dr. Ahmad Kilani MD, MBA, MLS, MSIT, CHCQM-PHYADV, FABQAURP, FACP, FACHE
Medical DirectorCleveland ClinicDr. Kilani is currently serving as Associate Medical Director for Cleveland Clinic Revenue Cycle Management and Medical Director of Throughput for Cleveland Clinic West Submarket. Nationally, he serves as Vice President of Operations for the American College of Physician Advisors. Dr. Kilani is board certified in Internal Medicine. Additionally, he has a Master of Business in Healthcare from Baldwin Wallace University, a Master of Legal Studies from Cleveland-Marshall College of Law, and a Master of Science in Information Technology from the University of Cincinnati. He is a Fellow of the American College of Physicians, a Fellow of the American College of Healthcare Executives, and board-certified in Healthcare Quality Management through the American Board of Quality Assurance and Utilization Review Physicians.”
Heather Wilson
Vice President and Chief Revenue Cycle OfficerThe Christ Hospital Health NetworkSession Type:General Session (Presentation)09:15amThe Death of the Black Box: Why Transparency is the New Competitive Advantage in Payment Integrity
The healthcare industry is at a turning point: payers and providers alike are demanding more from payment integrity than opaque rules engines and audit surprises. While black-box vendors have long promised value, their lack of transparency can lead to costly misalignment, internal dependency, and missed opportunities for learning and waste prevention.This session will explore the hidden costs of opacity in traditional payment integrity models and offer a modern alternative. We’ll examine how health plans can reclaim ownership of their payment integrity strategy by shifting to AI-powered platforms to empower internal audit teams (0-pass) phase, promote internal learning, reduce overdependence on black-box vendors, and align audit logic with clinical evidence.Attendees will learn how connecting prior authorization and claims data earlier in the care lifecycle can help identify root issues before they become payment errors. Beyond preventing waste, this approach can strengthen provider relationships, improve internal capabilities, and ultimately drive more proactive, accurate decision-making.Using real-world insights, we’ll show how a collaborative, clinical intelligence-driven model can give payers a sustainable edge in accuracy, agility, and provider trust.Sponsor(s):Cohere HealthSpeaker(s):Monique Pierce
Payment Solutions & OperationsCohere HealthMonique started her Payment Integrity career in COB at Oxford HealthPlans. After the merger with UnitedHealthcare, she led multiple teams and was responsible for creating innovative programs. Monique joined SCIO Health Analytics in 2014 and was responsible for system and process improvements before being promoted to VP of client engagement and business optimization In 2020, Monique joined start-up Devoted Health and created a full suite of programs from the ground up. Based on a passion for metrics and measuring performance, she centralized and standardized all programs reducing implementation time and maximizing savings. Today, Monique is driving opportunities to improve claim payment by designing and developing new prior auth and claim reconciliation products at Cohere Health.
Session Type:General Session (Presentation)09:45amCoffee Break
Session Topics:Medical Cost ContainmentSession Type:General Session (Presentation)09:50amFacilitated Meetings
Curated meetings based on your RCM/PI painpoints and investments -30 minutes each -3 meetings per registered individual -All those not scheduled to take meetings will be encouraged to take part in interactive sessions, competitions and activities in the exhibition room.
Session Topics:Medical Cost ContainmentSession Type:General Session (Presentation)10:25amFacilitated Meetings
Curated meetings based on your RCM/PI painpoints and investments -30 minutes each -3 meetings per registered individual -All those not scheduled to take meetings will be encouraged to take part in interactive sessions, competitions and activities in the exhibition room.
Session Topics:Medical Cost ContainmentSession Type:General Session (Presentation)11:00amPost Pay is Dead - Let us tell you why
Session Topics:Payment IntegritySponsor(s):Alivia AnalyticsSpeaker(s):
Matt Perryman
Chief Analytics & Insight OfficerAlivia Analytics
Novelette Wallace, MPH, PMP, CSSBB
Head of Payment IntegrityJohns Hopkins HealthcareNovelette 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
Lacey Crowl
VP of Health Plan OperationsLongevity Health PlanLacey 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.
Time:10:55am - 11:25amAgenda Track No.:Track 1Session Type:TrackHow to Vet RCM Tech Without Losing Your Budget - or Your Mind
In a market flooded with AI-powered RCM tools, how do you separate real innovation from empty buzzwords? This panel will guide payers, providers, and RCM leaders through what really matters when evaluating AI vendors, highlighting key red and green flags, how to measure real-world impact, and clarifying what “AI” actually means in today’s healthcare environment
Sponsor(s):SuperDialSpeaker(s):
Sam Schwager
Co-Founder & CEOSuperDialAgenda Track No.:Track 2Session Type:General Session (Presentation)Complimentary Medicine Fraud
Speaker(s):
Rae A. McIntee, DDS, MD, MBA, FACS, CPE
Medical Director Clinical Solutions (Supporting Payment Integrity & SIU)Louisiana BlueTime:11:30amAgenda Track No.:Track 1Session Type:General Session (Presentation)Revenue Cycle Automation - Can AI Drive Accuracy and Efficiency
As payers increasingly deploy AI and automation to accelerate denials and reduce payments, health systems must evolve their own technology strategies to keep pace. This session will share best practices for integrating AI, automation, and machine learning into revenue cycle operations—drawing on real-world examples from leading health systems, hospitals and practices. Explore the journey of implementing automation and machine learning while navigating governance, overcoming technical hurdles, and fostering adaptability across teams.
Learning Objectives:- Understand technical and operational obstacles in adopting automation and AI tools, and learn proven strategies to overcome them effectively.
- Gain insights into building flexible governance frameworks, supporting staff education, and fostering adaptability to maximize the impact of emerging technologies in your revenue cycle.
Speaker(s):
Deepak Nalli
Vice President Revenue Cycle OperationsSpire Orthopedic PartnersTime:11:30amAgenda Track No.:Track 2Session Type:Track12:15pmLunch
Session Type:General Session (Presentation)12:35pmFacilitated Meetings
Curated meetings based on your RCM/PI painpoints and investments -30 minutes each -3 meetings per registered individual -All those not scheduled to take meetings will be encouraged to take part in interactive sessions, competitions and activities in the exhibition room.
Session Topics:Medical Cost ContainmentSession Type:General Session (Presentation)01:10pmFacilitated Meetings
Curated meetings based on your RCM/PI painpoints and investments -30 minutes each -3 meetings per registered individual -All those not scheduled to take meetings will be encouraged to take part in interactive sessions, competitions and activities in the exhibition room.
Session Topics:Medical Cost ContainmentSession Type:General Session (Presentation)01:45pmStreamline Payment Accuracy on a Large Scale
Description: This session explores how health plans are tackling one of the biggest challenges in payment integrity today: fragmented, inconsistent pricing and reimbursement data. Through real-world case studies, we’ll examine how leading organizations have approached this issue with scalable strategies that reduce errors, improve transparency, and drive operational efficiency.Key Takeaways:Understand how fragmented pricing data leads to leakage and mistrustLearn practical steps to centralize and maintain consistent reimbursement logicSee how other plans have successfully implemented scalable solutionsSponsor(s):RialticAgenda Track No.:Track 1Session Type:General Session (Presentation)Proactive RCM Strategy Through Data Transparency
Outdated EHRs and legacy systems continue to hinder healthcare providers from accessing and leveraging real-time data—especially in revenue cycle operations. This session will address how fragmented and delayed information impacts claims management, payment tracking, and overall operational efficiency. Through practical strategies and emerging solutions, we’ll explore how organizations can overcome data silos, improve visibility into claims status, and move from reactive to proactive revenue cycle management.
Speaker(s):Corella Lumpkins
Manager of Coding, Compliance and Provider EducationLoudoun 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.
Agenda Track No.:Track 2Session Type:General Session (Presentation)Enhanced Interoperability for Stronger Relationships and Smarter Spending
Interoperability is a key driver of payer-provider collaboration and cost efficiency, but putting it into practice requires strategy, alignment, and persistence. This session takes you inside one health plan’s ongoing journey to modernize its interoperability infrastructure to support stronger partnerships with providers and deliver a more seamless member experience. From breaking down data silos to enabling real-time exchange and smarter workflows, discover how targeted process improvements are driving better outcomes, reducing administrative friction, and enabling more informed, value-based decisions.
Speaker(s):
Saikiran (Sai) Vodela, MPA, MS, PharmB
Advisor and Manager, HealthITL.A. Care Health PlanSaikiran (Sai) Vodela is an Advisor and Manager of HealthIT at L.A. Care Health Plan, where he leads strategic efforts in Health Information Exchange (HIE), California’s Data Exchange Framework (DxF), and interoperability initiatives that support care coordination for Los Angeles County’s safety net population.
Sai previously spearheaded the implementation of a clinical data repository under the Transforming Clinical Practice Initiative (TCPi), a nationwide effort by the Center for Medicare & Medicaid Innovation (CMMI) aimed at improving healthcare delivery through data-driven transformation. The program achieved $196 million in cost avoidance for the health plan. Earlier in his career, he developed performance monitoring solutions for Accountable Care Organizations (ACOs) and Medicare providers at an electronic health record company.
He holds a Master of Public Administration (MPA) in Healthcare Management, a Master of Science (MS) in Pharmaceutical Chemistry, and a Bachelor of Pharmacy (PharmB).
Time:02:15pmAgenda Track No.:Track 1Session Type:TrackEngaging Physicians in the Revenue Conversation
Physicians play a pivotal role in the health of the hospital’s revenue cycle—but they’re often left out of the conversation. This session explores how hospitals can drive meaningful improvements across the entire revenue cycle by actively engaging and educating their physician workforce. From clinical documentation and coding to prior authorization and medical necessity, learn how leading health systems are building alignment between clinical and financial goals.
Speaker(s):
Shalondan Hollingshed
Corporate Director, Revenue CycleEmory HealthcareTime:02:15pmAgenda Track No.:Track 2Session Type:Track02:45pmEnd of Event
Session Type:General Session (Presentation)
Jump to: Wednesday, 10 Sep | Thursday, 11 Sep
