Rise

Cheryl Alford Associate Director of Risk Adjustment Health Plans

Visiting Nurse Service of New York

Responsible for ensuring operational oversight and partnering on strategies that impact Risk Adjustment initiatives for Medicare products managed by VNSNY, CHOICE.

Prior experience with other organizations includes Claims Supervisor, and Healthcare Business Analyst roles for Medicare Advantage, Managed Long Term Care and PACE Organizations.

Beginning her career in health plan front-end operations, 13+ years ago, Cheryl committed to understanding the big picture, and contributing toward meaningful impact for every organization she has worked for. Transitioning into risk adjustment in 2014, was a natural progression. In her prior role with ArchCare, she successfully refined and executed processes to improve submission accuracy and completeness, and reconciliation for Medicare and PACE programs.  Joining VNS CHOICE in April 2020, Cheryl is responsible for partnering with senior leadership and executing strategies to sharpen operational efficiencies in Risk Adjustment.   

Brian Bargender Management Consultant, Subrogation and Other Payer Liability

Humana

Brian Bargender is an internal consultant with Humana, one of the country’s largest Medicare Advantage organizations.  In recent years, he has helped to lead Humana’s efforts to clarify and enforce the Medicare Secondary Payer (MSP) rules that pertain to Medicare Advantage and Medicare Prescription Drug plans.  He is also responsible for monitoring trends that may impact subrogation and MSP recovery efforts, developing new cost avoidance and payment recovery projects and advising operational leaders regarding subrogation and MSP issues.

Brian has almost 20 years of experience in leading and improving health benefit subrogation and MSP operations. He is frequently invited to speak with liability, no-fault and workers’ compensation carriers to explain emerging MSP issues.  He holds a Certified Subrogation Recovery Professional (CSRP) designation from the National Association of Subrogation Professionals and previously served as both a co-chair of NASP’s Wisconsin chapter.  He frequently conducts presentations on MSP and health subrogation issues for both the injury payer and health payer audiences.

Dr. Shannon Decker Principal

VBC One

Rafael Gonzalez Partner

Cattie & Gonzalez, PLLC

Rafael has over 35 years of experience in the auto, liability, no-fault, and workers’ compensation insurance industries. He has written extensively on liability, workers’ compensation, social security, and Medicare/Medicaid issues. He has also taught these subject matters at several law schools and medical schools in Florida. He lectures throughout the country on all aspects of Medicare and Medicaid compliance, including Mandatory Insurer Reporting, Conditional Payment Resolution, Medicare Set Asides, MSA Post Settlement Administration, Medicaid Third Party Lien Reimbursement, and Special Needs Trusts.

Over the last 30 years, Rafael has been recognized by City of Tampa Mayor Pam Iorio and Hillsborough County Commissioner Ronda Storm for his work on behalf of the Hispanic community in Tampa and Hillsborough County. He was awarded the Governors Appreciation Award by Governors Bob Martinez and Jeb Bush for his work in improving Florida’s workers compensation system. He was awarded the Governors Leadership Award by Governor Charlie Crist for his work in improving Florida’s Medicaid system. He was awarded Florida’s Distinguished Service Award by US Senator Mel Martinez for his work and advocacy to improve the US Social Security disability system. He has also been awarded the Presidential National Service Award by President George W. Bush for his work on improving the Medicare Secondary Payer system through the addition of the Mandatory Insurer Reporting process, and by President Back Obama for his work and support of the Affordable Care Act.

Recently, WorkCompCentral CEO Kristen Chavez presented Rafael with the Magna Comp Laude Award with Great Honor for his willingness to share his knowledge, experience, and scholastic work with the country’s workers compensation community. Also RISE CEO Ellen Wofford honored Rafael with the RISE Distinguished Service Award for his many years of leadership, scholarship, and professionalism in educating the thousands of professionals who have attended his numerous Medicare and Medicaid programs. And International Association of Industrial Accidents Boards and Commissions President Evelyn McGill awarded Rafael its President’s Award for his leadership and service to the international workers compensation community.

Rafael is active on social media. He is owner and manager of several LinkedIn groups, including Medicare and Medicaid Compliance (8,500 members), Medicare Mandatory Reporting, Medicare Conditional Payments, Medicare Set Aside Allocations, Medicare Set Aside Administration (3,500 members), Florida Workers Compensation (2,500 members), Social Security Benefits (1,500 members), Hispanic Issues and Demographics (500 members), and Affordable Care Act Compliance (250 members). Rafael is also active on Twitter with 2,000 followers and Facebook with 2,000 friends.

Born in Havana, Cuba, Rafael and his family escaped communism to Madrid, Spain, and ultimate immigrated to the US. He owes everything he has achieved to his mother, Miriam Lera. Her love and sacrifice have allowed him to live in freedom, succeed and prosper. Rafael graduated from Miami Senior High School, received his Bachelor of Science degree from the University of Florida and his Jurisprudence Doctorate degree from the Florida State University. He lives in Lithia, Florida with the love of his life, his wife Lisa, and his greatest pride, his two sons, Alex and Andres.

Dr. Ekaette Joseph-Isang Senior Director of CDI and Quality

Honest Medical Group

Aldiana Krizanovic Senior Health Policy Consultant, Federal Government Relations

Florida Blue

Rick Manaco Principal

Pareto Intelligence

Rick brings over 20 years of health experience to Pareto Intelligence, with extensive experience in leading, developing and executing strategic initiatives within the healthcare ecosystem.  This experience includes more than 15 years of dedicated emphasis in government programs, specifically assisting health plans design analytic strategies for comprehensive and accurate data capture to support risk adjustment and organizational initiatives.  In his current role, Rick is responsible for executive client management, analyzing and planning business strategy and advising clients on analytic solutions.

Prior to joining Pareto Intelligence, Rick was responsible for oversight of the global healthcare strategy, product portfolio, and customer advisory within the Health and Life Sciences division of SAS Institute.  In addition to his tenure with SAS, he held several leadership positions within UPMC Health Plan and Highmark Blue Cross Blue Shield focusing on healthcare analytics and risk adjustment domains.

Rick currently resides in Pittsburgh, PA and holds degrees from Duquesne University in Health Management Systems and Executive Management & Leadership from Notre Dame University (online).

Josh Miller Director of Payment Integrity

Prominence Health

Sherri Richardson COB Strategy & Program Director

Carelon

Sherri Directs Anthem’s Coordination of Benefits Strategy & Growth, Programs for all Anthem’s COB Efforts.

Anthem’s COB is unique in that all COB Operational, Prevention and Recovery Functions are consolidated, for all business, Commercial and Government, under the leadership of Program Integrity.

This includes Anthem’s Cost Containment Prevention Program; CMS HEW & MSP data match program, and the industry-wide CAQH COB Smart program.

Sherri has 30+ years of Health Insurance Industry experience. 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.

Sherri is a member of Anthem’s “Corporate Presenter” team, and enjoys developing training and motivational presentations as well as sharing her knowledge and best practices related to Health Coverage with groups, providers and other insurer peers.

Sherri achieved a personal MBA while working for Anthem, is an avid life-long learner and strongly encourages her teams to learn and grow through regular training programs and the educational opportunities Anthem provides.

On a personal note, Sherri has been a certified fitness trainer for 30+ years, enjoys Weight Training, Aerial Silks fitness, is a Master Swimmer, and sometimes likes a 5K run, and loves to cook.

Casey Ryan Vice President-Eligibility & Financial Determination

InnovAge

Howard Weiss VP, Public Policy & Government Affairs

Emblem Health

Howard Weiss currently works in the Government Affairs & Policy Department at EmblemHealth, a nonprofit health plan headquartered in New York City serving 3.2 million enrollees in New York, Connecticut, and Massachusetts. Weiss is responsible for analyzing federal and state legislation and regulation across all business areas and developing advocacy to support EmblemHealth’s goals. Prior to joining EmblemHealth in October 2016, Weiss worked at America’s Health Insurance Plans (AHIP) in Washington, DC for more than 15 years, focusing on Medicare Advantage, Part D, and Medicaid policy. Weiss received a BA in Political Science from the University of Michigan and an MA in Public Policy from the University of Chicago, both many years ago.

Denise Weston Director Product Performance – Government Programs

Sentara Health

Denyse Wise Chief Administrative Officer

Cody Consulting