Rafi Cices Head of Coding and Billing Function

CityBlock Health

Rafi Cices is the Head of Coding and Billing function at CityBlock Health, a tech-driven healthcare provider for those in underserved communities. Prior to joining Cityblock, Rafi led the Risk Adjustment strategy and analytics at Oscar Health for Medicare and ACA lines of business. 

Rafi has experience managing an organization's performance in value based contracts where he successfully implemented contracts with insurers and CMS when he worked at Caremount Medical. He has an undergraduate degree in finance from Rutgers University and EMBA from the Johnson Business School at Cornell University. 

Wynda Clayton, MS, RHIT Risk Adjustment Manager

Providence Health Plan

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.

Deniese Crittenden Vice President, Risk Adjustment Strategy and Solutions

Reveleer

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, MBA, RHIA, CCS-P, CRC, RAP, AHCCA 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.

Rebecca Darnall Sr. Director, Product Management

Episource

With more than 19 years of healthcare and product management experience, Rebecca is known for establishing solid operating policies and creating innovative solutions for all risk adjustment programs and products that comply with CMS requirements and industry known practices. 

Dr. Shannon Decker, PhD., M.Ed,

Risk Adjustment Specialist

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.

Ryan Dodson, CRC Risk Adjustment Consultant

Choice Medical Group

His background is in management and operational processes for 15 years and begun working in the Risk Adjustment arena 15+ years ago. Ryan has proven himself by helping Medical Groups and Health Plans to accurately improve their documentation with a solid track record of provider engagement. Ryan uses a unique blend of comedy, and deep risk adjustment knowledge to get buy-ins from providers to improve their documentation. His track record of results of improving documentation and thus improving revenue streams and patient care brings value to any group he works with. Having worked on the provider, payer, and now the vendor side Ryan is able to bring a unique perspective to the conversation and develop out of the box ideas to help any size group. In 2020 Ryan co-founded New Vision Healthcare Solutions to fill a niche in the market on providing provider education with data stemming from analytics, and provider chart data. Ryan is a Certified Risk Adjustment Coder (CRC) credential through the AAPC.

Lance Donkerbrook Chief Executive Officer

Commonwealth Primary Care ACO LLC

Mr. Donkerbrook has over twenty five years of healthcare experience ranging from consulting, business planning, financial management and contracting within national health insurers, hospital delivery networks, physician practices and healthcare technology companies. Outside of his more recent ACO leadership, Lance has implemented many innovative projects related to strategic planning, system selections, business case, process reengineering, productivity, and contracting associated with health plan operations and their IT systems implementations.

For the last five years, Lance has led as the COO, and more recently, elected as the CEO of the Commonwealth Primary Care Accountable Care Organization based in Tempe, Arizona. He has a BS in Economics from Arizona State University and an MBA from Texas Christian University. Lance serves as an advisor for three technology companies, and volunteers on the the Men’s Arts Council with the Phoenix Art Museum.

Timothy Dudley, MD Former Chief Medical Officer

Colorado Care Partners Group, Navina Medical Advisory Board

Tim has an active interest in technology in medicine and worked part time for Expert-24 in the UK and the US writing algorithms for their health risk appraisal and symptom checker programs.  The algorithms were used by companies such as the Mayo Clinic in the US and the NHS in England.  He is currently a clinical advisor to Navina, an Israeli technology company using natural language processing, artificial intelligence and machine learning to create concise patient portraits at the point of care.  These portraits allow clinicians and staff to capture relevant diagnoses and quality measures in an efficient manner.

Administratively, Tim was CMO for HealthONE’s Colorado Care Partners from 2014 to 2020.  The organization is an ACO serving over 50 practices around metro Denver holding multiple value-based contracts with an excess of 100,000 covered lives.

When not working, Dr. Dudley and his family enjoy all of the outdoor activities Colorado has to offer.

Caitlin Dugan, MPH Data Scientist

Cityblock Health

Caitlin Dugan is a data scientist on the Clinical Success team at Cityblock Health. Caitlin has 10 years of experience in the healthcare industry, with a focus on value based care initiatives at small startups and leading hospital systems.  Her fieldwork has explored the development of large-scale data pipelines, the generation of medical insights though analytics, and the application of Natural Language Processing to identify useful information in unstructured medical notes.  

Caitlin received her Masters in Public Health from Boston University with a focus on Epidemiology and Biostatistics. She is passionate about transforming patient care and committed to the idea that health outcomes and care delivery can be improved through data.

Rose T. Dunn, , MBA, RHIA, CPA, FACHE, FHFMA Revenue Cycle/Interim Vice President

Palomar Health

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.

Currently, Ms. Dunn is serving as an Interim CFO of a dual-hospital IDN based in California.

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.

Randi Escobedo, MS Associate Vice President of Risk Adjustment

Providence Health Plan

Randi Escobedo currently serves as the Associate Vice President of Risk Adjustment for Providence Health Plan in Oregon. Randi oversees all risk adjustment programs, projects, and activities for the Medicare Advantage and Individual and Small Group lines of business covering approximately 215,000 lives. Randi also oversees the Strategic Accounts Management team which serves as the outreach liaison arm between the Health Plan and our Provider partners. Prior to joining Providence, Randi served in several leadership roles with UnitedHealthcare including Director of Risk Adjustment, Director of Strategic Programs, and Director of Member Experience and CAHPS.

Randi started her career with United in the risk adjustment space and worked to create robust provider education, incentive, and coding accuracy programs. As the programs matured, it became increasingly necessary to innovate and think about engagement and program success from both a risk and quality perspective.  Randi's background in risk adjustment, project management, and process improvement allowed for a provider-centered approach with risk and quality working together in order to leverage clinical workflows, data and analytics, and most importantly, improve the health outcomes for members.

Randi also worked to overhaul the overall Medicare Advantage member experience and oversaw several large-scale programs for customer service, capitated-delegated integration, and foundational CAHPS improvement. These efforts started with a complete reorientation of the way the organization thought about CAHPS with a significant focus in change management and creating programs and processes that integrated member experience into every aspect of the business.

Randi resides outside of Portland, Oregon with her husband and two boys and often takes advantage of the many outdoor activities the Northwest has to offer. Fishing, hiking, football and wrestling are often on the weekend agendas.

Michael Forster Senior Consulting Actuary

Wakely Consulting Group, an HMA company

Michael Forster, FSA, MAAA 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 the state of Vermont on its all-payer Medicaid ACO model. Michael works on Medicare and Provider analytics along with Medicaid rate setting. He has led projects for health plans and state agencies throughout the country. His recent work has been on the development of the Wakely Health Analytics and Operational Optimization (WAHOO) suite of tools to help health plans and providers with all aspects of their business. The tool has proved to be successful for small start-up health plans as well as nationwide carriers. Michael has also worked extensively over the last year within a health plan on monthly Medicare financial reporting. This work includes monthly Incurred But Not Reported (IBNR) estimates, risk accrual estimates, forecasting, budgeting, minimum MLR filings, DIR filings, and various other financial items. He has communicated and worked directly with financial leaders at the organization to automate processes and identify opportunities for improvement. Michael has analyzed detailed claims data and worked with other Wakely actuaries to set rates.

Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I, CRC 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.

Eric Hedrick Vice President of Analytics

Advantmed

Eric oversees data analytics and reporting across all Advantmed solutions. He brings over 10 years of experience in healthcare that includes actuarial work, provider engagement, and risk adjustment leadership. Thru his extensive experience at both health plans and vendors, Eric understands the value of providing data that is actionable, nuanced, and trustworthy. He is focused on building these qualities into all solutions at Advantmed. His past experience includes roles at Priority Health and Cigna health plans as well as Pulse8 where he directed the provider-facing solutions and played key roles across all analytics.

Sion Hughes Senior Consultant

Wakely Consulting Group, an HMA Company

Sion Hughes has extensive payer and provider experience with product and strategy. His experience includes building successful integrated delivery financial models, value-based payment program development, product development, and leading strategic efforts for growth of lives. Sion has a proven track record of creating, improving and expanding profitable Medicare Advantage products, Medicaid programs, and value-based payment models. His expertise centers around strategic thinking, increasing operating margins, and enhancing stakeholder experience. He is a subject matter expert in successful planning, contract negotiations, implementation and growth of Government products as well as developing joint-venture economic models. Sion is the co-architect of Wakely Analytics Health Operations Optimization (WAHOO) program that positions payers and providers to be successful with managing risk.

Christi Isaac, COC, CPC Code Review Program Manager, Risk Adjustment Solutions & Medical Economics

Health Alliance Medical Plans

Christi Isaac, COC, CPC is the Code Review Program Manager for Risk Adjustment Solutions and Medical Economics at Health Alliance Medical Plans.  Christi has worked on the business side of healthcare for over 25 years. She has been a professional coder since 2005, and has a background in billing, coding, and compliance. She has worked in Risk Adjustment for the last four years.  In 2021 she was a part of the team that implemented several modules from the Veradigm Payer Analytics’ (formerly known as Pulse8) suite of services.

J.D. Kleinke

Medical Economist

J.D. Kleinke is a medical economist, author of three books on the structure of the US health care system, and a former health care executive. He has been instrumental in the creation of four health care information organizations; has served on the Boards of several health care companies; and spent many years advising both sides of the political aisle on non-partisan, practical approaches to health policy and legislation.

J.D. was one of the pioneers of the health care informatics industry. In the 1990s, he was a principal architect in the creation and rapid growth of HCIA / Solucient – now Truven Health Analytics – from a niche health care data analysis firm, to a leading provider of information products to health care organizations across the U.S. and Europe. He also helped establish HealthGrades, which he served as Executive Vice Chairman of the Board when it was a public company.

J.D. has been a member of the Editorial Board of Health Affairs, a frequent contributor to The Wall Street Journal, and a Resident Scholar in health policy at the American Enterprise Institute. His books include Bleeding Edge: The Business of Health Care in the New Century and Oxymorons: The Myth of a US Health Care System, both of which are used in health care management graduate education; and the critically acclaimed Catching Babies, a novel about the training and culture of OB/GYNs, which is currently in development as a television series by Warners Bros TV and ABC.

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP Director Clinical Documentation and Quality Improvement (CDQI)

Mount Sinai Hospital System

Donna Malone, CPC, CRC, 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 17^th 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, J.D. Sr. Health Policy Consultant, Government Relations

Florida Blue

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.

Rick Monaco Principal, Risk Adjustment

Pareto Intelligence

Rick brings over 20 years of health experience to GHG Advisors/Pareto Intelligence, with extensive experience in leading, developing and executing on 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 GHG Advisors, 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).

Jenni Monfils, CPC, CRC Director, Risk Adjustment Coding and Compliance

Bright Healthcare

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.

Jennifer Moore, AHCCA, MHA Director of Revenue Cycle Management

Aegis Medical Group

As the Director of Revenue Cycle Management at Aegis Medical Group and Primary Care Alliance Jennifer leads multiple teams focused on pursuing risk adjustment revenue opportunities. She began her career with Premier Medical Associates and Paradigm ACO, gaining unparalleled experience in the compliance space, while also establishing herself as a respected manager of clinical operations. With her move to Aegis Medical Group in 2019, Jennifer began working closely with physicians and support staff on coding and documentation guidelines. She is well versed in cross- functional collaboration programs which enabled her to build a successful prospective and retrospective auditing team comprised of International Medical Graduates( IMGs). Jennifer then started a premium billing company, claims and ancillary service department. She has since developed a successful training presentation that was recently accepted by the University of Texas School of Medicine for CME credits. She has also developed an interactive learning session for providers to understand Medicare payment methodologies.  Jennifer believes that it takes a village to raise RAF. She continues to educate on the importance of physician, support staff, health plan and patient collaboration. She is a highly analytical professional combining more than 15 years of experience in medical office operations and the Medicare Advantage workspace.

Brandy Morse, CRC Director, Risk Adjustment

Oschner Health Plan

Brandy has been working in the healthcare industry for 18 years with initial beginnings in Long Term Care & Acute Care Facilities.  In 2014, she transitioned into Managed Care working for Provider Groups.  Brandy joined Ochsner Health Plan in July 2022 as the Director of Risk Adjustment.  In the past 8 years, she gained a unique skill set in Risk Adjustment, HEDIS/Quality, data analytics and member/provider engagement activities.  Currently, she is utilizing her skill set and expertise to develop and implement the Risk Adjustment program at Ochsner Health Plan.  Brandy has extensive experience in developing and leading member engagement programs and has worked directly with Providers and their teams to improve their HEDIS quality gap closure and chronic condition care gaps.  Brandy earned her Master’s of Science in Healthcare Administration from California State University, Long Beach and is AAPC Risk Adjustment Coder Certified.

Hemanshu Patel, MD Board Certified, Chief Quality Officer, Medical Director

Choice Healthcare Associates

Dr. Hemanshu Patel is a practicing physician in Southern California serving over 2500 patients.   He’s been awarded the cities Best Primary Care Award from 2016-2021.   

He serves as a board member, oversees multiple departments including the Quality department, MA training.  He leads over 100 employees and is the chief director of Choices High Risk Program.  He serves and educates providers on proper documentation, RAF coding and aids in developing the ground work to reduce provider burnout via upcoming medical technology. 

Diane Pittman Senior Clinical Analyst

3M.MModal Health Information Systems

Diane Pittman is a Senior Clinical Analyst for 3M/MModal Health Information Systems. Diane currently develops clinical content for 3M’s Health Info-Systems. She is a Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), and Certified Professional Medical Auditor (CPMA). Diane has worked on multiple projects, including Computer Assisted Coding (CAC), Hierarchical Condition Category (HCC), and Social Determinants of Health (SDoH). Diane lives in Pittsburgh, Pennsylvania, where she attended Pittsburgh Technical College and contributed to the medical coding field for over a decade.

Dr. Carlos Rodriguez, IMG, AHCCA Manager of Revenue Cycle Management

Aegis Clinics MRA Manager

Carlos Rodriguez is the Manager of Revenue Cycle Management who is employed by Aegis Medical Group. For the past three years, he has worked on ensuring patients are taken care of in their entirety. This includes but is not limited to reviewing medical records for accurate coding and documentation, developing training materials, and the education of providers and their support staff. 

Carlos is passionate about healthcare because he has always loved medical research and finding better ways to treat patients and maintain them with health. He always tries to give his best with providing premium healthcare to every patient.

Carlos graduated from Universidad Americana, Nicaragua. It was here that he obtained his Doctor of Medicine. Soon there after, he completed his internship with the Hospital Jose Nieborosky, Boaco Nicaragua as Chief of Interns.

In his spare time, Carlos enjoys spending time with his family, following up with formula 1 races, and playing soccer. Although he was born in California, raised in Nicaragua, he currently calls central Florida home. He shares this home in the sunshine state with his loving wife, Paola, and son, Lucas.

Laura Sheriff, RN, MSN, CPC, CRC Operations, Risk Adjustment

SWHR Risk Department

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. 

Jill Strassler Vice President, Solutions Management

Veradigm Payer Analytics (formerly Pulse8)

Jill Strassler is the VP of Solutions Management at Veradigm Payer Analytics (formally known as Pulse8).  She is a dynamic healthcare executive focused on innovating the analytics and reporting solutions for Health Plans for Risk Adjustment, Quality and Value Based Care models.  Jill brings expertise in developing novel solutions to address emerging and transformative change in the healthcare industry.  Jill excels at delivering value across the ecosystem by increasing transparency and building connectivity among all stakeholders.  Over her notable 20-year career, Jill has developed holistic member engagement and quality strategies for health plans. Prior to her focus in risk adjustment, she led solutions for molecular diagnostic utilization management and reimbursement.  Jill received her BA in Psychology from The University of Chicago and received her MBA and MS in Management Information Systems from Boston University.

Rebecca Turner Principal Data Analyst

Veradigm Payer Analytics (formerly Pulse8)

Rebecca Turner is a Principal Data Analyst specializing in Medicare Advantage and Affordable Care Act Risk Adjustment at Veradigm Payer Solutions (formerly known as Pulse8).  Prior to joining Veradigm in 2019, she worked in healthcare analytics at a health plan for almost 15 years.  At the plan, she touched every aspect of risk adjustment including supporting bid operations, submissions to CMS, forecasting risk scores, and supporting data validation audits.  Rebecca received her Bachelors and Masters in Mathematics from the University of Tulsa.  She is currently working through the credentialing process to become an actuary.

Dr. Maria Vasquez, MD

Aegis Medical Group Provider in the Clermont Region

For the past 20 years has been actively working as a primary care physician in different medical settings, states, and demographics. These experiences have provided her with a better understanding and different strategies to establish the importance of the Medical Risk Adjustment Department for a medical practice or environment. 

This past year Dr. Vázquez Torres integrated as Primary Care Physician at Aegis Medical Group in Clermont FL. Since she integrated the organization, Dr. Vazquez Torres has been identifying, developing and implementing multiple strategies in conjunction with the MRA department with very successful results for both the MRA department expectations and Aegis Medical Group Company goals. 

Prior to joining Aegis, she was the chairman for the company’s growth committee for IMA Medical Group as well as the Medical director of the East Colonial & Semoran Blvd. Orlando Florida Offices.  For the past 6 years she been successfully working hands on, strategizing, and successfully implementing different plans and dynamic to improve the Medical Risk Adjustment (MRA) Department performance for physicians. While creating, developing, modifying, training, and reenforcing the use of standardized Electronic Medical Records documentation or data base. Which assist and facilitate the physicians and MRA department to work more efficiently and accurate in accordance with The Centers for Medicare and Medicaid services (CMS) guidelines. These joint venture between both the MRA department and physicians has made great improvement on the companies Risk Adjustment Payments Systems (RASP).

Jessica Vaughn Director of Clinical Risk Adjustment Operations

Advocate Aurora Health

A nurse of 26 years, Jessica has 12 years of CDI experience and joined Advocate Aurora Health in 2022.

In 2015, she started and led one of the nation’s first and extraordinarily successful ambulatory CDI programs focused on risk adjustment for value-based care and population health for Atrium Health Wake Forest Baptist. She is a leader in the industry, having spoken at multiple conferences, authored articles, received ACDIS’s Professional Achievement Award and helped write both the original study guide and the initial CCDS-O certification exam. Among her other credentials, Jessica has held certifications in oncology, chemo and biotherapy, and AHIMA’s approved ICD-10 CM/PCS trainer. Jessica completed her Doctor of Nursing in Executive Leadership at Duke University and believes in empowering interprofessional healthcare teams to improve patient care.

Aaron Walters Process Improvement Consultant

Cambia Health Solutions

Susan Waterman, RHIT, CCS, CPC, CRC Director of Risk Adjustment

Scott and White Health Plan

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 Risk Adjustment, brought all chart review activity in-house, and partnered with the hospital CDI/Quality Physicians to create an Outpatient CDI Department focused on documentation quality, Risk Adjustment activities and clinic training. 

A proven leader in her field, Susan’s professional experience includes risk adjustment, coding and compliance management, auditing and provider training, system management, and consulting services.

Scott Weiner, CRC, CMA, CFM, MBA Director, Government Programs

Sentara Health Plan

Scott is the Director of Government Programs at Sentara Health Plans. Prior to joining Sentara, Scott was the founder of Quadralytics, a data analytic, software, and finance consulting company. Previously, he was the Senior Vice President, Analytics and Strategy, EMSI HEALTH where he was focused on expanding the company’s HEDIS, Medicare Stars, Medicaid Risk Adjustment and data analytics offerings to better meet the needs of health plans and other clients. He has extensive executive-level and health-plan consulting experience, having held managed care, risk adjustment and data analytics positions for more than 20 years. He has a Master of Business Administration (MBA) from Seattle University and a bachelor’s degree in accounting from Central Washington University. He holds the Certified Risk Adjustment Coder (CRC) and Certified Professional Coder (CPC) designation from AAPC and CMA and CFM from the Institute of Management Accountants. Scott served on the RISE Advisory Board and has been involved with RISE for many years.

Michelle Zilisch Director, Product Management

Ciox Health

Michelle Zilisch serves as Director, Product Management at Ciox Health/Datavant. With more than 20 years in adult education training experience and 16 years healthcare, Michelle has led the training and implementations for provider and facility EMR/EHR systems, Health Information Exchanges, hospital time and attendance systems, capital purchasing/budgeting software, and Medicare Advantage, Medicaid and ACA Risk Adjustment and Quality software and services solutions for health plans. Her career in Risk Adjustment and Quality has focused on intervention identification, coding, submissions, and clinical documentation improvements through knowledge management, improving efficiencies, customer engagement, and compliance management. Michelle has a Master of Arts in Curriculum and Instruction: Educational Technology from University of Northern Iowa and enjoys spending her free time in the kitchen cooking and baking for family, friends, and colleagues.