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  • Highlights on DRG processes and procedures for success 
  • KPIs, and Client Concerns 
  • AI - A DRG Game-changer? 
  • Case studies on DRG audits
Track 2

Author:

Katreece Baker,

VP of Clinical Operations
DRG Claims Management
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Katreece Baker,

VP of Clinical Operations
DRG Claims Management

Author:

Tom Martin

PI Consultant
Independent
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Tom Martin

PI Consultant
Independent

Learn how health plans can realize cost avoidance savings of $4.00-$7.00 PMPY (per member per year), by adopting proactive AI-based provider education, including a provider self-monitoring portal. For a mid-size health plan with 500k members, $2M-$3.5M in cost avoidance could be realized annually. As the payment integrity industry continues to ‘shift left’ through pre-claim submission efforts, it seeks AI-driven tools to maximize coding accuracy and increase savings. Health plans can benefit from automation to address resource constraints, identification of previously undetectable emerging coding issues, and collaboration and trust with their provider network. Join us to hear about our health plan partner journeys to pre-pay cost avoidance without provider abrasion. 

Track 1

Author:

Jesse Montgomery

VP of Analytics and Data Science
Codoxo
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Jesse Montgomery

VP of Analytics and Data Science
Codoxo

Author:

Rena Bielinski

VP Customer Success
Codoxo
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Rena Bielinski

VP Customer Success
Codoxo
Track 1

Author:

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.

... read more

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.

 

Lawrence M. Simon, MD, MBA, FACS

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

Dr.

Read full bio

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.

Track 1

Author:

Ram Davaloor

Founder and COO
Claimshark
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Ram Davaloor

Founder and COO
Claimshark

Author:

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.

... read more

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.

Author:

Tina Azar

Vice President, Market Leader
EXL Health

As EXL’s Vice President of Market Leadership, Tina Azar works to ensure EXL’s products and services drive to the greatest opportunities while servicing the needs of customers. Using strategic planning and thought leadership, her primary focus is to analyze insights and trends of the US Healthcare and then design and execute  comprehensive programs. She is a trusted client partner with over 22 years’ experience in claims, finance, program management, implementation and has lead operational, account management, and sales teams for Payment Integrity for over 12 years. With 12 years of experience in leading Sales and Account Management, she achieved top-in-class recognition while delivering customer and organization cost containment goals while serving as a cultural ambassador, corporate trainer, and mentor. Prior to EXL, she has worked for Change Healthcare, Emdeon and Viant.

... read more

Tina Azar

Vice President, Market Leader
EXL Health

As EXL’s Vice President of Market Leadership, Tina Azar works to ensure EXL’s products and services drive to the greatest opportunities while servicing the needs of customers. Using strategic planning and thought leadership, her primary focus is to analyze insights and trends of the US Healthcare and then design and execute  comprehensive programs. She is a trusted client partner with over 22 years’ experience in claims, finance, program management, implementation and has lead operational, account management, and sales teams for Payment Integrity for over 12 years. With 12 years of experience in leading Sales and Account Management, she achieved top-in-class recognition while delivering customer and organization cost containment goals while serving as a cultural ambassador, corporate trainer, and mentor. Prior to EXL, she has worked for Change Healthcare, Emdeon and Viant.

 

Alan Coulter

VP of Business Development
Performant

Alan Coulter

VP of Business Development
Performant

Alan Coulter

VP of Business Development
Performant
 

Debra Hamer

Director, FWA Analytics
CERIS

Debra Hamer

Director, FWA Analytics
CERIS

Debra Hamer

Director, FWA Analytics
CERIS
Track 1

Author:

Mike Spellman

Senior Director, Consulting & Solution Design
Lyric
... read more

Mike Spellman

Senior Director, Consulting & Solution Design
Lyric

Author:

Harold Davis

VP, Product Growth
Rialtic
... read more

Harold Davis

VP, Product Growth
Rialtic