Amanda Banister Senior Manager of Provider Engagement
Amanda Banister is a Senior Manager of Provider Engagement for Veradigm. She has over 25 years of healthcare experience, including 15 years of practice administration for both private practice and regional healthcare systems. Amanda has extensive experience coaching teams in the implementation of process and quality improvement activities. She has worked directly with Providers and their teams to improve their care coordination, population health management and risk stratification efforts as well as improvements in documentation and accurate coding related to HCC’s and HEDIS quality scores including 5 Star and Part D measures. Amanda is a Lean Six Sigma in HealthCare Green Belt, a Certified Clinical Microsystems Coach and a Certified Professional Coder.
Jessica Barnett is the Manager of Risk Programs & Audit at Blue Cross and Blue Shield of Kansas City (Blue KC). Certified in healthcare compliance (CHC), outpatient coding (COC), professional coding (CPC) and risk adjustment coding (CRC), with over ten years of healthcare experience on both the provider and payer sides, Jessica has the opportunity to lead a team focused on improving health outcomes for Blue KC’s Medicare Advantage and ACA members by building consultative type relationships with the providers who care for their members and by auditing internal and external sources to ensure the illness burden of their members is accurately reflected. Since insourcing all Government Programs operations for Blue KC in 2020, Jessica has developed and expanded prospective programs that evaluate current provider workflows and offer provider education focused on expanding chronic condition management, improving quality of care, developing pre-visit planning workflows and increasing documentation and coding accuracy. By expanding risk adjustment and quality strategies to include prospective programs, Blue KC has seen significant increases in provider engagement, chronic condition assessment rates, and preventative care visits for their members which improves member experience and overall quality of care.
Before turning to healthcare as a career in 1994, Kathleen Bartholomew held positions in marketing, business, communications and teaching. It was these experiences that allowed her to look at nursing from a different perspective and speak poignantly to the issues that effect nurses today.
Kathleen Bartholomew, RN, MN has been a national speaker for the nursing profession for the past 20 years. As the manager of a 57 bed surgical unit in Seattle, Kathleen quickly recognized that creating a culture where staff felt a sense of belonging was critical to retention. Throughout Swedish Medical Center Kathleen spoke to the numerous factors which propel our society toward isolation and encouraged staff to connect and value one another. During her tenure as manager, staff, physician and patient satisfaction improved significantly as she implemented her down-to earth strategies for creating community. Despite the nursing shortage, Kathleen could always depend on a waiting list of nurses for her unit.
Kathleen’s Bachelor’s Degree is in Liberal Arts with a strong emphasis on Sociology. This background laid the foundation for her to correctly identify the norms and particular to healthcare – specifically physician-nurse relationships and nurse-to-nurse hostility. For her Master’s Thesis she authored “Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication” which is the only book to date which addresses physician-nurse issues. In December of 2005, Kathleen resigned her position as manager in order to write a second book on horizontal violence in nursing. The expression, “why nurses eat their young” has existed for many years in the nursing profession (and has troubled many in the profession). In her book, “Ending Nurse to Nurse Hostility” (2006), Kathleen offers the first comprehensive and compassionate look at the etiology, impact and solutions to horizontal violence. Kathleen won the best media depiction of nursing for her Op Editorial in the Seattle P.I. and in 2010 she was nominated by Health Leaders Media as one of the top 20 people changing healthcare in America.
Kathleen’s passion for creating healthy work environments is infectious. She is an expert on hospital culture and speaks internationally to hospital boards, the military, leadership and staff about safety, communication, cultural change and power. With her husband, John J. Nance, she co-authored, “Charting the Course: Launching Patient-Centric Healthcare.” From the bedside to the boardroom Kathleen applies research to practice with humor and an ethical call to excellence. Everyone that hears her is inspired.
Michael Brown is the Vice President of Risk Accuracy at Tandigm health in Conshohocken, PA. Mike has over 20 years of healthcare experience in medical practice management and consulting, having spent most of his career working directly with primary care providers. At Tandigm Health, he oversees their prospective chart review program, coding and audit functions, and provider education.
Heather Bullock Director, Risk Adjustment Process and Operations
Heather Bullock is the Director of Risk Adjustment Process and Operations at Horizon Blue Cross Blue Shield of New Jersey. A dedicated risk adjustment executive with a passion for optimizing revenue and ensuring compliance, Heather leads end-to-end risk adjustment operations, encompassing vendor management, coding and compliance, provider engagement, member engagement, and long-term strategy.
Prior to her role at Horizon, she held several roles supporting a newly developed risk adjustment department, building financial planning and analysis for ACA, and supporting Government Programs for multiple states and lines of business at HCSC.
Heather holds Bachelor's in Social Work from the University of Mary Hardin-Baylor. When she's not working, she enjoys exploring NYC with her husband, drinking too much coffee, and making terrible costumes for her two cats.
Jeannine Bumford Director of Coding Operations, Risk Adjustment
Southwestern Health Resources
Jeannine Bumford has worked in the Risk Adjustment industry for over eleven years, beginning her journey in 2012 as a Risk Adjustment Auditor. She is currently the Director of Coding Operations for Southwestern Health Resources (SWHR). She has successfully built Provider Education, Coding, and Quality Assurance programs throughout her career. She was accepted into the SWHR inaugural class for Women in Leadership and holds Professional Coder (CPC) and Risk Coder (CRC) certifications. She lives in Waxahachie, Texas, with her husband and three girls.
John has over 25 years of entrepreneurial and executive experience in the healthcare space, building relationships across major, national health plans and large regional healthcare systems. John’s newest venture, Porter, designed to reach beyond standard home interventions, is the only quality stars and risk adjustment-focused care coordination program. John previously founded Pulse8, a healthcare analytics and technology company delivering complete visibility into the efficacy of risk adjustment and quality management programs, and led them to a successful acquisition by a publicly traded health IT company. John was recently granted a patent by the United States Patent and Trademark Office for a method and apparatus for risk adjustment.
Vice President, Risk Adjustment Strategy and Solutions
Deniese Crittenden Vice President, Risk Adjustment Strategy and Solutions
Deniese Crittenden is the Vice President, Risk Adjustment Strategy and Solutions at Reveleer. Deniese brings more than 18 years of experience in the Medicare/Medicaid industry as well as more than 31 years of healthcare experience as a Registered Nurse and a Geriatric Social Worker. Among many things, Deniese provides gap analysis, assessment, design, and implementation in managed care risk-adjustment activities. Deniese has extended experience across all operational areas of Risk Adjustment for Payors and Providers and provides a unique perspective having worked for both Provider and Payer organizations.
Deborah Curry Director Risk Adjustment & Recoveries
Paramount Healthcare/ProMedica Health System
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 Performance Improvement teams. Prior to her position with Paramount she had 21 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 attended The University of Toledo for both her undergraduate and graduate degrees and currently holds a Masters of Business Administration with major in Healthcare Systems Management. 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 an AHIMA-approved ICD10-CM Trainer. Deb is also an active member of the America Academy of Professional Coders (AAPC) and is a Certified Risk Adjustment Coder (CRC). Also, Deb is a member of RISE and holds certificates as a Risk Adjustment Practitioner (RAP) and Advanced HCC Auditor (AHCCA). Deb is blessed with one awesome husband of 29 years, three amazing children (one son-in-law), two adorable grandsons, and three beautiful granddaughters who all fill her life with a lot of joy, a little mischief, and a whole bunch of love. In her spare time, Deb volunteers at her church as a Team Captain in the Youth Ministry, is Board Member of the University of Toledo Health Information Administration Advisory Board, Health and Human Services Alumni Affiliate at The University of Toledo, and Health Information Technology Advisory Committee at Owens Community College.
Dr. Shannon Decker is principal at VBC One, a consulting firm assisting physician groups, health plans and vendors maximize the performance of their value based contracts and offerings. Dr. Decker has more than 20 years experience in health care and most recently led teams in risk, quality, data and analytics, telehealth, COVID response and delegation compliance. Of her more than 20 years of experience in healthcare--15 include working with risk adjustment, quality and Medicare. Dr. Decker has a PhD. in Interdisciplinary Studies, dual MBA degrees--in Finance and in Marketing, as well as an M.Ed. in Secondary Education and a M.Ed. in Administration and Leadership. Dr. Decker is on the faculty at Arizona State University and is also an associate professor of Higher Education & Adult Learning (HEAL) and chief methodologist for Walden and Capella Universities where she chairs and oversees the dissertations of doctoral students. An author of two books and several peer-reviewed articles, and a prolific national public speaker, her interests include the study of human behavior and how theories on motivation and learning may be brought to bear on population health management.
Art has 30-years of healthcare experience, including benefit strategy development and management, risk adjustment and quality rating program leadership roles with health plans, national medical groups, vendor solution and management consulting firms. Art has designed, implemented and managed risk adjustment and quality programs supporting the Medicare Advantage, Health & Human Services (HHS) Marketplace and managed Medicaid lines of business. Art is currently the Vice President of Performance and Quality for Centrum Health, a primary medical group serving patients in Florida and Texas. Centrum manages approximately 300K Marketplace, Medicare Advantage and Managed Medicaid members under value-based agreements with multiple national health plans.
His background is in management and operational processes for 15 years, and began working in the Risk Adjustment arena 12 years ago. Ryan has proven himself by helping Medical Groups raise their RAF scores to their proper levels. He directed the movement of a 10,000 member group up 43% over a two year period, and an 1800 member group up 53% in the first year. Ryan achieves these results through chart documentation audits, provider and staff documentation training, and provider relationship building. In his most current role Ryan works with multiple groups to optimize their RAF score, while at the same time achieving CMS 5 Star quality. Ryan explains to these groups that getting their RAF score to the correct level will not only drive revenue, but it will also lead to better patient care with improved documentation habits. Ryan is a Certified Risk Adjustment Coder (CRC) credential through the AAPC.
Dona Doran Assistant Director Risk Adjustment Operations
Cambia Health Solutions
As Program Director of Risk Adjustment Operations for Cambia Health Solutions, Dona is responsible for driving the tactical execution of the Medicare Advantage and ACA risk adjustment strategy and program management. Serving in the healthcare industry for over 15 years, Dona continues to focus on improving efficiencies, data accuracy, and compliant outcomes through operational excellence and strong vendor partnerships.
Ms. Dunn is a Past AHIMA President and recipient of AHIMA’s 1997 Distinguished Member and 2008 Legacy Awards. Rose served as Interim CEO for AHIMA in 2011.
She is Chief Operating Officer of St. Louis-based, First Class Solutions, Inc., a national health information management consulting firm providing interim leadership at the revenue cycle and HIM levels, coding compliance and coding support services, and HIM operational consulting services for hospitals, physician practices, and SNFs.
Rose is active in ACHE, AICPA, HFMA, HIMSS, and AHIMA. Ms. Dunn is the author several on-line learning products, more than a dozen texts, including Dunn & Haimann’s Healthcare Management published by Health Administration Press, and hundreds of published articles.
Mary brings over 14 years of healthcare experience and over 9 years of experience focusing on the risk adjustment space. She is an MD by training with a broad medical background as well as a certified risk adjustment coder.
Mary worked closely with Clinical Documentation Improvement programs focusing on the implementation, provider education, chart reviews ensuring the overall success of these programs across hundreds of independent practices and hospitals in NYC. In addition, Mary has developed materials and implemented training programs for providers focusing on the importance of proper documentation for prospective capture of chronic conditions in the Medicare Advantage population.
In her current role, Mary is an integral member of the Risk Adjustment Consulting team at Pareto Intelligence. She focuses on providing guidance on prospective programs, coding guidelines, HCC compliance, and developing provider training materials.
Michael Forster, FSA, MAAA, is a senior consulting actuary and works in the New York office of Wakely Consulting Group, LLC, an HMA Company. Michael joined Wakely in 2016. He has extensive experience working with payers and providers taking risk in the Medicare Advantage, Medicaid, ACA, and large group markets. He has led pricing, forecasting, and analytics projects for health plans and state agencies throughout the country. He guides the deployment and ongoing development of the Wakely Health Analytics and Operational Optimization (WAHOO) suite of tools to help health plans and providers integrate operations and analytics. Michael has also worked extensively within health plans on monthly Medicare financial reporting. This work includes monthly Incurred, but Not Reported (IBNR) estimates, risk accrual estimates, forecasting, budgeting, minimum Medical Loss Ratio filings, and various other financial items. He has communicated and worked directly with financial and executive leaders at the organization to automate processes and identify opportunities for improvement. He has a background in analyzing claims data and uses that core background to help his clients drive data driven solutions.
Director Clinical Documentation Integrity and Coding Compliance
Colleen Gianatasio Director Clinical Documentation Integrity and Coding Compliance
Capital District Physician’s Health Plan (CDPHP)
Colleen Gianatasio CPC, CPC-P, CPMA, CPC-I, CRC has 18 years of experience in the health insurance field. She has experience in customer service, claims, quality and coding. As Risk Adjustment Quality and Education Program Manager for Capital District Physician’s Health Plan (CDPHP) Colleen’s primary responsibilities are provider engagement and clinical documentation improvement for accurate coding. Colleen specializes in developing innovative coding curriculum and instruction to support compliance with federal guidelines and appropriate reimbursement processes. She is a certified AAPC instructor and enjoys teaching a variety of coding, documentation and auditing classes. Colleen serves as President-Elect of the AAPC National Advisory Board.
Raymond Griffith, CPC, CRC, has 19 years of experience in the health insurance field, with a focus on coding, risk adjustment, and provider education. As Director of Medical Record Review Solutions for Advantmed, he has the privilege to partner with various health plans in executing their coding, quality, software, and business strategy needs.
Carrie Horn, MSHA, BBA, RN, CCDS, CCDS-O, CRC, CPC, CHFP, CRCR, is the system director for Outpatient CDI at Baylor Scott & White Health in Temple, Texas. She has 26 years of nursing experience, 13 of those spent in CDI leading high quality, cost-effective programs while standardizing process improvement across inpatient and ambulatory CDI operations. Prior to joining BSWH as the Outpatient CDI director in 2022, she spent 12 years building and transforming Inpatient CDI, Outpatient CDI and Provider CDI Education at a large academic health system in Michigan. She has expertise in developing, monitoring, and auditing compliant Inpatient and Outpatient CDI infrastructure, risk adjustment, provider coding education, clinical denials, and post-payment audits. Her leadership fosters relationships to support full burden of illness documentation and coding capture across the health system and health plan. She continues to serve the ACDIS community as a member of the Leadership Council and has presented at MACDIS, MHIMA, the ACDIS Outpatient Symposium, EPIC UGM, 3M, and annually in the ACDIS exhibit hall.
Shannon C. Huggins
Senior Vice President, Contract Strategy and Population Health
Shannon C. Huggins Senior Vice President, Contract Strategy and Population Health
Methodist Health System
Shannon embarked on her journey with Methodist in 2002, where she has played a pivotal role in managing non-governmental payor contracting and fostering relations on behalf of Methodist facilities, joint venture organizations, Accountable Care Organization / CIN, and physician groups. In addition to these responsibilities, Shannon oversees the operational aspects of population health services, ensuring Methodist's commitment to holistic and equitable healthcare.
Shannon's expertise extends to the realm of designing and executing innovative contracting and pricing strategies for Methodist, positioning the organization at the forefront of healthcare excellence. She serves as the driving force behind Methodist's engagement in value-based care arrangements, championing transformative healthcare models.
Notably, under Shannon's leadership, MPCACO has achieved remarkable Medicare savings for ten consecutive years, a distinction shared by only ten other ACOs nationwide. Shannon's wealth of experience spans over three decades, encompassing contracting, payor relations, population health, financial analysis, and decision support, making her an invaluable asset in the healthcare industry.
Shannon received her undergraduate degree in Marketing/Finance from University of the Ozarks and her master’s degree in healthcare administration from Texas Woman’s University.
As a Senior Consultant and Risk Adjustment SME, Melissa supports the company's Health Language solutions with content maintenance, sales support, and product development.
Melissa has more than 25 years of health care experience in coding, billing, physician and coder education, accounts receivable cycle management, consulting, and regulatory and compliance. Prior to working at Health Language, she spent seven years in the Risk Adjustment space performing RADV, IPM and OIG audits for a major Medicare Advantage Payer.
She received her Associates degree from Pueblo Community College. She is a Certified Professional Coder, Certified Risk Adjustment Coder, and Certified Professional Medical Auditor.
Ava Johnson comes from a colorful background as an experienced Risk Adjustment and multi-specialty Medical Coding instructor, auditor, and CDI expert. Being a teacher at heart, Ava’s goal is to help industry medical coders and documentation specialists understand the weight of their impact in the risk adjustment world and realize their truest potential, both professionally and personally. Ava’s passions also include music and the arts.
Chief Medical Officer
Methodist Patient Centered ACO & VP, Value Based Care
Methodist Patient Centered ACO & VP, Value Based Care
Dr. Brian Jones joined the Methodist Medical Group as a Family Medicine Physician in 2001 and quickly developed a fast-paced successful medical practice. As a physician, he is a leading champion for quality care delivery, elevated patient experience, and value in health care. Currently serving as the Chief Medical Officer for Methodist Patient Centered ACO and the VP of Value Based Care for Methodist Health System in Dallas, Texas, Dr. Jones plays a central role in transforming the health landscape in North Texas.
With the extensive experience, he oversees the Methodist Alliance for Patients and physicians (MAP2) clinically integrated network development, and provider engagement strategies within Methodist and its affiliated Methodist Medical Group. Driven by a passion for patient-centered care, he has facilitated the successful Methodist Patient Centered Accountable Care organization in moving healthcare delivery from volume to value.
Dr. Jones received his medical degree from Texas Tech University Health Sciences Center in Lubbock, Texas, and his MBA from The University of Massachusetts at Amherst. His wealth of knowledge and commitment to excellence make him a highly regarded leader in the medical community.
Dr Ekaette Joseph-Isang is a value-based care transformation subject matter expert (SME) whose breadth of experience spans risk management, care quality, health information management, and automated clinical solutions. Her career started as an internal medicine physician before she transitioned into healthcare strategy and innovation. Prior to her current role, she worked with a large payer identifying and mitigating risks for a demographic that comprised high utilizers. Her happy place in health care is at the intersection of payers, providers, and patients where she deploys technology, systems thinking, and innovative solutions to achieve the triple aim.
Brian Machut is an experienced health actuary with expertise in healthcare analytics and actuarial consulting with a passion for applying data to better understand health utilization and costs, develop solutions to reduce inefficiencies in the healthcare system, and help others adopt and maintain healthier lives.
Since joining the Minneapolis office of Wakely Consulting Group, an HMA Company, Mr. Machut has been involved in a wide variety of areas within healthcare actuarial consulting. He is a leader within Wakely’s value-based payment practice, supporting many organizations across several Medicare accountable care organization (ACO) programs, including the Medicare shared savings program (MSSP) and ACO REACH programs and other CMMI programs. He supports organizations entering into value-based payment arrangements in Medicaid and providers engaging in risk-bearing contracts from Medicare Advantage plans.
Mr. Machut has a depth of experience supporting payer organizations in Medicare Advantage, from medical expense trend analysis and forecasting to bid pricing support and strategic planning. He is a frequent author of Wakely whitepapers and briefs discussing recent developments within MSSP, ACO REACH, and Medicare Advantage.
Mr. Machut earned a bachelor’s degree in business administration, actuarial science from the University of Wisconsin-Madison and is a Fellow of the Society of Actuaries.
Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP Director Risk Capture, Population Health Management
Donna Malone Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP Director Risk Capture, Population Health Management
Mass General Brigham
Donna Malone, CPC, CRC, is formerly the Director Ambulatory Clinical Documentation Quality Improvement (CDQI) with Mount Sinai Health System, Adjunct Professor with MassBay Community College, Chair of the RISE Risk Adjustment Academy HCC Coding Faculty Advisory Group and President of the Watertown AAPC Chapter
Previously, she worked for Tufts Health Plan in their enterprise risk adjustment division for seven years with as Director Enterprise Risk Adjustment Coding and Provider Education, and was responsible for audit and coding review management, development and implementation of department and vendor policies and procedures, development of provider and coding training materials, implementation of provider system education and process review, government audits (CMS RADV, HHS RADV, OIG), coding team performance management.
Additionally, Donna serves at the MassBay Community College in Framingham, where she has been an advisor and adjunct professor currently in her 17th year. Her specialty area is the Medical Coding and Medical Office Administration Programs. Prior to Tufts Health Plan, Donna worked for ENJOIN as the Director of Ambulatory CDI – Risk Adjustment, 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 other healthcare settings previously. Donna also has served as Education Officer (2016) and President (2017 – current) for the AAPC chapter in Watertown, MA.
Donna speaks nationally for RISE, AAPC and AHIMA.
J. Gabriel McGlamery
Sr. Health Policy Consultant, Government Relations
J. Gabriel McGlamery Sr. Health Policy Consultant, Government Relations
Gabriel McGlamery is in charge of Federal regulatory policy for Florida Blue’s individual market business. This means analyzing, influencing, and general problem solving for the insurer covering roughly 10% of Marketplace enrollment. Prior to joining Florida Blue in 2012, Gabriel helped develop the rules for the ACA at HHS and graduated with honors from the University of Connecticut School of Law.
Assistant Vice President, Risk Adjustment Coding and Compliance
Jenni Monfils Assistant Vice President, Risk Adjustment Coding and Compliance
Jenni has over 18 years of healthcare experience. Her expertise spans many areas including professional medical coding, revenue cycle processes, documentation improvement, compliance and risk adjustment. Jenni is currently the Risk Adjustment Coding Assistant Vice President for a nonprofit healthcare plan in Minnesota that provides Medicare Advantage, Medicaid and ACA Exchange products. Her primary responsibility is the compliance oversight of the plans risk adjustment activities and project lead for all risk adjustment audits.
Ryan leads a team of clinicians, engineers and data science experts who work together to deliver AI-infused solutions to improve patient care and health costs via a growing client network of over 690+ hospitals and 470,000+ physicians. Ryan is a growth-oriented leader who delivers business value in investor/venture and PE-backed, high-growth, public and private companies. He has developed and executed strategies in the health analytics and real-time clinical decision support solution markets – from both the provider and payer perspectives.
Donna is principle and co-founder of CareOne Consulting, supporting payers and providers in operational excellence, compliance, and program execution for VBID/VBC model reporting, contract management, care navigation design, and member engagement/retention. Prior to CareOne, Donna was an operational executive with leading industry organizations, such as Anthem (Elevance), AR BCBS, Cigna, and Pulse8. With over two decades of experience in developing and leading diverse teams & initiatives, Donna has a proven track record in elevating health equity, improving outcomes for patients, driving accuracy and compliance in risk validation, eliminating data leakage, and executing high-performing quality programs. Donna currently holds a Finance degree from the Terry College of Business at the University of Georgia, is an active AAPC CRC (Certified Risk Coder) and CPCO (Certified Professional Compliance Officer), is a certified hospice volunteer and respite care provider, and is passionate about simplifying care, lowering costs, and ensuring equitable healthcare access for all.
Dr. Kevin Rodriguez Clinical Documentation Improvement Specialist (CDIS) Manager
Aegis Medical Group
I am an international medical graduate from Nicaragua with a passion for healthcare and a focus on Value Based Medicine. I'm particularly intrigued by the Medicare Advantage industry and its influence it's had on the healthcare landscape. My primary focus is to bring about positive change to this industry while maintaining ethical standards.
Laura Sheriff, RN, MSN, is currently working as a consultant with physician groups and health plans to capitalize on risk adjustment performance and operations. Laura is an MSN with >12 years’ experience in Medicare, Medicaid, and Marketplace Managed Care and has led teams in risk, quality, telehealth, and population health analytics. Laura demonstrates effective leadership, innovative problem-solving techniques, and goal-oriented focus to execute business objectives and meet performance metrics. Laura designed and coordinated activities including provider education, training, auditing, data mining, and data analysis to direct program success and achieve all risk goals. Laura is also a certified professional coder and a certified risk coder.
Matt Simko is Vice President of Product Management at PINC AI where he guides the development of clinical decision support, risk adjustment, and automated prior authorization systems. He previously worked as a consultant for Cumberland Consulting Group where he led software development and implementation projects for health systems as well as a large national commercial payer. Matt is a part-time firefighter-emergency medical technician and holds an MS in Management Information Systems from Northern Illinois University.
Risk Adjustment & Value-based Care, Program Operations and Compliance
Khush Singh Risk Adjustment & Value-based Care, Program Operations and Compliance
Khush Singh, MD is a trained clinician and an experienced healthcare management executive with more than 15 years of health information management (HIM) and CMS Managed Care (Medicare & Medicaid) regulatory experience. Khush focuses on helping his clients through his expertise in Medicare risk adjustment and coding compliance, specifically assisting medical providers succeed in value-based care programs while staying compliant under the Medicare Part C program guidelines and other APMs (Alternate Payment Models).
Khush has a passion for working with clinical data models that leverage healthcare data to improve patient lives and help medical providers serve their patients in a meaningful way. He started his HIM career by managing clinical study data for industry-sponsored FDA clinical trials. He also led the risk adjustment coding and compliance teams, often acting a liaison between medical providers and the managed care business world.
While serving as a senior leader on risk adjustment teams at number of MA health plans, he oversaw Medicare, Medicaid and commercial ACA risk adjustment efforts. He has also worked as a consultant providing physician practices with HCC coding education and quality and value-based care HIM expertise. Specifically, he has helped clients refine their HCC coding recapture workflows, resolve EDPS submission-related problems, and leveraged the clinical documentation improvement process to recapture appropriate and accurate HCC risk scores for the Medicare & Medicaid lives under management.
Khush has also served as a senior executive at a healthcare technology vendor company. While there, he engaged with risk adjustment and finance executives at several large national MA, Medicaid and commercial health plans and large physician group ACOs, to improve their risk adjustment coding and documentation workflows focused on optimizing risk revenue streams while maintaining compliance with CMS risk adjustment data validation (RADV) guidelines.
Adele L. Towers
Director of Risk Adjustment, Associate Professor of Medicine, Division of Geriatric Medicine
Christian Trygstad, MBA, is Vice President of Product at Biomedix. With over a decade of experience in healthcare technology, Chris has been a key opinion leader in facilitating organization change and expansion, most recently serving as the architectural lead on expanding Biomedix product and service into the value-based care marketplace. Chris is passionate about working with healthcare leaders to improve clinical outcomes and enable cost-effective population health management through the early identification and care management of chronic conditions, as well as behavioral health issues and social determinants of health.
Vice President of Clinical Documentation Improvement
Sunita Varghees Vice President of Clinical Documentation Improvement
Baylor Scott and White Healthcare
Dr. Sunita Varghees serves as System VP of Clinical Documentation Improvement for Baylor Scott and White Healthcare in Texas. Dr. Varghees began her career in Hospital Medicine, and later went on to become Division Director of that group. She moved into the Quality/Physician Documentation space in 2014 for the legacy Scott and White clinics and hospitals, allowing her to understand the intersection and interdependence of quality and provider documentation.
Dr. Varghees received her bachelor and medical degrees from Texas A&M University and completed an internal medicine residency at Scott & White in Temple Texas. She also holds a PhD in Bacterial Pathogenesis from Texas A&M HSC.
Meghan West is a Sr. Solutions Manager in the healthcare industry with over 10 years of experience, specializing in provider engagement, risk adjustment, gap closure, and product development. With a strong background in financial planning and analysis, and prior roles as a Sr. Business Analyst and Director of Financial Planning and Analysis, she possesses a wealth of knowledge and experience. Her track record of leading cross-functional teams and delivering innovative solutions that meet both customer and business needs, coupled with her expertise in Provider Engagement, makes her an excellent partner to help healthcare organizations drive provider engagement and improve outcomes.