The Risk Adjustment Forum features hand-picked renowned speakers in the industry to share unique perspectives to strengthen and evolve risk adjustment programs for Medicare Advantage, Medicaid, and Commercial health plans.
John Barkley is the Vice President of Enterprise Risk Adjustment and Data Integrity for Emblem and ConnectiCare. John has been with the enterprise for nine years. Prior to joining Emblem John was with Aetna for twenty one years with the last six years in the risk adjustment space. John has been an attendee and presenter at RISE events for several years now. When not executing risk adjustment activities he enjoys kayaking, biking and fishing on Cape Cod, Massachusetts where he lives.
Wynda Clayton is a Risk Adjustment Manager at Providence Health Plans in Beaverton, OR. She received her Health Information Degree from College of Saint Mary’s, her BS in Health Care Management from Bellevue University and her MS from Clarkson College. Wynda has been in the health care field for over 25 years with experience on all phases from compliance to billing and reimbursement to coding to Quality Assurance to being a RADV Auditor to risk adjustment and providing physician education. Wynda is very enthusiastic and loves basketball, traveling and helping those unfortunate. To help is not always meaning to give, but it also means to teach others how to make a difference in their lives. Currently Wynda resides in Portland, OR with her husband Kevin. She can be contacted at Wynda.Clayton@providence.org.
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. Jatin Dave joined New England Quality Care Alliance as Chief Medical Officer in 2016. Dr. Dave is an internist and geriatrician with more than 15 years of diverse health care experience in clinical, academic and managed care settings. He is board certified in internal medicine, clinical informatics, geriatrics and hospice and palliative care. Before joining NEQCA, Dr. Dave served as the Medical Director of Geriatrics and Senior Care Options for Tufts Health Plan. He also practiced at Brigham and Women’s hospital for 12 years both as a primary care physician and consultant geriatrician. Dr. Dave completed his training in Internal Medicine at the University Of Illinois College Of Medicine and subsequently completed a General Internal Medicine fellowship at New York University. He then completed a fellowship in Geriatric Medicine at Harvard University where he received his master’s degree in public health. Jatin lives with his wife and two sons in Lexington, MA.
Dr. Shannon Decker is Vice President of Clinical Performance for Brown and Toland. Dr. Decker has more than 19 years of experience in healthcare--13 of which include working with risk adjustment 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, 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.
CRC, Regional Manager, Risk Adjustment Mississippi, New Mexico, and Texas
Ryan Dodson CRC, Regional Manager, Risk Adjustment Mississippi, New Mexico, and Texas
Molina Health Care
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.
Randi Escobedo West Region Director of Strategic Programs
Randi Escobedo, MS currently serves as the West Region Director of Strategic Programs for UnitedHealthcare Medicare and Retirement. She is responsible for program and project oversight and implementation for 20 local markets and close to 2 million members. Prior to this role, Randi served as the West Region Director of Risk Adjustment where she developed strategy for accurate documentation and diagnostic coding programs. Randi has been in the health care field for over 12 years serving in both the private and public sector. Randi is a certified Project Manager and has a Lean Six Sigma Yellow Belt. When not working to improve the healthcare delivery system, Randi spends time with her husband and two sons fishing, hiking, and playing Legos.
Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I, CRC Director of Ambulatory CDQI
Mount Sinai Health Partners
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.
Steven Graessle, CPC, CRC, CPMA Compliance Review Specialist
St. Elizabeth Physicians
Steven has worked in the Risk Adjustment field for 5 years at St. Elizabeth Physicians. Steven's responsibilities in the Coding and Education department include educating providers on HCC Coding and documentation as well as developing new processes to direct information from the insurance companies to the providers. Previously Steven worked in provider education for an orthopedic office.
Steven earned his Bachelors in Business Administration from Northern Kentucky University and is also a Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), and Certified Professional Medical Auditor (CPMA).
Eric Harmanhas beenboard certified in Family Medicine since 2000 anda member of Mountain Region Family Medicine(MRFM) in Kingsport, TN,since 2002. PresentlyDr Harmanserves asMRFM'sIT Committee Chairman andboard President. He is a graduate of University of Maryland College Park and East Tennessee State University College of Medicine. He has been active in population health improvement projects through committee work with Highlands Physicians IPA,QualuableACO, and through MRFM’s participation inMedicare Advantage shared savings programs.Heenjoys spending time with his wife and 3 kids in his spare time andalsotravelling.
Bill Jonakin, MD
Medical Director, Medicare Advantage and Risk Adjustment
Donna Malone, CPC, CRC Director of Enterprise Risk Adjustment: Coding and Provider Education (CDI)
Tufts Health Plan
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.
Eleesa Marnagh has over 20 years of experience in the healthcare field, including managing Northern New England Practice Transformation Network, a part of the Centers for Medicare and Medicaid Services Transforming Clinical Practice Initiative. She is an innovative, strategic thinker, passionate about using data to drive meaningful actions to set the vision for the evolution of value-based health care, with special emphasis on the importance of understanding, documenting, and effectively intervening on social determinants of health in patient populations.
Eleesa received her Masters of Public Health in Health Policy and Administration from Yale University’s School of Public Health.
Gabriel McGlamery J.D.
Sr. Health Policy Consultant, Government Relations
Gabriel McGlamery J.D. 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.
Dave Meyer Vice President, Risk Adjustment and Quality
Dave is a strong leader with 14+ years of experience in Revenue and Clinical Outcomes Program Development and Management in various healthcare environments (Plans, MG/IPA, Academic, and Consulting). Proven record of success in optimizing Operations, PE / Investor Meetings, Maintaining Compliance, Recovering / Maximizing Revenue, Enhancing Clinical Quality and Developing Software and Custom Analytics. Specialties: RA / HCC, Pay for Performance (P4P), CMS Stars Program, NCQA HEDIS, Off‐shore Software Product Development, HOS, CAS, NCQA Accreditation, Physician Profiling, Encounter Programs, Contract and Claims Analytics. Previously, Dave served as an independent consultant to health plans, was Corporate VP, Operations(Revenue and Quality) at InnovaCare Health. He has also performed as Sr. Consultant, Risk Adjustment and Health Plan Operations for Dynamic Healthcare Systems, and in other roles with health plans.
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 Manager 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. In addition to her risk adjustment duties, she manages the Compliance 360 application for the plan.
Tara Russo VP, Medicare Risk Adjustment, HEDIS and Navigate Directorate
Tara is the Vice President of Medicare Risk Adjustment and HEDIS Quality Initiatives for Island Doctors, a provider organization based in St. Augustine, Florida. Island Doctors operate 14 wholly-owned offices in Clay, Duval, Saint Johns, Flagler, Putnam and Volusia counties, as well as manage a network of 32 affiliate providers throughout these six counties and around the Orlando area. Prior to her current role, Tara previously worked as a financial analyst for Humana, Florida Hospital and Visiting Nurse Service of New York. Earlier, she was the Finance Manager for the Department of Medicine at Memorial Sloan-Kettering Cancer Center in New York. She has a Master of Public Health from Columbia University Mailman School of Public Health, and holds credentials as a CPC, CPMA, and CRC.
Bahar Sedarati, MD, FCUCM National Medical Director
A physician executive with diverse experience across the continuum of care, including private medical practice, medical group management, integrated delivery system leadership, and payers.
The national expert in clinical documentation and utilization management with an MCG Utilization and Case Management certification. Additionally, she is physician trainer on HCC Risk Adjustment Model, inpatient, and outpatient clinical documentation, DRG validation, as well as utilization management, with a niche in training providers on harvesting data to achieve precision in utilization and higher pay per performance.
She is also the Fellow of Collage of Urgent Care Medicine, certified in urgent care management, CUCMP, and on-demand care with over a decade of running successful medical practices in Southern California as Chief Executive Officer of startup primary care and urgent care practices.
Bahar is a dynamic speaker, and an engaging educator. She is passionate in formulating creative ways to make connection with fellow physicians and has created many innovative tools empowering them to succeed in the value-based care space and reach the quadruple-aim by creating value not only for the patients but also their practice.
Adele Towers, MD, MPH, FACP, CRC
Associate Professor of Medicine and Psychiatry, Director, Risk Adjustment,
UPMC Enterprises, University of Pittsburgh, School of Medicine, Division of Geriatric Medicine
Adele Towers, MD, MPH, FACP, CRC Associate Professor of Medicine and Psychiatry, Director, Risk Adjustment,
UPMC Enterprises, University of Pittsburgh, School of Medicine, Division of Geriatric Medicine
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.
Kevin is Chief Medical Officer at Vera, leading the Quality, Provider and Product teams. Central to Kevin’s role is enhancing the Vera Whole Health clinical roadmap and improving quality, patient outcomes, patient satisfaction, and clinician satisfaction.
Kevin has previously worked at DaVita Medical group, Evolent Health, and Huron Consulting Group where he successfully designed and implemented population health clinical interventions across diverse healthcare landscapes including health plans, academic medical centers, employer-based care centers, integrated delivery systems, large physician groups, and independent community hospitals.
Kevin’s training was in the New York-Presbyterian Healthcare System, an affiliate of the Weill Medical College of Cornell University. Kevin holds a B.S. in Biochemistry and Molecular Biology from the University of Maryland Baltimore County and a Doctor of Medicine (M.D.) from New York Medical College. Dr. Wang has been with Vera for 6 months.
Ashby Wolfe, MD, MPP, MPH Regional Chief Medical Officer
Centers for Medicare & Medicaid Services
Dr. Ashby Wolfe is a board-certified family physician and serves as co-Chief Medical Officer for the Centers for Medicare & Medicaid Services (CMS) offices in Denver, San Francisco and Seattle. Dr. Wolfe has been based at CMS San Francisco since 2015, and now also supports the Denver and Seattle regional locations in her focus on the implementation of Medicare and Medicaid policy across the Western States and the Pacific Territories (AK, ID, OR, WA, AZ, CA, HI, NV, CO, MT, ND, SD, UT, WY, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands). As a senior medical advisor for CMS programs in the Western United States, she provides clinical expertise to the divisions of Medicare and Medicaid payment policy, quality improvement, survey operations, contracted health plans and serves as the principle liaison with the clinical community.
Dr. Wolfe completed her medical degree at Stony Brook School of Medicine in New York, and her residency training at the UC Davis Medical Center in Sacramento, California. She also holds a Masters of Public Policy and a Masters of Public Health from the University of California, Berkeley. Dr. Wolfe has practiced broad-scope family medicine in academic, integrated and community clinical settings over the course of her career and holds a particular interest in improving the quality and equity of care for underserved and low-income populations. She has published multiple articles on Medicare and Medicaid policy, and is a contributing author of the public health text, Prevention is Primary (Jossey-Bass).
Ihavebeeninthemedicalfield40years.Ihaveworkedindoctor’sofficesstartingasareceptionistandworkingmywayuptoOfficeManagerandAdministratorforPrimaryCareaswellasafewdifferentspecialties.Ihavebeencodingsincethe80’sbutbecameaCPC(CertifiedProfessionalCoder)in2003.IalsoamaCPC‐I(CertifiedProfessionalCodingInstructor),CPMA(CertifiedProfessionalMedicalAuditor)andCHCCS(CertifiedHCCSpecialist).IamalsoanICD‐10certifiedtrainer.Ihavebeeninmanagementfor25yearsandthelast13yearshavebeenworkingforMedicareAdvantageHealthplansasDirectorRiskAdjustmentAuditandEducation.Inowhavemyownconsultingbusiness,SusanWyattHealthCareConsultingInc.Myspecialtyiseducatingclinicians,codersetc.ontheMedicareRiskAdjustmentHCCmodel.IfocusontheclinicianstoeducatethemonproperdocumentationandcodingforICD‐10diagnosesasitrelatestoHCC.IalsodofocuschartauditsforRiskAdjustmentHCCwithanalysisandeducationalfeedbacktotheclinician.Ihaveexperiencewith RADV's as Well. ICD-10 tools is specialty of mine as well.