Meleah Bridgeford Director of Risk Adjustment, Payer Solutions
Meleah Bridgeford is the Director of Risk Adjustment, Payer Solutions at Episource. Meleah oversees risk adjustment analytics and services and plays a vital role in supporting our epiEncounter submissions solution. She has over 10 years’ experience within healthcare organizations as well as vendor/consultant organizations.
Tim has over 15 years of professional experience in health care operations and regulatory risk management. A strategic and forward-thinking business executive, Tim has a proven track record of success in risk adjustment operations, coding and documentation programs, regulatory compliance, and consulting and business advisory services. Throughout his career, Tim has demonstrated effectiveness as a leader with an ability to build and coach teams that deliver integrated and optimal results.
In his current role as National Vice President for DaVita Medical Group (DMG), Tim is responsible for the national strategy, development, and implementation of programs focused on comprehensive health assessment and quality, coding documentation improvement, and revenue accuracy. In this capacity, Tim is responsible for the oversight of six geographic markets and a growing national infrastructure, focused on DMG’s Medicare Advantage patient population.
Previously, Tim served as the Compliance Officer for DMG, Vice President of Compliance for DaVita Kidney Care, and was a management consultant with PricewaterhouseCoopers’ Health Care Practice.
Deniese Scheff‐Crittenden, a Senior Consultant for Dynamic Healthcare Systems, is a subject matter expert on Risk Adjustment. In this role, Deniese leads Dynamic’s risk adjustment segment of business supporting development, operations, and account management to provide gap analysis, assessment, design and implementation in managed care risk adjustment activities. She provides leadership to ensure delivery of Dynamic’s services to ensure client program compliance and quality, risk mitigation, integration of critical data to support clinical and revenue management performance outcomes and accurate revenue realization. Deniese provides a unique perspective having worked for both Provider and Payer organizations. She brings Dynamic Healthcare Systems more than 12 years of experience in the Medicare/Medicaid industry as well as more than 25 years of healthcare experience as a Registered Nurse and a Geriatric Social Worker.
As a former Director of Risk Adjustment, Deniese has supported start‐ up Medicare Advantage health plan operations for all aspects of Risk Adjustment: clinical coding support and quality documentation provider outreach programs, policy and procedure development, design and strategy development for RA activities. Denies has a proven track record with developing scalable Risk Adjustment program and organizational alignment with Population Health Management and HEDIS/Stars initiatives to drive quality improvement, program compliance, contain healthcare costs and ensure revenue realization.
Deniese previously served as a high risk Obstetrical Nurse and a Geriatric Social worker. She holds a Bachelor of Arts Social Work from Michigan State University, Master of Science Nursing and Healthcare Administration from University of Phoenix.
Deniese enjoys hiking, biking, organic gardening and cooking and world history, culture and travel.
Deb joined Paramount Healthcare in May 2013 and manages the Medicare, Medicaid, and Commercial Marketplace Risk Management Program. Additionally, she is a member of Paramount’s STARS/HEDIS/Medicaid P4P and FWA strategic teams. Prior to her position with Paramount she had 19 years’ experience working with the State of Ohio workers’ compensation program, both for the government and a contracted managed care organizations. She came to Paramount with extensive knowledge in medical coding, provider billing and education, Medicare payment methodologies, quality assurance, and regulatory compliance.
Deb graduated from the University of Toledo with a Bachelors of Science in Health Information Management and will graduate with her Masters of Business in Healthcare Systems Management from the University of Toledo in December 2015. She is an active member of the American Health Information Management Association (AHIMA) and is a Registered Health Information Administrator (RHIA), Certified Coding Specialist, physician based (CCS-P), and certified ICD-10 trainer through AHIMA.
Deb is blessed with one awesome husband of 24 years, three amazing children (one son-in-law), and one adorable grandson who all fill her life with a lot of joy, a little mischief, and a whole bunch of love.
Dr. Shannon I. Decker is the Executive Director of Risk Adjustment for NAMM California, Primecare, Part of OptumCare. Dr. Decker has more than 15 years of experience in healthcare, 11 of which include working with Risk Adjustment and Medicare. Dr. Decker has a PhD. in Interdisciplinary Studies, a dual MBA, one in Finance, the other in Marketing, as well as an M.Ed. in Secondary Education and a M.Ed. in Administration and Leadership. Dr. Decker is also an Associate Professor of Higher Education and Adult Learning (HEAL) and Chief Methodologist for Walden University where she chairs and oversees the dissertations of doctoral students. An author of two books as well as several peer reviewed articles, she consults in both the fields of healthcare and education. Her interests include the study of human behavior and how theories on motivation and learning may be brought to bear on population health management.
Scott Filiault is the Chief Revenue Officer of Pulse8, a cutting-edge healthcare technology and data analytics company focused on delivering the highest financial impact by providing an unprecedented view into risk adjustment for health plans with Commercial, Medicare Advantage and Long-Term Care populations. Scott leads Pulse8’s sales efforts by focusing on new business development, and assists in the company’s business strategy and future channel opportunities.
Prior to joining Pulse8, Scott served as Vice President of Sales for Matrix Medical Network, the nation’s leader in prospective assessments. He was instrumental in the company’s growth and is recognized as one of the Industry’s leading executives.
In addition to his Managed care experience, he has led and developed sales and marketing strategies for the Medical Device field and the Institutional/Hospital markets. He is also credited with improving health plan performance and profitability through effective, state-of-the-art care management programs, risk adjustment services, and data-driven strategies.
Scott has served as National Director of Sales, working with both HIX and Medicare Advantage plans. He helped develop and deliver the marketing strategy for a predictive modeling company and the identification and stratification of members for case and disease management. In addition, Scott planned and implemented the Managed Care Training Program for the New York City Managed Medicaid initiative.
Scott has international experience where he helped develop and market software programs that measure cognitive function for neurological conditions such as Alzheimer's and Parkinson's diseases, MS, and schizophrenia.
Ms. Grossman is one of the nation’s foremost experts on Medicare Advantage, Medicaid, and Commercial physician engagement, risk adjustment, quality, HEDIS success strategies, and moving to value and risk reimbursement. She is a thought leader in healthcare business strategy and product development. Her expertise extends to provider enablement and engagement, HEDIS, STARS, QRS, analytic design, care impact, and best practices implementation. She has a wide variety of healthcare experience at organizations that include health plans, medical groups, Physician Hospital Organizations (PHOs), start-ups, integrated hospital systems, and the Institute of Health Professionals Education.
Ms. Grossman has held executive positions that encompass her areas of expertise which include: Hierarchical Condition Category (HCC) and Medicaid risk adjustment, network alignment and management, executive client relationship management, predictive and reimbursement modeling, MLR strategies and implementation, business development, strategic planning, building Centers of Excellence, acute and chronic care pathway creation, and product development and marketing for healthcare companies.
Before joining DataLink, she held executive roles with ArroHealth, Gorman Health Group, CenseoHealth, and Optum. Over the past fifteen years, Ms. Grossman has been a founding partner in three risk adjustment, quality, and cost of care reduction companies focusing on Medicare Advantage, ACA, and Medicaid. Prior to that, Ms. Grossman served as Health Net of Arizona’s Vice President of Network Strategy and Development, as well as serving in roles at Scottsdale PHO and Blue Cross Blue Shield of Arizona. She holds a Master of Science in healthcare planning from Florida State University.
Liaw Huang, PhD, FSA, MAAA, EA, FCA Principal and Senior Research Actuary
The Terry Group
Liaw is a senior actuarial consultant who works with clients in both the commercial and government programs context. He has considerable experience with risk adjustment, financial projections, data analytics, actuarial forensics and litigation support.
Before joining The Terry Group, Liaw was a vice president at Aon Hewitt. Previously, he was a vice president at JPMorgan Compensation and Benefits Strategies and its predecessor firm, CCA Strategies. Prior to joining the actuarial profession, he was an assistant professor (mathematics) at Indiana Wesleyan University.
Liaw is a Fellow of the Society of Actuaries, a Member of the American Academy of Actuaries, a Fellow of the Conference of Consulting Actuaries, an Enrolled Actuary under ERISA, and a member of the Joint Committee on Retiree Health of the American Academy of Actuaries. Liaw received his PhD in mathematics from the University of California at Berkeley.
Sharalee Johnson has over 19 years of healthcare experience, including eight years of management experience in HEDIS®/Risk Adjustment operations with a large, multi-state health plan. Sharalee began her career in a clinical setting, which then transitioned into Quality Management roles with experience in Medicaid, Medicare, and Commercial populations.
Prior to joining Pulse8, Sharalee’s most recent role included direct oversight for HEDIS®/Retrospective Risk Adjustment data collection, year-round Interventions, and strategic planning for Molina Health Care of Utah and Molina Healthcare, Inc. During her role with Molina Healthcare, Inc., she oversaw the development and implementation of the internal risk adjustment coding platform and chart retrieval repository for the Risk Adjustment and Quality Departments.
Sharalee is a Registered Nurse, with extensive training in Women’s Health and Quality Management, including HEDIS®, STARS, Interventions, and Risk Adjustment. Sharalee earned a BS in Nursing from Brigham Young University.
Donna has been on the job with the Tufts Health Plan in their senior products division since August 2014, and is responsible for audit and coding review management, development and implementation of department and vendor policies and procedures, simulation RADV Audits for preparedness, coding team performance management and provider education development and management. Additionally, Donna serves at the MassBay Community College in Framingham, where she has been an advisor / professor for nearly 10 years. Her specialty area is the Medical Coding Certificate and Medical Office Administration Program.
Prior to Tufts Health Plan, Donna worked for Blue Cross Blue Shield of Massachusetts as an HCC Professional Audit III for four years. Earlier, she worked for AM B Care for 9 years and Maine Medical Center.
Jenni has over 13 years of healthcare experience. Her expertise spans many areas including professional medical coding, revenue cycle processes, documentation improvement and risk adjustment. Jenni is currently the Risk Adjustment Coding Manager for UCare, a nonprofit healthcare plan in Minnesota that provides Medicare Advantage, Medicaid and ACA Exchange products. Her primary responsibility is the compliance oversight of the plan’s risk adjustment activities and developing educational tools for the provider group. Prior to joining UCare, Jenni was the Clinical Coding Manager for Fairview Health Services, where she managed a large team of coders and provided education to the clinical provider group.
Mike Nemeth Director Business Systems Analysis, Revenue and Quality Analytics
SS&C DST Health
Michael Nemeth is a health solutions executive for SS&C Health. In this role he supports and develops strategies for revenue management and quality solutions with a focus on perfecting and maturing our current product capabilities while identifying opportunities to differentiate SS&C Health with new and innovative offerings.
Michael is a 27-year veteran of the healthcare industry, an experienced leader, and a respected subject matter expert in government programs and risk adjustment strategy and execution.
Before joining SS&C, Michael worked as a senior consultant for Gorman Health Group, leveraging his background in government business operations and risk adjustment. Earlier in his career, he spent more than 20 years with Florida Blue. His most recent positions with Florida Blue included Senior Director, Government Programs and Senior Director, Revenue Program Management.
Michael earned a B.A. in business development from Jacksonville University and a M.S. in risk management and insurance form Florida State University. He has served on the board of Florida Aging Services Providers (FASP) board since 2012.
Acting Deputy Director, Medicare Plan Payment Group
Eugenia Ross Senior Vice President Strategy & New Markets
Eugenia ("Gennie") Ross serves as Senior Vice President of Strategy, Product & Marketing for Ciox Health.
Gennie focuses on helping clients implement solutions to increase efficiencies and generate the best outcomes for their members and their business. She manages the HealthSource SmartChart and HealthSource Vault products, and drives Ciox's market leadership in the use of advanced technologies for data aggregation, extraction and management. Prior to Ciox, Gennie was an Associate Partner at McKinsey & Company, where she led strategy for healthcare clients. Gennie holds an MBA from the Wharton School at the University of Pennsylvania and an MA in International Economic Policy from American University in Washington, DC.
Laura leads a dynamic Risk Adjustment Team, managing the day to day operations for Medicare and Marketplace members. She has a proven track record of maximizing risk scores. Laura designs and coordinates all team activities which focus on provider education, training, auditing, data mining, and data analysis to steer program success and achieve performance metrics. Laura is familiar with developing strategies for seeing high risk members utilizing technical dashboards, auditing processes, and working 1:1 with local vendors. Additionally she identifies end-to-end processes and prioritizes interventions to correct known weaknesses. Laura also provides support to corporate compliance efforts for RADV audits for both lines of business. She collaborates with business partners and develops best practices, and shares them with other health plans.
She has over 20 years of varied clinical nursing practice experience including more than ten years of Clinical Coding Certification practice. Laura is a Master’s prepared nurse, who also maintains her CPC and CRC through the AAPC.
Don Taylor Retired Colonel, United States Air Force
Don Taylor consults, teaches and lectures on healthcare policy, emerging disruptors and the exciting opportunities within the changes of today’s dynamic healthcare industry. Don is a retired Colonel who served in the United States Air Force for over 27 years in various roles supporting DoD healthcare. He has been the CEO of hospitals and served as the COO of Wilford Hall Academic Medical Center in San Antonio. He also led the Air Force theater (trauma) hospital in Balad AB, Iraq in 2006.
As the Health Benefits and Policy advisor to the Air Force Surgeon General, he was instrumental in developing the military health plan TRICARE and created the TRICARE for Life benefit with CMS and the Senate/House staff. Don was President of an engineering and medical support company that served clients in 14 countries. He has served as the Associate Director for various VA Medical Centers. Most recently, he served as the Director, Southwest Health Resources Integration, where he supported the development of the clinically integrated network of Southwestern Health Resources.
Don is a certified trainer for leadership development with two organizations. As a volunteer, Mr. Taylor founded the Air Force Association’s Wounded Airman Program. He now serves as the Chairman of the National Air Force Association Veteran and Retiree Council. He has published the book, “The Quiet Heroes: Timeless Reflections of American Airman” where he captured the story of a bomber crew member from World War II. Don has a BS in Architecture from the University of Texas at Arlington and a Master of Health Administration from Penn State. He lives in Southlake, Texas with his wife Judy Hoberman.
Dr. Towers is the Senior Clinical Advisor for UPMC Enterprises. She is directly involved in the development of healthcare related technology, with emphasis on use of Natural Language Processing (NLP) for Risk Adjustment coding and use of Clinical Analytics to optimize clinical performance. Prior to this role, she has served as the Medical Director for Health Information Management at UPMC with responsibility for Clinical Documentation Improvement as well as inpatient coding denials and appeals. She has been on the faculty in the Division of Geriatric Medicine at the University of Pittsburgh for over 25 years, and continues to see patients at the Benedum Geriatric Center in UPMC. She is the former Medical Staff President at UPMC Presbyterian, and her prior positions have been as Vice Chair for Quality Improvement and Patient Safety for the Department of Medicine, Medical Director of UPMC Home Health, Medical Director of the Benedum Geriatric Center and Medical Director of Primary Care at the Western Psychiatric Institute and Clinic. Dr. Towers has presented the experience at UPMC with use of NLP for coding at multiple regional and national conferences.
Mr. Weiner is founder of Quadralytics, a healthcare‐focused consulting and analytics group, where he has worked with high‐tech start‐ups, insurance plans and healthcare providers of varying sizes. The focus is on Medicare plans including Medicare Risk Adjustment, (RAPS), Medicare Stars, HEDIS, and financial and operational analytics. Mr. Weiner has spoken extensively on the above topics. In addition, he has also served clients in various roles on an interim basis including CFO, COO, and VP of Sales.
Previously he was VP of Solutions and Client Services at Outcomes Health Information Solutions. He was responsible for the product strategy related to the company’s Medicare and Medicaid Revenue and Medicare Stars product offerings along with client management.
Prior to joining Outcomes, he was National VP of Medicare Finance for Amerigroup. There he provided strategic and financial leadership related to the expansion of the Medicare product from one plan to 34 plans in seven states. In addition, he ran the enrollment and reconciliation teams. He has also served as VP of Consulting and Client Service for DataLoom Solutions, a healthcare consulting and solutions company focused in the Business Intelligence and Data Warehousing space. Mr. Weiner began his career with PacifiCare Health Systems where he was Northwest Regional Finance Manager responsible for reporting for the Oregon and Washington markets. He received his MBA from Seattle University and BS in Accounting Central Washington University. He is a certified as a CMA and CFM by the Institute of Management Accountants. He has served on the Healthcare committee of the Washington Society of CPAs and the Education committee of the Florida Chapter of HFMA and currently sits on the Board of the Hampton Roads Chapter of the Juvenile Diabetes Research Foundation.
Joe Wilson Enterprise Business Architect, Risk Adjustment
Joe has over three decades experience in software engineering and technical product management. He has expertise in several technical fields, including Risk Adjustment, Cloud Computing, and Image Processing. In over four years at WellMed, Joe has served as the Senior Director of the Risk Adjustment Product team, and has recently been promoted to the role of Enterprise Business Architect. In his current role he leads a team that sets the long-term business and technical strategy for the WellMed Risk Adjustment platform.
As Director of Risk Adjustment, Susan Waterman has been empowered to plan, design and oversee business and strategic objectives in creating and optimizing a Risk Adjustment Department responsible for ensuring the accuracy of risk adjustment payments while successfully managing all activities related to Medicare Advantage, ACA and Exchange Risk Adjusted lines of business. In that capacity Susan directed department changes that resulted in multi‐million dollar gains in ACA Risk Adjustment, brought all chart review activity in‐house saving 500K per year in vendor coding fees, and partnered with the hospital CDI/Quality Physicians to create an Outpatient CDI Department focused on documentation quality, Risk Adjustment activities and clinic training for 1,200 providers.
A proven leader in her field, Susan’s professional experience includes coding and compliance management, auditing and provider training, system management, and consulting services.
Kirk has a strong actuarial background with a passion for risk adjustment. His core expertise resides around data management, mathematics, and computer programming.
Kirk has worked with many healthcare clients including dozens of health plans, provider groups, and vendors. He is focused on understanding risk adjustment calculations, market impacts, and data submissions. He is well‐versed in working with complicated data sets and providing presentations to executive leadership.
Throughout his career, Kirk was responsible for the development of innovative software that improved efficiency and accuracy in calculating Medicare receivables, positioning client companies to save millions of dollars annually; improvement of accuracy and efficiency of the CMS bidding process by developing an algorithm that provided a simplified overview of data for use by health plans and actuaries; standardized and automated process for plan benefit package claims mapping and risk scoring; and creating an algorithm and comprehensive, multiple‐year database that could be easily accessed.
Additionally, Kirk designed, automated, and implemented extraction, transformation, and loading (ETL) processes for most CMS standard data sets, such as the Monthly Membership Report, and designed algorithms to process data using business rules in conjunction with technical definitions. He has also assisted health plans and provider groups with identifying errors in their risk adjustment processes, worth millions of dollars.
Kirk has a Bachelor of Science in Mathematics from Kennesaw State University and MAS, Master of Actuarial Science from Georgia State University.