Rise

Jessica Assefa President & CEO

Ameropia Advisors, LLC

Jessica Assefa leads efforts to maximize outcomes for government regulated, Quality focused programs including Star Ratings, rewards & incentives, provider experience, value-based contracting, HEDIS, CAHPS, and HOS for ATRIO Health Plans’ multiple Medicare Advantage contracts in collaboration with key internal and external stakeholders.  

Prior to joining ATRIO Health Plans, Jessica served as the Senior Director over the Star Ratings consulting divisions for Gorman Health Group and Healthscape Advisors. She brings over 20 years of diverse experience and achievement in managed care, quality improvement and clinical operations. She has strong Medicare, Medicaid, Marketplace, and dual eligible programs knowledge.  Jessica is also an experienced national conference presenter on the topics of heath care quality improvement and Medicare Star Ratings with over 10 years of direct managed care experience including delegated case management oversight and quality ratings program leadership, in addition to her years of nursing experience in the states of MN, IN and NY, primarily focused on geriatric, disabled, and dual-eligible populations. 

Prince Baawuah, DrPH, MPH, CSM® Founder / Chief Tutor

The HEALS Academy

Dr. Prince Baawuah, DrPH, MPH, CSM®, has knowledge, interest and practical expertise in the field of Medicare Advantage Risk Adjustment and Encounter Data. As the Founder and Chief Tutor of HEALS Academy, he specializes in guiding healthcare providers and plans through the intricate processes of Medicare Advantage Risk Adjustment, leveraging his extensive experience and deep knowledge. Holding a Doctorate in Public Health from Johns Hopkins Bloomberg School of Public Health, with focus in Health Informatics and a Master of Public Health from the University of Michigan, Dr. Baawuah combines academic excellence with practical expertise, ensuring a comprehensive understanding of the Medicare Advantage Risk Adjustment operational policy landscape. 

At the Centers for Medicare & Medicaid Services (CMS), Dr. Baawuah distinguished himself as a leading authority in risk adjustment and encounter data policy operations and analytics. His 7+ years tenure at CMS was marked by significant contributions to the development and operationalization of Medicare Advantage Encounter Data for Risk Adjustment payments. Notably, his work in leading the Encounter Data Dashboard & Analytics (EDDA) project was groundbreaking, earning the prestigious FedHealthIT Innovation Award in 2018 and a CMS Honors Innovative Award in 2020. These accomplishments underscore his skill in creating analytic frameworks that enhance data accuracy and utility for risk adjustment purposes. 

Beyond his technical achievements, Dr. Baawuah is also renowned for his educational and training initiatives. He was instrumental in leading several CMS user group calls, site visits to give technical assistance, and industry training. He developed several Medicare Advantage Risk Adjustment resources, and teams in developing risk adjustment applications, which have greatly improved the understanding and efficiency of risk adjustment processes within the industry. His ability to distill complex information into accessible training and education programs makes him a sought-after speaker and educator. Dr. Baawuah's commitment to sharing his knowledge and insights ensures that health plans and providers are well-equipped to manage the challenges and opportunities in Medicare Advantage Risk Adjustment and encounter data management in a simple and easy fashion to understand and execute. 

John Barkley VP, Enterprise Risk Adjustment

Emblem Health

John Barkley is the Vice President of Risk Adjustment and Data Integrity for Emblem Health. Emblem Health is one of the nation’s largest nonprofit health insurers, with 3.2 million members and an 80 year legacy serving New York’s communities. Emblem family of companies includes ConnecitCare, Advantage Care Physicians Group and Well Spark Health. John is responsible for all risk adjustment operations, submissions and data integrity activities for Emblem and ConnectiCare. He has been with Emblem for 13 years and prior to that 21 years with Aetna in various financial roles, including leading risk adjustment operations. John started his career as a CPA working for Deloitte. John has been an attendee and presenter at many RISE conferences over the years. When not executing risk adjustment operations John enjoys boating, kayaking and fishing on Cape Cod Massachusetts where he lives.

Chris Bresette HHS Office of Inspector General

Jeremy Cale Browning, MBA, CPC, CRC Director, CDE Performance Management

Ochsner Health Network

Cale Browning, MBA, CPC, CRC is the Director of Clinical Documentation Excellence & Risk Adjustment for Ochsner Health Network, the Value-Based Care division of Ochsner. Cale has nearly 10 years of experience in Risk Adjustment in various roles such as Risk Adjustment Coder, MRA Frontline Lead, Manager of Risk Adjustment Education, and Director of Revenue Cycle on both the payer and provider side of healthcare. Cale started at Ochsner in October of 2020 as a Risk Adjustment Performance Improvement Manager tasked with building out the necessary Key Performance Indicators (KPIs), dashboards, and educational material for Executive Leadership then absorbed the Clinical Documentation Excellence Team in February of 2022. Since that time, Cale and the CDE Leadership Team have designed and implemented a state-of-the-art Ambulatory / Outpatient CDI Program that supports Primary Care and Specialty service lines with proven success within the first year, subsequently presenting their vision at several conferences and work groups since. 

Jeannine Bumford Director of Coding Operations, Risk Adjustment

Southwestern Health Resources

Jeannine Bumford has worked in the Risk Adjustment industry for over eleven years, beginning her journey in 2012 as a Risk Adjustment Auditor. She is currently the Director of Coding Operations for Southwestern Health Resources (SWHR). She has successfully built Provider Education, Coding, and Quality Assurance programs throughout her career. She was accepted into the SWHR inaugural class for Women in Leadership and holds Professional Coder (CPC) and Risk Coder (CRC) certifications. She lives in Waxahachie, Texas, with her husband and three girls.

Rafi Cices Head of Risk Adjustment, Coding and Billing

Cityblock Health

Deborah Curry Director Risk Adjustment & Recoveries

Paramount Healthcare/ProMedica Health System

Deb joined Paramount Healthcare in May 2013 and manages the Medicare, Medicaid, and Commercial Marketplace Risk Management Program. Additionally, she is a member of Paramount’s STARS/HEDIS/Medicaid Performance Improvement teams. Prior to her position with Paramount she had 21 years’ experience working with the State of Ohio workers’ compensation program, both for the government and a contracted managed care organizations. She came to Paramount with extensive knowledge in medical coding, provider billing and education, Medicare payment methodologies, quality assurance, and regulatory compliance. Deb attended The University of Toledo for both her undergraduate and graduate degrees and currently holds a Masters of Business Administration with major in Healthcare Systems Management. She is an active member of the American Health Information Management Association (AHIMA) and is a Registered Health Information Administrator (RHIA), Certified Coding Specialist, physician based (CCS-P), and an AHIMA-approved ICD10-CM Trainer. Deb is also an active member of the America Academy of Professional Coders (AAPC) and is a Certified Risk Adjustment Coder (CRC). Also, Deb is a member of RISE and holds certificates as a Risk Adjustment Practitioner (RAP) and Advanced HCC Auditor (AHCCA). Deb is blessed with one awesome husband of 29 years, three amazing children (one son-in-law), two adorable grandsons, and three beautiful granddaughters who all fill her life with a lot of joy, a little mischief, and a whole bunch of love. In her spare time, Deb volunteers at her church as a Team Captain in the Youth Ministry, is Board Member of the University of Toledo Health Information Administration Advisory Board, Health and Human Services Alumni Affiliate at The University of Toledo, and Health Information Technology Advisory Committee at Owens Community College.

Dr. Shannon Decker

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 Risk Adjustment Consultant

Choice Medical Group

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.

Tina Dueringer Vice President, Clinical & Quality

Rebellis Group, LLC

Eirinn Erny, M.D. VP / Medical Director – Clinical Documentation Excellence

Ochsner Health Network

Dr. Eirinn Erny, M.D. joined Ochsner Health in August 2019 with the Medvantage Clinic in Primary Care and Wellness at Ochsner Jefferson Hwy.  In January 2022, she transitioned to the Ochsner 65+ Clinic while working as a Physician Lead in Population Health. Prior to joining Ochsner Health, she was a Medical Director at a risk-based clinic. As of August 2022, Dr. Erny joined the OHN Clinical Documentation Excellence team as Medical Director while continuing to see patients at the Ochsner 65+ Clinic. She has worked with the CDE team to expand suspecting of HCCs, education of clinicians, and understanding of the BPA and metrics in practice. 

Colleen Gianatasio Director Clinical Documentation Integrity and Coding Compliance

Capital District Physician’s Health Plan (CDPHP)

Colleen Gianatasio CPC, CPC-P, CPMA, CPC-I, CRC has 18 years of experience in the health insurance field. She has experience in customer service, claims, quality and coding. As Risk Adjustment Quality and Education Program Manager for Capital District Physician’s Health Plan (CDPHP) Colleen’s primary responsibilities are provider engagement and clinical documentation improvement for accurate coding. Colleen specializes in developing innovative coding curriculum and instruction to support compliance with federal guidelines and appropriate reimbursement processes. She is a certified AAPC instructor and enjoys teaching a variety of coding, documentation and auditing classes. Colleen serves as President-Elect of the AAPC National Advisory Board.

Ana Handshuh Principal

CAT5 Strategies

Ana Handshuh, Principal at CAT5 Strategies, is a government programs executive with expertise in creating and implementing corporate programs for the healthcare industry. Her background includes Quality, Core Measures, Care Management, Benefit Design and Bid Submission, Accreditation, Regulatory Compliance, Revenue Management, Communications, Community-based Care Management Programs and Technology Integration. Ms. Handshuh currently serves on the Board of the Resource Initiative and Society for Education (RISE), the preeminent national professional association dedicated to managed and accountable care financing and delivery. She is a sought after speaker on the national healthcare circuit in the areas of Quality, Star Ratings, Care Management, Member and Provider Engagement, and Revenue Management. Her recent consultancy roles have included assisting organizations create programs to address the unmet care management needs in the highest risk strata of membership, document their processes and procedures, achieve accreditation status, design and submit government program bids, institute corporate-wide programs and create communications strategies and materials. She possesses sophisticated business acumen with the ability to build consensus with cross-functional groups to accomplish corporate goals. Ms. Handshuh served as the Vice President of Managed Care Services at Central Florida Inpatient Medicine (CFIM). In this role, she provided leadership and strategy on CFIM projects and collaborations with physicians, risk entities, hospital health care systems, and health plans. CFIM is the largest Hospitalist group in Central Florida, with 70 providers discharging over 50,000 patients annually from multiple hospitals across two health care delivery systems and 24 skilled nursing facilities. At CFIM Ms. Handshuh previously served as the Vice President of Operations. Prior to those assignments, she worked with Precision Healthcare Systems as their Vice President of Quality Improvement. In that capacity, she led the IPA’s Quality efforts and collaborated with payers on implementing programs to move the needle on Quality and Star Rating initiatives. Ms. Handshuh also served as the Director of Corporate Program Development at Physicians United Plan. In this role, she led the Quality Management and Corporate Communications departments and spearheaded the development of innovative integrated technology solutions to drive business excellence and Star Rating achievement initiatives. For the past fifteen years Ms. Handshuh has taken an active role in redefining and implementing changes that have led to improvements and greater efficiency within Government programs and healthcare delivery. Prior to joining Physicians United Plan Ms. Handshuh was the founder of I-Six Creative. Under Ms. Handshuh’s vision and leadership, I-Six Creative provided expertise in the areas of managed Medicare benefit design, MSO/IPA operations, provider network strategy, new market launches, technology integration, corporate communications and quality improvement.  

Eric Hansen Physician

Hansen Medical

Dr. Hansen currently practices in the High Desert area of San Bernardino County. He has been in independent practice, Family Medicine, since 2002. He has been involved in organized medicine the entire time he has been in practice. He was awarded his fellowship from the American Academy of Family Practice in Legislative Advocacy in 2017. He was recently elected to serve as the Vice Chair of the Board for the California Medical Association, representing all of the Independent Solo and Small Group Practicing physicians of California to the California Legislature through the CMA. He also serves on the Governing Board of the California Political Action Committee (CalPac), he serves as Vice Chair of the Legislative Commission for the San Bernardino County Medical Society, as well as serves on the Legislative Committee for Cap-MPT and on the California Legislative Committee for Aledade. Dr. Hansen is a past president of the San Bernardino County Medical Society from 2017–18, and serves as a clinical faculty member for Western University College of Osteopathic Medicine, and Associate Clinical Professor for the California University of Science and Medicine; School of Medicine. 

Jennifer Hawkes Government Funding Risk Programs Manager

Blue Cross of Idaho

Jennifer is a Risk Program Manager and a key player in vendor contracting, planning, developing, monitoring, and improving Medicare and ACA risk adjustment programs. She is responsible for the success of several risk adjustment prospective and retrospective programs. She brings over 27 years of experience in the health insurance, auditing and healthcare industries and holds certifications in professional and risk adjustment coding. She’s been focused on Risk Adjustment since 2017 and enjoys the challenge of improving member’s health outcomes and creating understanding. Her current focus is on strategic planning around member education and adoption of risk adjustment activities and collaboration with other stakeholders to combine efforts and maximize outcomes. 

She is also passionate about bringing understanding, education, and awareness to managing type 1 diabetes and living an active love and laughter filled life. 

Chanda Hinton Founder and Executive Director

Chanda Center for Health

When you look into the face of Chanda Hinton, you see vitality and radiant health; you see a young woman with passion and determination; you see a person of strength and purpose. If you glance down from her face, you will see her wheelchair, and you realize that the goals of the nonprofit organization she founded 17 years ago. You will see that her role is rooted in her own personal story.   

Chanda is the Executive Director of the Chanda Center for Health and Chanda Plan Foundation, which provides access to holistic, collaborative, access and disability competent healthcare programs to individuals with physical disabilities.  In 2009, she led the movement to pass Colorado House Bill 1047, which created the Spinal Cord Injury (SCI) Waiver, offering acupuncture, massage, and chiropractic care through Medicaid to evaluate cost-effectiveness and improve quality of life for persons with spinal cord injuries in the Denver metro area. In 2021, she expanded these services legislatively to other diagnosis and to be a statewide benefit.   

In addition to her work (passion), Chanda presents extensively to diverse audiences about wellness and disability.  Her previous honors include the 2008 Unsung Hero Award from Mayor Hickenlooper in honor of Denver’s 150th anniversary, 2010 Health & Wellness Award from the Commission for People with Disabilities, 2015 Kathy Vincent award from the Colorado Cross Disability Coalition, 2015 Diversity Award from Mayor Hancock, 2017 Denver Business Journal 2017 40 under 40 honoree, 2019 Linda Andre Lifetime Trailblazer Award from the Colorado Fund for People with Disabilities and 2019 AMTA National Government Relations Activist Award, Colorado Women's Chamber 2020 Top 25 Powerful Women  

Chanda is from Nebraska and has a bachelor’s degree in Communications from the University of Denver and recently earned a Masters in Non-Profit Management from Regis University.  In her spare time (wait, what spare time?), she enjoys cheesy ‘80s chick flicks, intense conversations with people in community and spending time with loved ones.    

Chanda Center for Health: Deliver and advocate for integrative therapy, primary care, and other complementary services to improve health outcomes and reduce healthcare costs for persons with physical disabilities. https://chandacenter.org/  

Kacey Holman Manager, Risk Adjustment Consulting

Pareto Intelligence

Kacey Holman is a Manager for Risk Adjustment Consulting at Pareto Intelligence bringing over 18 years of healthcare experience in areas including HCC compliance, medical record auditing, provider engagement, coding education and operational strategy. Kacey has worked on both the plan and provider sides implementing and managing risk adjustment program capabilities. In her current role, Kacey focuses on providing guidance to health plans and value based care entities on risk adjustment best practices for government programs including MA, PACE, ACA and Medicaid.

Stan Hornebacher Director, Risk Adjustment

Blue Shield of California 

Stan leads Blue Shield of California's risk adjustment team by leveraging member and provider engagement to drive prospective programs for risk and quality.  He brings over 25 years of healthcare experience in areas of risk adjustment, quality, chart retrieval, provider partnership and education, and vendor relations. He oversees risk adjustment programs for Medicare, ACA, and Medicaid.  His focus is on innovative solutions to ensure both members and providers have the tools needed to drive risk and quality performance.  He has designed and implemented strategic risk/quality programs to improve both patient outcomes and provider communication.

Ava Johnson Manager, Ambulatory CDQI

Mount Sinai Hospital, NYC

Ava Johnson comes from a colorful background as an experienced Risk Adjustment and multi-specialty Medical Coding instructor, auditor, and CDI expert. Being a teacher at heart, Ava’s goal is to help industry medical coders and documentation specialists understand the weight of their impact in the risk adjustment world and realize their truest potential, both professionally and personally. Ava’s passions also include music and the arts.

Ekaette Joseph-Isang MD, MBA, MPH Principal Consultant

RiteBridge

Dr. Ekaette Joseph-Isang is a subject matter expert in population health and value-based care with over 20 years combined experience in payor-provider strategy.

Her expertise cuts across population health, risk adjustment, healthcare quality, and healthcare innovation. Her specialty is in serving as a bridge between payers and providers and supporting  organizations in getting their providers the tools,  resources, and education that they need to stay competitive and efficient in the value based care space.

She is certified across multiple professional organizations in the risk adjustment, CDI, coding, and healthcare quality and is highly sought after for healthcare strategy and operations consulting.

Carolyn Kapustij HHS Office of Inspector General

Jimmy Liu VP Analytics and MRR Solutions

Advantmed 

Donna Malone Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP Director Risk Capture, Population Health Management

Mass General Brigham

Donna Malone, CPC, CRC, is formerly the Director Ambulatory Clinical Documentation Quality Improvement (CDQI) with Mount Sinai Health System,  Adjunct Professor with MassBay Community College, Chair of the RISE Risk Adjustment Academy HCC Coding Faculty Advisory Group and President of the Watertown AAPC Chapter

Previously, she worked for Tufts Health Plan in their enterprise risk adjustment division for seven years with as  Director Enterprise Risk Adjustment Coding and Provider Education, and was responsible for audit and coding review management, development and implementation of department and vendor policies and procedures, development of provider and coding training materials, implementation of provider system education and process review, government audits (CMS RADV, HHS RADV, OIG), coding team performance management. 

Additionally, Donna serves at the MassBay Community College in Framingham, where she has been an advisor and adjunct professor currently in her 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 Director of Commercial Market Strategic Integration

Florida Blue

Melissa McVaugh Director, Clinical Operations

Mountain Health CO-OP

With over 20 years of diversified experience, Melissa McVaugh is a proven leader in the healthcare industry. Melissa is a foundational part of the Mountain Health Co-Op, where she serves as the Director of Clinical Operations. In this pivotal role, Melissa oversees clinical operations, including risk adjustment, medical management, claims and payment integrity for three states. Using her deep operational knowledge, she has leveraged her nearly 20 years of experience to improve risk scores, quality metrics, member and provider experience, and outreach. By focusing on the relationships between data, quality, and risk adjustment, Melissa has put her knowledge to good use. Her passion for member-driven care has led Mountain Health Co-Op to adopt many signature benefits available to all members, like access to zero-cost insulins, heart medications, anti-depressants, and more. Melissa was applauded by the Co-Op for helping implement a 24/7 telehealth option that proved to be life-changing during the pandemic. Over the years, her strengths at Mountain Health Co-Op have garnered recognition for the success of the risk adjustment program. Strategic changes to associated programs generated results that exceeded National benchmarks. A proven leader in her field, Melissa’s professional experiences include consulting services, auditing, coding, and mentoring graduate nursing students and new leaders.

Christina Medrano Sr. Director ACA Risk Adjustment Operations

Florida Blue

Jenni Monfils AVP, Risk Adjustment Coding and Compliance

Molina HealthCare

Jenni Monfils, CPC, CDEO, CRC has over 20 years of healthcare experience in revenue cycle, coding, and documentation improvement. She is an accomplished risk adjustment professional with extensive experience in both the Medicare and HHS HCC model plus Medicaid. Jenni specializes in developing provider risk adjustment education and HCC quality oversight programs to ensure compliance. She has project managed HHS-RADV audits, Medicare Advantage Contract Level RADV audits and Part C Improper Payment Measure (National RADV) audits. Jenni demonstrates effective leadership and innovative problem-solving skills to plan and execute the necessary oversight in the everchanging risk adjustment space.

Amy Page Vice President, Growth

Greater Good Health

Amy Page is Vice President of Growth at Greater Good Health, where she is focused on developing and executing innovative and effective partnerships with risk-bearing entities across the spectrum of value-based care. With 15+ years of experience across the healthcare industry, Amy has built workflows and programs for Medicare, Medicaid, commercial insurance, and corporate enterprises in a variety of disciplines, including medication adherence, women’s health, musculoskeletal care, and caregiver support. Throughout her career, Amy has focused on member engagement, improving clinical outcomes, and delivering an excellent experience for partners, providers, and patients.

Scott Roeber Manager, Client Services

Episource

Scott has led the Episource Payer Client Success team for the past 5+ years, having been in healthcare related customer engagement roles throughout his entire career. Driven by a passion to serve his clients and a desire to sincerely understand their individual challenges related to Risk Adjustment, Scott provides the connection to creative solutions and establishes the conduit to strategically interact with SMEs across platforms, tools, and services within Episource.

Corrina Rottum Director, Clinical Documentation Integrity

Panoramic Health

Corrina has been working in healthcare for 22 years. Her experience includes all phases of coding, compliance, revenue cycle, auditing, monitoring, and education. Corrina has managed and developed risk adjustment programs for 8 years.  Currently, Corrina is the Director of Clinical Documentation Integrity at Panoramic Health, the leading integrated Nephrologist led group managing patients in Medicare’s Value Based Chronic Kidney Care Choices program. Corrina is currently responsible for oversight of the CDI program at Panoramic which supports prospective chart reviews and retrospective risk adjustment compliance reviews for their nationwide network of Nephrologists.

Masha Sciolla VP, Customer Experience

Porter

Laura Sheriff 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. 

Khush Singh Risk Adjustment & Value-based Care, Program Operations and Compliance

Bulwark Health

Khush Singh, MD is a trained clinician and an experienced healthcare management executive with more than 15 years of health information management (HIM) and CMS Managed Care (Medicare & Medicaid) regulatory experience. Khush focuses on helping his clients through his expertise in Medicare risk adjustment and coding compliance, specifically assisting medical providers succeed in value-based care programs while staying compliant under the Medicare Part C program guidelines and other APMs (Alternate Payment Models).

Khush has a passion for working with clinical data models that leverage healthcare data to improve patient lives and help medical providers serve their patients in a meaningful way. He started his HIM career by managing clinical study data for industry-sponsored FDA clinical trials. He also led the risk adjustment coding and compliance teams, often acting a liaison between medical providers and the managed care business world.

While serving as a senior leader on risk adjustment teams at number of MA health plans, he oversaw Medicare, Medicaid and commercial ACA risk adjustment efforts. He has also worked as a consultant providing physician practices with HCC coding education and quality and value-based care HIM expertise. Specifically, he has helped clients refine their HCC coding recapture workflows, resolve EDPS submission-related problems, and leveraged the clinical documentation improvement process to recapture appropriate and accurate HCC risk scores for the Medicare & Medicaid lives under management.

Khush has also served as a senior executive at a healthcare technology vendor company. While there, he engaged with risk adjustment and finance executives at several large national MA, Medicaid and commercial health plans and large physician group ACOs, to improve their risk adjustment coding and documentation workflows focused on optimizing risk revenue streams while maintaining compliance with CMS risk adjustment data validation (RADV) guidelines.

Mandvi Tandon Executive in Risk Adjustment & Quality

Kei Shoa Tikkanen Manager, BoI Strategic Initiatives

Cityblock Health

Corrina has been working in healthcare for 22 years. Her experience includes all phases of coding, compliance, revenue cycle, auditing, monitoring, and education. Corrina has managed and developed risk adjustment programs for 8 years.  Currently, Corrina is the Director of Clinical Documentation Integrity at Panoramic Health, the leading integrated Nephrologist led group managing patients in Medicare’s Value Based Chronic Kidney Care Choices program. Corrina is currently responsible for oversight of the CDI program at Panoramic which supports prospective chart reviews and retrospective risk adjustment compliance reviews for their nationwide network of Nephrologists.

Chris Trygstad Vice President, Product

Biomedix

Vijaya Vishwanathan Director, Product

Episource

Vijaya leads Episource’s risk adjustment and analytics platform by leveraging technology and data to provide insights and segmentation into healthcare data, helping manage interventions efficiently, and thereby providing better patient care. She brings in-depth knowledge of Medicare Advantage, Medicaid, and other programs from her experience with health plans in various functions. 

Nick Volpe Sales Director

Wolters Kluwer, Health Language 

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

Baylor Scott and White Healthcare 

Monica Watson Corporate Coding Director

Allegheny Health Network

Adrian White RN, MBA, CPPS, CPXP VP - Quality Operations, Clinical Safety & Patient Experience

Southwestern Health Resources

Adrian is an influential, people-centric executive who bridges gaps and drives results across clinical, safety, quality, and patient experience workflows through cross-functional collaboration, emotionally intelligent people management, and business acumen. He received his nursing degree from the Royal College of Surgeons in Ireland, an MBA from University College Dublin, and is a Certified Professional in Patient Safety (CPPS) and in Patient Experience (CPXP). He has been active in the areas of Clinical Care, Quality, Safety, Accreditation and Patient Engagement for over 20 years, having worked at St. James’s Hospital in Dublin, Mayo Clinic Health System in Minnesota, UT Southwestern in Texas in 2013 before joining Southwestern Health Resources (SWHR).

In his former role as the VP for Quality Operations, Patient Experience and Clinical Safety, his service lines blended the strengths of University of Texas Southwestern Medical Center and Texas Health Resources; includes a network of 29 hospital locations and more than 5,000 physicians, committed to being the national leader in population health. Adrian’s role focused on strategies to develop, deploy and sustain comprehensive programs across the multi-specialty SWHR Clinically Integrated Network, leading the strategic direction of this large-scale matrixed organization. Currently Adrian in an independent consultant partnering with organizations focused on Value Based Care (VBC).