Revenue Cycle Management
Payment Integrity
Josh Miller
Director, Payment Integrity
Prominence
Panels and Presentations Addressing Key Challenges of Revenue Cycle Management
Revenue Cycle Management
Panels and Presentations Addressing Key Challenges of Payment Integrity
Payment Integrity
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.
Medical Cost Containment
Moderator
Sarah Armstrong
CEO
Trend Health Partners
Sarah 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 Director
CareOregon
With 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 Integrity
Medica
Mandi Heiple is the Director of Payment Integrity at Medica, where she leads a high-performing team dedicated to ensuring accurate, compliant, and efficient claims payment across commercial and government lines of business. She oversees end-to-end payment integrity strategy – from prospective editing and coding validation to retrospective audits. Her teams drive measurable savings while protecting provider relationships and improving member experiences.
With over 20 years in healthcare operations and payment integrity, Mandi has focused on designing and implementing solutions that close process gaps, reduce improper payments, and strengthen compliance frameworks.
Dr. Ahmad Kilani MD, MBA, MLS, MSIT, CHCQM-PHYADV, FABQAURP, FACP, FACHE
Medical Director
Cleveland Clinic
Dr. 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 Officer
The Christ Hospital Health Network
Medical Cost Containment
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.Simi Binning, Responsible AI Lead, HCSC
Charlie Jensen, Head of Payment Integrity Strategy, Blue Cross Blue Shield, Illinois Provider Contracts Uncovered: From Fine Print to Financial Power
Contracts are more than legal fine print. They decide whether your organization thrives or just survives. In this session, we’ll pull back the curtain on contract language, expose common traps that drain revenue, and share negotiation tactics that actually move the needle. Expect real talk, practical tips, and a fresh look at how providers can flip contracts into cost-containing, revenue-protecting assets.
Quick-Hit Takeaways
Spot the traps: Know the clauses that cost you most.
Negotiate smarter: Tactics payers don’t want you to know.
Stay compliant: Align terms with today’s rules.
Think strategic: Make every contract work for your bottom line.Maya Turner, Executive Managing Director, Turner Expert Consulting Services, LLC
Medical Cost Containment
Maya Turner
Owner/Executive Managing Director
Turner Expert Consulting
Dave Cardelle
Chief Strategy Officer
AMS
Charlie Jensen
Head of Payment Integrity Strategy
Blue Cross Blue Shield, Illinois
Simi Binning
Responsible AI Lead
HCSC
Simi 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.
Machinify
Website: https://www.machinify.com/
Machinify is redefining payment integrity with AI-powered solutions designed to be frictionless, intelligent, and future-ready. Trusted by over 60 health plans, Machinify simplifies the complexity of healthcare claims with a platform that coordinates, validates, and pays claims with precision. Backed by cutting-edge technology and healthcare expertise, Machinify delivers cost savings, operational clarity, and strategic insight—empowering payers to take full control of their payment operations.
Machinify Solutions
Machinify offers a unified platform for payment integrity, combining pre-pay and post-pay solutions to detect, prevent, and resolve improper payments across the claim lifecycle.
- Pre-Pay Adjudication & Accuracy: Automatically identify potential errors or duplications before claims are paid, reducing downstream recovery efforts.
- Post-Pay Analytics & Recovery: Leverage advanced AI to uncover patterns, prioritize audits, and streamline recovery with high accuracy and minimal friction.
- Audit & SIU Support: Equip Special Investigation Units and audit teams with AI-enhanced tools to detect fraud, waste, and abuse faster and more effectively.
- Configurable, Modular Platform: Tailored to integrate into existing workflows with flexibility and speed, enabling rapid value without disruption.
Machinify’s intelligent platform unifies fragmented payment integrity processes, empowering payers to reduce costs, increase efficiency, and improve payment accuracy at scale.
AMS Intelligent Analytics
Website: http://www.amspredict.com/
Advanced Medical Strategies (AMS) is the premier provider of payment integrity, risk management, and business intelligence solutions to identify and address excessive claims, prevent and recoup overpayments, and effectively manage the risks associated with high-cost claimants and group health underwriting.
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.
Revenue Cycle Management
Betye Ochoa
Director, Revenue Cycle Redesign
NorthShore University HealthSystem
Kimberly D Conner
Subject Matter Expert
Independent
Payment Integrity