Fahad Ahmed, an independent consultant with 10 years immense experience in Encounter Data Management. He’s built in-house end-to-end data platforms that support risk adjustment data oversight and controls. He has developed numerous data reconciliation and audit systems to ensure complete and accurate submission to and payment from CMS.
In his prior role at Optum, he collaborated with numerous provider groups and health plans to successfully migrate from RAPs to EDS. He has helped develop strategies to mitigate risk associated with transition from RAPS to EDS and assisted in meeting CMS guidelines. The strategies focus on HCC adds, deletes, and supporting documentation.
He has an MBA from Georgetown University and Bachelor of Science in Information Technology and Finance from University of Maryland, College Park. He is committed to lifelong learning and has recently completed the High Potentials Leadership Program at Harvard Business School, Executive Education. Fahad Ahmed has been recognized for ideating and conceptualizing numerous innovations to help organizations navigate complex challenges. He's received Innovation of the Year recognition from two different fortune 500 companies for his contribution.
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.
Chief Medical Officer and Director of Clinical Affairs
Jatin Dave Chief Medical Officer and Director of Clinical Affairs
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.
Shannon Decker Vice President of Clinical Performance
Brown & Toland
Dr. Shannon Decker is the Vice President of Clinical Performance for Brown & Toland. Dr. Decker has more than 20 years of experience in healthcare--14 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.
One of the world's leading Futurists, Ben Hammersley is the founder and principal of Hammersley Futures, an international strategic forecasting consultancy.
Their main work is in guiding corporations and governmental agencies to think clearly about the future. They, and he, specialize in how society reacts to technological innovation: including the future of crime and conflict, the changing nature of the workplace and the market, and the new cognitive tools needed to flourish in the coming decades.
Previously Ben was executive editor of WIRED, the writer and presenter of the BBC’s “Cybercrimes with Ben Hammersley” (now on Netflix or Amazon Prime internationally), a war correspondent in Afghanistan, an advisor to the European Commission, a pilot and wilderness medic in the USA, the author of 5 books, and the inventor of the word "Podcast".
He lives in Brooklyn, New York, with his wife and daughter.
Donald Hendrix Manager of RA and HEDIS Chart Review
Martin's Point Health Care
Donald Hendrix is the Manager of Risk Adjustment and Hedis Chart Review for Martin’s Point Health Care. Donald has been with Martin’s Point Health Care since 2011 and during his career has worked throughout the company in various capacities such as Utilization Management, Risk Adjustment Coding Supervisor, and a Coding Specialist. When not knee deep in Risk Adjustment work, Donald can be found on the football field on Friday nights officiating High School football.
Christina Keesecker Senior Director, Medicaid Product Solutions,
Christina is a seasoned industry expert with 17 years of analytics experience and is a key driver for new product development at Pulse8. She led the implementation efforts of our revolutionary Illumin8 Active Intelligence platform ensuring timely and accurate delivery to all customers. She is responsible for the direction of her team’s efforts across the delivery of various Pulse8 products and leads our efforts to support the Medicaid risk adjustment needs of customers with nearly three million managed Medicaid lives. Her combination of Medicaid experience alongside expertise with the Pulse8 analytics platform provides tremendous value for Pulse8 and enables continuous innovation for our product suite to remain unmatched in the industry.
Prior to her arrival at Pulse8, Christina led the retrospective risk adjustment program at Evolent Health, ensuring vendor support that included risk adjustment coding, chart retrieval, and NLP platform management. Christina spent four years at United HealthCare Community and State division managing up to 13 Medicare Health Plans and 18+ Medicaid Health Plans on both retrospective and prospective risk adjustment programs, supplying monthly reporting on risk adjustment program progress within each respective state. Her experience also includes managing Amerigroup’s (now Anthem) initial Medicaid Risk Adjustment program that utilized the following state-selected models: ACG, CDPS, CDPS +Rx, and CRG. In this position, Christina played a major role in identifying members with chronic conditions using defined algorithms. She also spent time in the Fraud, Waste, and Abuse sector at Amerigroup.
Christina earned a Bachelor of Business Administration degree with a concentration in Information Technology from Old Dominion University.
Bryan is a seasoned Healthcare Executive with over 30 years’ experience working with Payers and Providers focused in Government Programs, operations, compliance and payment practices. He possesses a deep understanding of how to build, implement and leverage technology to achieve performance improvement. He as built successful teams focused on providing comprehensive business process and compliance management solutions for Medicare Advantage, Medicaid and Commercial Marketplace health plans. His expertise in CMS transaction processing and regulatory requirements has led to the successful design and implementation of dynamic rules-based healthcare analytic solutions.
He has significant P&L management experience with a track record of business growth and profit improvements. He has been successful in leading multi-year, multi-million dollar projects, operational consolidations as well as continuous improvement initiatives that achieve bottom-line results. Bryan has driven change with his leadership style stressing expectations that align with business goals. This, coupled with unwavering accountability at every level of the organization, results in the achievement of the desired cultural and financial results.
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.
Jason McDaniel Vice President, Risk Adjustment & Quality
Intermountain Healthcare, Nevada
Jason McDaniel has over a decade of experience as a healthcare leader in provider, payer, and government operations and is currently the Vice President of Risk Adjustment and Quality for Intermountain Healthcare. In partnership with the Medical Director of Risk Adjustment and Quality, Jason has direct oversight of quality nurses, CDI nurse reviewers, value-based care focused nurse practitioners, medical coders, vendor relationships, and all other aspects of risk adjustment and quality prospective and retrospective operations.
Prior to his time at HCP, Jason was the Risk Adjustment Operations Director at Banner Health in Arizona. As a senior leader, he directed multiple teams in establishing the Banner Health risk adjustment and quality program as well as overseeing a pivotal segment of the integration of Banner Physician Hospital Organization and Arizona Integrated Physicians.
Jason spent 6 years at Cigna Healthcare of Arizona as the Medical Coding Manager and Medical Business Trainer as part of both medical group and payer operations. During his time at Cigna, Jason helped develop risk stratification and social determinants of health criteria, an internal point of care solution for population health, Medicare Advantage metrics and an extensive provider education program.
Jason was a Certified Professional Coder for 14 years. He earned his Bachelor's Degree in Healthcare Administration from the University of Phoenix and his Master's Degree in Healthcare Innovation from Arizona State University.
Sherry Miller D.M., CHC, CHPC, CPC, CRC, CEMC, Compliance Officer
Beaver Medical Group and EPIC Health Plan
Sherry Miller has a 30-year career in healthcare with an emphasis on compliance, privacy, and risk adjustment. She has collaborated with multi-specialty and primary care medical groups, IPAs, and health plans to develop working solutions to support Medicare Advantage operations. She has a Doctor of Management in Health Care Leadership and Management. Her research was focused on strategies leaders need to overcome obstacles to improving provider Medicare Advantage performance.
Jennifer Monfils CPC, CRC, Risk Adjustment Compliance Coding Manager
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.
Group Director of Payment Policy and Financial Management Group
Centers for Medicare & Medicaid Services, Consumer Information and Insurance Oversight
Dawn Peterson Director of Risk Adjustment and HEDIS Operations and Analytics
Martin’s Point Health Care
Dawn Peterson is the Director of Risk Adjustment and HEDIS Operations and Analytics for Martin’s Point Health Care. Dawn has seventeen years of service on the business side of medicine within nonprofit integrated health systems across the Nation. Professional positions Dawn has served in are various and in the fields of communication, auditing, education, billing and coding and leadership for professional fee for service, risk adjustment, care and utilization management, population health and HEDIS chart retrieval and review.
Jennifer Ross Director Risk Adjustment and Compliance Programs,
Aegis Medical Group
Jennifer Ross is the Director of Risk Adjustment and Compliance Programs for Primary Care Alliance, ACO and Aegis Medical Group. 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. She is widely known for her compliance, documentation, and Medicare risk adjustment expertise. She is a highly analytical professional combining more than 15 years of experience in medical office operations and the Medicare Advantage workspace.
Jessica brings over 12 years progressive healthcare experience including risk adjustment, clinic operations, patient experience, and quality performance including Medicare Star, HEDIS, and ACOs. She has demonstrated success reporting to several external entities including CMS, NCQA and the Integrated Healthcare Association. As a seasoned managed care leader, Jessica’s expertise spans the commercial, Medicaid, Medicare Advantage populations across provider groups, large health systems, IPAs and health plans. In her current role, Jessica has oversight for the market’s risk adjustment strategy which spans six regions comprised of 150,000 Medicare Advantage patients. She is accountable for the development and deployment of programs, analytics and reporting. Jessica attended the University of Massachusetts and received her BS in Business Administration. She later attended the University of San Diego and received her MBA. Before joining Optum California (formerly Healthcare Partners), Jessica worked for Molina Healthcare, Brown & Toland Physicians, and Scripps Health, as well as providing her own consulting services. Outside of work, Jessica enjoys spending time with her two boys and running her own AAU Basketball Program.
Director, Division of Reinsurance Operations in the Payment Policy and Financial Management Group
Centers for Medicare & Medicaid Services, Consumer Information and Insurance Oversight
Laura Sheriff, RN, MSN, CPC, CRC, National Director, Risk Adjustment,
Molina Healthcare, Inc.
Laura leads a dynamic Risk Adjustment Team, managing the day to day operations for Medicare and Marketplace members. She has a proven track record of maximizing risk scores. Laura designs and coordinates all team activities which focus on provider education, training, auditing, data mining, and data analysis to steer program success and achieve performance metrics. Laura is familiar with developing strategies for seeing high risk members utilizing technical dashboards, auditing processes, and working 1:1 with local vendors. Additionally she identifies end-to-end processes and prioritizes interventions to correct known weaknesses. Laura also provides support to corporate compliance efforts for RADV audits for both lines of business. She collaborates with business partners and develops best practices, and shares them with other health plans.She has over 20 years of varied clinical nursing practice experience including more than ten years of Clinical Coding Certification practice. Laura is a Master’s prepared nurse, who also maintains her CPC and CRC through the AAPC.
MD MPH FACP, CRC, Associate Professor of Medicine and Psychiatry, Director, Risk Adjustment
Adele Towers MD MPH FACP, CRC, Associate Professor of Medicine and Psychiatry, Director, Risk Adjustment
Dr. Towers is the Director of Risk Adjustment for UPMC Enterprises, and is also a geriatrician on the faculty at the University of Pittsburgh. At 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 and Clinical Analytics at multiple regional and national conferences.
CRC, CMA, CFM, MBA, Director, Government Programs,