View Agenda | The Optimizing Appeals and Grievances Summit | A RISE Health Conference

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The 9th Annual Optimizing Appeals and Grievances Summit
June 25th – 26th, 2024
Virtual

Agenda

 

 

 

Tuesday - June 25, 2024

10:00 AM 11:00 AM

9:00 AM 10:00 AM

8:00 AM 9:00 AM

7:00 AM 8:00 AM

Pre-Conference Workshop Part 1: Integrating Artificial Intelligence in Appeals Processing

  • Discuss ethical considerations and privacy concerns in the deployment of AI technologies 
  • Examine case studies where AI has reduced processing times and errors 
  • Highlight the potential of AI and machine learning to streamline appeals and processing 

 

11:00 AM 12:00 PM

10:00 AM 11:00 AM

9:00 AM 10:00 AM

8:00 AM 9:00 AM

Pre-Conference Workshop Part 2: Leveraging Data Analytics for Proactive Grievance Management

  • Discuss how data analytics can be used to predict potential grievances before being escalated 
  • Outline how to effectively integrate real-time analytics into daily operations 
  • Highlight the value of integrating data across departments to gain a holistic view of potential grievance triggers 

12:00 PM 1:00 PM

11:00 AM 12:00 PM

10:00 AM 11:00 AM

9:00 AM 10:00 AM

Lunch Break

1:00 PM 1:10 PM

12:00 PM 12:10 PM

11:00 AM 11:10 AM

10:00 AM 10:10 AM

Day 1 Opening Remarks

1:10 PM 2:00 PM

12:10 PM 1:00 PM

11:10 AM 12:00 PM

10:10 AM 11:00 AM

Cultivating a Member-Centric Approach in Clinical Services and Operations

  • Explore how to align clinical services and operations with member needs in the appeals process 
  • Discuss the value of integrating patient advocacy into clinical decision-making for appeals and grievances 
  • Learn how to leverage clinical insights to improve the overall member experience 

Deborah Curry, Director of Risk Adjustment and Recoveries
Promedica

2:00 PM 2:10 PM

1:00 PM 1:10 PM

12:00 PM 12:10 PM

11:00 AM 11:10 AM

Break

2:10 PM 3:00 PM

1:10 PM 2:00 PM

12:10 PM 1:00 PM

11:10 AM 12:00 PM

Effective Management of High-Volume Appeals

  • Review strategies for streamlining operations to handle appeals more efficiently 
  • Discuss best practices on prioritizing cases to ensure timely resolutions 
  • Outline the role of cross-functional teams in managing workload and reducing backlog 

3:00 PM 3:10 PM

2:00 PM 2:10 PM

1:00 PM 1:10 PM

12:00 PM 12:10 PM

Break

3:10 PM 4:00 PM

2:10 PM 3:00 PM

1:10 PM 2:00 PM

12:10 PM 1:00 PM

Audit Excellence in Appeals and Grievances: A Proactive Approach

  • Highlight best practices for preparing for internal and external audits 
  • Review how to continuously improve your processes to keep up with regulatory changes 
  • Hear about successful examples of effective audit strategies 

4:00 PM 4:50 PM

3:00 PM 3:50 PM

2:00 PM 2:50 PM

1:00 PM 1:50 PM

Achieving Quality Improvement through Appeals and Grievances Management

  • Explore how effective management of appeals and grievances can positively impact quality measures 
  • Discuss strategies for analyzing appeals and grievances data to drive positive results 
  • Learn about aligning appeals and grievances processes with broader quality improvement goals 

4:50 PM 5:00 PM

3:50 PM 4:00 PM

2:50 PM 3:00 PM

1:50 PM 2:00 PM

Day 1 Closing Remarks

Wednesday - June 26, 2024

10:00 AM 10:10 AM

9:00 AM 9:10 AM

8:00 AM 8:10 AM

7:00 AM 7:10 AM

Welcome remarks and Day 1 Takeaways

10:10 AM 11:00 AM

9:10 AM 10:00 AM

8:10 AM 9:00 AM

7:10 AM 8:00 AM

Navigating the Regulatory Landscape of Appeals and Grievances

  • Examine recent changes in regulation affecting appeals and grievances operations 
  • Discuss how to maintain compliance while adapting to new CMS guidelines 
  • Learn about the role of analytics in ensuring regulatory adherence and minimizing risk 

Mark Dwinnells, Sr. Director, Medicaid Compliance Officer
Commonwealth Care Alliance

11:00 AM 11:10 AM

10:00 AM 10:10 AM

9:00 AM 9:10 AM

8:00 AM 8:10 AM

Break

11:10 AM 12:00 PM

10:10 AM 11:00 AM

9:10 AM 10:00 AM

8:10 AM 9:00 AM

Transforming Call Center Operations for Superior Member Experience

  • Discuss methods for optimizing call center performance and member satisfaction 
  • Investigate the impact of digital transformation on call center efficiency 
  • Analyze the value of empathy training for call center staff in handling sensitive cases 

12:00 PM 1:00 PM

11:00 AM 12:00 PM

10:00 AM 11:00 AM

9:00 AM 10:00 AM

Lunch Break

1:00 PM 1:50 PM

12:00 PM 12:50 PM

11:00 AM 11:50 AM

10:00 AM 10:50 AM

Member Education: Empowering Members to Understand Their Rights and the Appeals Process

  • Review strategies for educating members about their rights and the steps involved in the appeals process 
  • Understand how to develop accessible educational materials for members 
  • Highlight the role of member education as a factor in improving member experience 

1:50 PM 2:00 PM

12:50 PM 1:00 PM

11:50 AM 12:00 PM

10:50 AM 11:00 AM

Closing Remarks

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