John Barfield Payment Policy and Financial Management Group

Center for Consumer Information and Insurance Oversight

John Barfield works as a Program Analyst in the Division of Policy and Analysis within CCIIO’s Financial Management Group. Prior to his work at CCIIO, John worked at the Board of Veterans’ Appeals as a Program Specialist and at a veterans’ non-profit resource center as a case manager. John is also a United States Army veteran where he served as a Behavioral Health Specialist.

Amy Campbell, RN, MSM, CCDS-O Clinical Documentation Improvement Director

Wolters Kluwer, Health Language

Amy has been a nurse for over thirty years working predominantly in the Critical Care setting. Over the last several years, she has been active in Risk Adjustment from both the auditor and Outpatient CDI perspectives. She has built outpatient CDI programs across the country, collaborating with and teaching providers, payers, and HIM partners about chronic condition capture bounded by compliant practices.

Amy completed her Master of Science in Business Management focusing on Health Care Administration during the pandemic. This program honed her skills in strategic analysis of metrics, transformational and developmental leadership, and achieving CDI program goals to the unique needs of each institution.

In early 2021, Amy moved into the tech industry with Wolters Kluwer, Health Language using her expertise as a CDIS to build and develop clinical natural language processing content for use in risk adjustment clinical diagnosis validation.

In her spare time, Amy leads a small group of women as they recover from abuse, is a beekeeper, and enjoys spending time with family, pets, and the outdoors.

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, RN VP, Risk Adjustment Strategy and Solutions

Dynamic Healthcare Systems

Deniese Crittenden, VP, Risk Adjustment Strategy and Solutions, is a subject matter expert on Risk Adjustment at Dynamic Healthcare Systems. In this role, Deniese leads Dynamic’s risk adjustment segment of business supporting development, operations, and account management to provide gap analysis, assessment, design, and implementation in managed care risk adjustment activities.  She provides leadership to ensure the delivery of Dynamic’s services to ensure client program compliance and quality, risk mitigation, integration of critical data to support clinical and revenue management performance outcomes, and accurate revenue realization. Deniese provides a unique perspective having worked for both Provider and Payer organizations. She brings Dynamic Healthcare Systems more than 12 years of experience in the Medicare/Medicaid industry as well as more than 25 years of healthcare experience as a Registered Nurse and a Geriatric Social Worker. 

Deniese has supported start-up Medicare Advantage health plan operations for all aspects of Risk Adjustment:  clinical coding support and quality documentation provider outreach programs, policy and procedure development, design, and strategy development for RA activities.  She has a proven track record of developing scalable Risk Adjustment programs and organizational alignment with Population Health Management and HEDIS/Stars initiatives to drive quality improvement, program compliance, contain healthcare costs, and ensure revenue realization. 

Deniese previously served as a high-risk Obstetrical Nurse and a Geriatric Social worker.  She holds a Bachelor of Arts in Social Work from Michigan State University, and a Master of Science in Nursing and Healthcare Administration from the University of Phoenix.

Deborah Curry Manager, Risk Adjustment

ProMedica

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.

Jeff De Los Reyes VP, Risk Adjustment, GHG Advisors

Pareto Intelligence

Jeff De Los Reyes is the leader of the Risk Adjustment division at Pareto's sister company, GHG Advisors. In this role, health plans and providers look to Jeff to enhance, optimize, and ensure superior outcomes related to revenue accuracy and compliance across all government- and state-sponsored programs (Medicare, Medicaid, and ACA).

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

Dona Doran Program 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.

Wilson Gabbard Vice President, Risk Adjustment

Advocate Aurora Helath

Wilson Gabbard is the Vice President of Clinical Risk Adjustment for Advocate Aurora Health, one of the 12 largest not-for-profit, integrated health systems in the United States and a national leader in population health serving over 1.3 million patients in value-based contracts. Mr. Gabbard joined Advocate Aurora in 2020 where he is responsible for risk adjustment strategy including over $3 billion in system risk-based revenue. He co-leads the system’s Medicare Advantage (MA) core team that is responsible for driving performance in MA joint ventures, full risk and shared savings contracts. Previously, he spent seven years leading population health operations for UNC Health Care where he was responsible for strategy and operations during its transition from fee-for-service to value-based reimbursement. Mr. Gabbard was a founding member of the UNC population health services team that grew from two to over 200 team members during his seven-year tenure. Prior to joining UNC, he led regional operations for primary and specialty care practices and regional emergency and hospitalist service lines for Vidant Medical Group. Mr. Gabbard received his Bachelor and Master of Business Administration degrees from Morehead State University and is a Fellow of the American College of Healthcare Executives (FACHE).

Colleen Gianatasio Director, Clinical Documentation Integrity and Coding Compliance

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.

Anne Hayes Hartman Partner

Constantine Cannon LLP

Anne Hayes Hartman represents whistleblowers bringing qui tam actions under the False Claims Act as a partner in Constantine Cannon’s San Francisco office.  Ms. Hartman has pursued claims for whistleblowers reporting fraud in numerous industries, including healthcare, government procurement, natural resources, and finance.  She is one of the attorneys representing the whistleblower in a case against UnitedHealth Group alleging the fraudulent inflation of Medicare Advantage risk scores.  Recognized by the Daily Journal as one of the Top 100 Women Lawyers in California, Ms. Hartman received a J.D. and M.P.P. from the University of California at Berkeley. 

Eric Hedrick VP 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.

Bill Horn EVP Payer Growth

Ciox Health

Bill Horn is Sr. Vice President of Payer Growth for Clinical Data Acquisition and Insights at Ciox Health.  Bill has more than twenty-five years of experience in healthcare, having spent the past seven years at Ciox. He is a RISE certified Risk Adjustment Practitioner with in depth experience in Risk Adjustment, HEDIS, Business Process outsourcing, Natural Language Processing, Medical Record Retrieval and Coding Services and holds a Bachelor Degree in Economics from the University of Arizona.

Dr. Ahmad Inram Vice President Value-Based Care and Quality

Prime Healthcare

Ahmad Imran is the Vice President of Quality and Valued-Based Care for Prime Healthcare. Prime Healthcare is an award-winning health system operating 46 hospitals and more than 300 outpatient locations in 14 states, providing over 2.6 million patient visits annually. It is one of the nation's leading health systems with nearly 50,000 employees and physicians dedicated to providing the highest quality healthcare.

As Vice President of Quality and Value-Based Care, Ahmad partners with others to implement and expand value-based care and population health initiatives for Prime Healthcare. Under his leadership and direction, Prime Healthcare has been nationally recognized for award-winning quality care and has been named a Top 10 and Top 15 Health System by IBM Watson Health. Prime's hospitals have also been named among the nation's best as "100 Top Hospitals" 53 times and have received more Patient Safety Excellence Awards from Healthgrades than any other health system in the past five years.

Ahmad, who joined Prime Healthcare in 2012, previously served as Corporate Director of Performance Improvement. Prior to Prime Healthcare, Ahmad held various leadership roles, including serving as Chief Operating Officer in acute care hospitals in LA region. Ahmad earned his medical degree and MBA and has multiple certifications in healthcare quality including fellowship status with the American Institute of Healthcare Quality.. He is Board Certified in Utilization Management Physicians as well as a certified professional in Healthcare Quality Management (CPHQ), Healthcare Compliance (CHC), and Healthcare Quality Management and Utilization (CHCQM). He currently serves as President of the California Association of Healthcare Quality and is a member of the Health Care Compliance Association and National Association for Healthcare Quality.

Peter Janelle Director of Risk Adjustment

Vital Data Technologies

Peter Janelle has over a decade of experience in health insurance, having worked both for payers and vendors. He has extensive knowledge of Medicare Advantage finance, including risk adjustment, stars, value-based arrangements, and healthcare economics. Before joining Vital Data Technology, Peter oversaw risk adjustment operations at UCare, a regional Minnesota insurer with books of business in Medicaid, Medicare Advantage, and ACA.

Dr. Mansoor Khan CEO

Persivia Inc.

Dr. Mansoor Khan is a 20-year veteran of the software and healthcare industries. He is a serial entrepreneur who has been developing advanced technologies and cutting-edge software since the mid 90s. Over the years he has led teams that have developed technology and applications for Disease Surveillance, Artificial Intelligence, Quality Management, Analytics, Care Management and Cost and Utilization Management. He has had a particular interest in helping providers and patients transition from Fee-for-Service to Value Based Care. These efforts have won numerous awards over the years including best Decision Support System for ACOs (Blackbook) and Top 100 AI companies. Previously Dr. Khan founded and had successful exits from KeyCommerce (1997 – 2004), DiagnosisOne (2005 – 2012) and was CEO of Alere Analytics (2012 – 2015).

Sophia Kim Chief Revenue Officer

Centauri Health Solutions

With 25 years of strategic revenue generating experience, Sophia Kim oversees business development, sales and marketing operations at Centauri.

Most recently, she served as VP of Strategic Accounts for MHK, leading business development for their cloud-based care, quality and compliance software solutions for health plans, ACOs, PBMs and specialty pharmacies.

Prior to that, Sophia was SVP of Sales Operations and Enablement for Change Healthcare, directing sales analytics, operations and enterprise programs, proposals, demos and strategic advisory for sales systems, tools and processes.

Earlier in her career, she worked as a consultant with Accenture, focused on health and life sciences and as a director for Medicaid Marketing and Sales for Kaiser Permanente’s national Program Office based in Oakland, California.

Sophia is a graduate of Barnard College of Columbia University.

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

Mount Sinai Hospital System

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.

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.

Jenni Monfils Director, Risk Adjustment Coding and Compliance

Bright Healthcare

Sarah Paine Director of Risk Adjustment Programs

Anthem, Inc.

Joshua Paul Risk Adjustment and RADV Technical Lead

CCIIO, Financial Management Group, Division of Policy and Analysis

Joshua Paul serves as a health insurance specialist and the risk adjustment and risk adjustment data validation technical lead within CCIIO’s Financial Management Group in the Division of Policy and Analysis. He has also served in the Government Accountability Office’s Applied Research and Methods Team and, prior to entering the public sector, has previously worked in non-profit organizations where he conducted program evaluation activities for public health services, education programs, and services for the unhoused.

Andrew Perlstein Senior Vice President, Customer Success

Episource

Andrew is responsible for Episource's Client Services division and ensures that client organizations derive maximum value from their Episource partnerships. He has over 15 years of client relations experience in the health care industry and has held a variety of leadership roles with McKesson Corporation, RelayHealth (a division of Change Healthcare), and The Advisory Board Company. Andrew earned his Bachelors degree in political science and Spanish from Duke University.

Spencer Pratt Vice President, Sales Solutions

UniteUs

Spencer Pratt is Vice President of Sales Solutions at Unite Us, where he works at the intersection of product, technology, and the market to support growth strategy and execution in new and existing markets. Spencer has spent his career building and implementing data-driven solutions in the healthcare industry. He has extensive experience in payer and provider markets, having worked with health plans, health systems, and employer groups across the country for over a decade. Prior to joining Unite Us, Spencer led high-performing teams at Carrot Health, a health and social care analytics company, across product development, product management, strategy, and innovation; and built the Consumer Analytics & Strategy function within the Optum Health division of UnitedHealth Group.

Carlos Rodriguez IMG, Senior Medical Risk Adjustment Analyst

Aegis Clinics MRA Manager

Carlos Rodriguez is a Medical Research Analyst who is employed by Aegis Medical Group. For the past two 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 new born son, Lucas.

Jennifer Ross, 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.

Victoria Ruetten Director Enterprise Clinical Risk Adjustment

Advocate Aurora Health

Laura Sheriff, RN, MSN, CPC, CRC,

Risk Adjustment Specialist

MSN with 10 years’ experience in Medicare, Medicaid, and Marketplace Managed Care with proven success in Risk Adjustment. Confirmed track record in operations, program management and process improvement. Demonstrates effective leadership, innovative problem solving techniques, and goal oriented focus to execute business objectives and meet performance expectations. Designed and coordinated all team activities including provider education, training, auditing, data mining, and data analysis to steer program success and achieve performance metrics.

Jonathan Smith Former Senior Technical Advisor and Program Manager, RADV

Independent Consultant

Mr. Smith is a proficient economist and data scientist with decades of experience working within Medicare and Medicaid. Having spent 26 years at CMS in the Office of the Actuary and Part C payment areas, Jonathan has deep knowledge and experience with risk adjustment models and the Risk Adjustment Data Validation (RADV). Overseeing all contract-level RADV audits, he was intimately involved in rulemaking, related regulations, and the Part C payment error measurement. Since leaving CMS, he has worked with health plans, federal contractors and consultancies providing advisory services focused on risk adjustment, payment accuracy and risk mitigation. 

Lou Steinberg Senior Vice President, Payer Market Sales

Apixio

Lou Steinberg is SVP of Payer Markets with Apixio and has been with the organization for the past 8 years. Apixio is a Silicon Valley healthcare technology organization focused on advancing healthcare with AI-Powered analytics and intelligence. Apixio leverages proprietary technology, algorithms and AI to surface actionable insights that improve administrative, clinical, and financial outcomes for healthcare organizations nationwide.

Lou splits his time between Boston & San Diego and has 2 grown children. 

Scott Stratton MPH, Chief Data Scientist and VP, Product Analytics,

Pulse8

Scott Stratton is an industry leader in the design and development of analytic products and technologies that demonstrably improve health care quality and financial results. Scott joined Pulse8 in 2013 and is the chief architect of Pulse8’s predictive models, clinical inferencing logic, and Dynamic Intervention Planning, for which two patents are pending.

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

Rebecca Welling Associate Vice President

SelectHealth

Rebecca Welling is the Associate Vice President for SelectHealth, a not for profit Health insurance company serving over one million lives in the Utah, Idaho and Nevada regions.  Rebecca’s responsibilities include oversight of all risk adjustment programs pertinent to Medicare, Medicaid and ACA lines of business with focus on physician coding education, coder training and clinical documentation initiatives.  In addition, Rebecca’s team oversee encounter data submissions, and analytical analysis of related risk adjustment work. Rebecca also serves in a consultative role for Intermountain Health for risk adjustment related iniatiaves.

Jackie Wilson Health Insurance Specialist

CMS, CCIIO, PPFMG, DPA

Jackie Wilson works as a Health Insurance Specialist in the Division of Policy and Analysis within CCIIO’s Financial Management Group. She recently joined CCIIO as a Presidential Management Fellow, following completion of her master’s degree in public health. Prior to joining the public sector, she worked as a Senior Consultant at Booz Allen Hamilton, where she served on a variety of health care projects.