Item 68 Stars Market Operations West Region Lead

Cigna

Su Bajaj Senior Vice President Product Development

Episource

Su Bajaj is Episource’s Senior Vice President of Product Development. Su has built extensive solutions for payers, including ACOs, Medicaid, MA, and the ACA exchange. She uses technology to integrate Revenue Programs with Quality and Care Management while maintaining a dedication to adding value to the beneficiary's experience with the health plan through those solutions. Su has a Bachelors in Economics from Northeastern University in Boston, MA and is a Six Sigma Yellow Belt.

John Barkley VP of Risk Adjustment

Connecticare/Emblem

John Barkley is the Vice President of Enterprise Risk Adjustment and Data Integrity for Emblem and ConnectiCare. John has been with the enterprise for nine years. Prior to joining Emblem John was with Aetna for twenty one years with the last six years in the risk adjustment space. John has been an attendee and presenter at RISE events for several years now. When not executing risk adjustment activities he enjoys kayaking, biking and fishing on Cape Cod, Massachusetts where he lives.

Fred Bentley Managing Director

Avalere | an Inovalon company

Fred Bentley advises clients on health delivery and payment innovation, providing analytic and strategic insight on issues related to the delivery of care.As an expert in fields ranging from payer strategy to hospital–physician alignment and post-acute care, he has worked with providers, including integrated delivery networks, academic medical centers, post-acute providers, and long-term care organizations as well as national and regional health plans. Over the past 5 years, his work has focused on supporting health systems engage in Medicare and Medicaid payment and delivery system transformation initiatives.Prior to joining Avalere, Fred was a principal in the Accountable Care Solutions practice at The Chartis Group. In this role, he worked with leading hospitals and health systems in developing strategic roadmaps to guide their clinical innovation, population health, and cross-continuum integration initiatives. He also served as a managing director with The Advisory Board Company, managing a team of consultants and analysts who supported provider organizations ranging from physician groups and health systems to post-acute care providers.Fred holds an MPP and MPH from the University of California, Berkeley, and a BA in political science from Haverford College.

Laurence Bishoff President 

Laurence Bishoff & Associates

Richard Bitting VP, Actuarial Informatics

Jefferson Health/Delaware Valley Accountable Care Organization

Richard Bitting has been a member of the Jefferson Health System team since June of 2015. Prior to joining Jefferson Rich served the Geisinger Health System in a variety of capacities for 29 years. Rich has extensive experience and understanding of both the Provider and Health Insurance segments of Healthcare. He has both led and created multiple start-up decision support and informatics teams. He currently leads a multi-disciplinary team of analysts supporting Quality reporting, Medical Cost analytics, Risk Score Optimization, Leakage/Keepage analytics, Population Risk Stratification, Patient Assessment/Coordination and ACI Regulatory Reporting.Mr. Bitting leads and/or serves a variety of teams at Jefferson Health and DVACO. The groups include payor specific Value Based Purchasing Negotiating, Health Affairs, Payment Innovation, Network Performance and IT Steering. Together these teams make certain we have everything needed in place to assure appropriate KPI transparency, strategy development and performance management of our VBP contracts. In support of the Population Health Chassis, Rich’s team is accountable for all Value Based Purchasing analytics at the DVACO.

Matt Bowden Manager of Risk Adjustment

Hometown Health Plan, Inc.

Professional
Worked for Hometown health for 5 years
The majority of roles were in data analytics, now I manage our risk adjustment processes

Educational
Have dual B. S Degrees in Finance and Economics
Graduated from Grad school with a M.S in Economics.

Personal
Born and raised in Reno Nevada
Married 5 years
Have two daughters one is 3 the other is 11

Keith Brophy Director, Business Lab Product Team

Emergent Holdings

Keith Brophy is Director of the Business Lab Product Team for Emergent Holdings Inc. which creates innovative healthcare solutions for use by health care organizations. Keith has served in a variety of leadership roles across the business and health technology industry, including State Director of the Michigan Small Business Development Center; CEO of Ideomed, a Medicaid focused chronic disease management digital solution; and founder and CEO of Sagestone, a nationally focused software developer with strong focus in healthcare. Keith is a former West Michigan Entrepreneur of the Year, started in the industry at IBM, has presented at U.S. House Subcommittees on Digital Innovation, and has been a national speaker on Future Trends for two decades. Keith has a Bachelors of Science in Computer Science from the University of Michigan, and a Masters of Information Systems from Strayer University.

Timothy Burke Chief Compliance Officer

Radiology Partners, Former National VP Medicare Risk Adjustment and Coding

Tim has over 15 years of professional experience in health care operations and regulatory risk management.  A strategic and forward-thinking business executive, Tim has a proven track record of success in managed care operations, risk adjustment strategies, coding and documentation programs, regulatory compliance, and consulting and business advisory services. Throughout his career, Tim has demonstrated effectiveness as a leader with an ability to build and coach teams that deliver integrated and optimal results.

In his current role as Chief Compliance Officer at Radiology Partners, the largest physician owned and led radiology practice in the U.S., Tim oversees all aspects of regulatory compliance for both inpatient, outpatient, and value-based operations, including direct responsibility for coding and audit activities.

Dawn Carter Director, Product Strategy

Centauri Health Solutions

Dawn Carter is a Director of Product Strategy at Centauri Health Solutions, LLC. Her career in healthcare spans 26 years, which most recently includes extensive experience in developing revenue integrity and quality software solutions, with a focus on encounter management and risk adjustment solutions for Medicare Advantage, Medicaid and Commercial health plans. Prior to that, her experience spans all domains of health care including health plan and provider systems administration, and healthcare applications development. Her experience also includes multiple teaching engagements in medical administration, billing and coding. Dawn holds a Bachelor’s degree in Business Administration. She is a passionate and prolific industry speaker, author, blogger and subject matter expert in claims, EDI management, and risk adjustment.

Stacy Coggeshall Vice President of Risk Adjustment

Fallon Health

Stacy is the Vice President of Iora Health’s Medicare Risk Operations. Prior to joining Iora, she spent 5 years as the Director for Prospective Business Operations at Optum and was responsible for the Prospective Program updates, readiness and execution of products designed to assist providers in closing clinical and quality gaps in care for Medicare Advantage, Medicaid and Commercial Exchange members. Stacy has over 12 years’ experience serving in different roles within Medicare Advantage Risk Adjustment. She is also spent 4 years at the Centers for Medicare and Medicaid Services and was a registered nurse caring for liver and kidney transplant patients at Johns Hopkins Hospital. Stacy has received a Bachelor’s of Science from Cornell University and a Bachelor of Science in Nursing, a Master’s of Science of Nursing and a Master’s of Business Administration from Johns Hopkins University.  

David Costello Ph.D., Senior Vice President, Risk Adjustment & Innovation

Cotiviti

David is responsible for leading analytic efforts for Cotiviti as well as new market facing solutions. He works closely with the Product, Consulting, Data Operations, and Client Engagement teams to ensure that Cotiviti’s proprietary analytics help our clients meet their business objectives and remain relevant in the industry.

Prior to joining Cotiviti, David was the chief analytic officer at Press Ganey. He was responsible for building a set of analytic products that allowed hospitals and provider groups to enhance patient experience, solidify their reimbursements, and identify areas for process improvement and revenue enhancements. David also previously served as SVP of consumer segmentation and engagement strategies at Health Dialog, where he was responsible for building and implementing strategies that targeted, activated, and engaged members related to their specific health conditions.

David holds a B.A. in Business Administration and Sociology from Northern Michigan University and a M.A./Ph.D. in Sociology from the University of Delaware. He also served for four years in the United States Air Force.

Sean Creighton Vice President of Federal Policy

Humana

Sean Creighton serves as vice president for Federal Policy at Humana, a leading health care firm. Sean provides leadership in the development and implementation of federal policy strategy. Prior to Humana, Sean works for 3 years as Managing Director and head of policy analytics at Avalere, a premier consulting firm focused on health care. Sean led projects in a number of key areas, Part D reform, risk adjustment and RADV, and analysis of Medicare Advantage performance relative to FFS on cost, quality and utilization. Sean also spent 2 years as SVP for risk adjustment product at Verisk Health (now Cotiviti) working on data aggregation, coding, and submission products for Medicare and the commercial market to ensure appropriate revenue and elevate performance. Before joining Verisk Health, Creighton was the deputy group director of the Payment Policy and Financial Management Group in the CMS Center for Consumer Information and Insurance Oversight. He also served as the director of the division of Payment Policy and Risk Adjustment in the Medicare Plan Payment Group in the Center for Medicare. While at CMS, Creighton was responsible for payment policy and operations for both private marketplace and Medicare plans. Notable accomplishments include developing and implementing a system to make advance premium-tax credit and cost-sharing reduction subsidy payments to marketplace issuers under the Affordable Care Act; developing and implementing Parts C and D risk adjustment models; and serving as the sponsor and chief architect of the Medicare Encounter Data System (EDS). Creighton holds a Bachelor of Arts degree in European studies from the University of Limerick, a Higher Diploma in Statistics from Trinity College, Dublin, a Master of Science degree in Sociology from the London School of Economics, and conducted doctoral research at Indiana University, Bloomington. He has won numerous awards for development and implementation of risk adjustment and payment models.

Shahyan Currimbhoy Head of Product

Talix

Mr. Currimbhoy is an experienced healthcare executive and has led teams to createinnovative product and services to drive growth. Mr. Currimbhoy is a seasoned productleader with experience in conceptualizing and launching new products to market andenhancing existing products. Prior to joining the Company, he was VP, ProductManagement at Healthline. Prior to that, Mr. Currimbhoy worked for Caradigm USA,LLC, Microsoft Corporation and Siemens Healthcare. He holds a master’s degree inSoftware Engineering from Carnegie Mellon and a bachelor’s degree in ComputerScience from Cornell University.

Deb Curry MBA, RHIA, CCS-P, CRC, 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 SVP of Healthcare Analytics and Risk Adjustment Solutions

Gorman Health Group (GHG)

Jeff De Los Reyes is a Senior Vice President of Healthcare Analytics and Risk Adjustment Solutions at GHG. In this role, health plans and providers look to Jeff to provide Consulting services to enhance, optimize, and ensure superior outcomes related to revenue accuracy and compliance across all Government and State Sponsored Programs (Medicare, Medicaid, and ACA). Jeff brings over 15 years of healthcare experience focusing on all areas of risk adjustment including developing comprehensive and complementary retrospective and prospective programs, ensuring accurate and complete encounter data submissions, and supporting revenue projections for Actuarial and Financial reporting. Prior to joining the GHG team, Jeff was responsible for enterprise risk adjustment, revenue management and encounter data submissions at EmblemHealth, and prior to EmblemHealth Jeff spent 8 years at Optum in a variety of risk adjustment roles at OptumInsight including leading product and program strategy, provider engagement and client services. Jeff received his MBA from the University of Connecticut and a Master’s degree from Boston University.

Shannon Decker Vice President of Clinical Performance

Brown and 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.

Duane DiFranco MD, Vice President of Medicare Stars and Clinical Performance

Blue Cross Blue Shield of Michigan

Duane J. DiFranco, MD, is a board-certified psychiatrist and Vice President of Medicare Stars and Clinical Performance for Blue Cross Blue Shield of Michigan. DiFranco has been active within managed care for the past 20years. During his tenure as an Assistant Clinical Professor of Psychiatry at the University of Michigan, he led a managed behavioral health care organization through its first National Committee for Quality Assurance accreditation, as well as oversaw the addition of behavioral health services at Blue Care Network, Michigan’s largest Health Maintenance Organization. Beyond managed care, DiFranco has extensive expertise in utilization management, provider relations, medical policy, and quality improvement. He holds positions on several boards of charitable organizations including President of the Michigan Psychiatric Society, a professional organization devoted to education, research, and advocacy of quality care for people with mental disorders. DiFranco is a graduate of the University of Notre Dame and earned his Doctor of Medicine degree from the University of Michigan, where he completed his residency training in psychiatry.  

Hemanth Doma Senior Director, Product Management

Inovalon

Hemanth Doma has product management responsibilities for Inovalon’s Data Visualization and Reporting platform, also called INDICES®. In his current role, Hemanth and the team are responsible for analyzing healthcare data visualization market dynamics and trends, discovering market needs, and developing product strategy and roadmap for INDICES. Before his current role, Hemanth led healthcare data analytics for Inovalon’s Quality Improvement solution and was responsible for quality gap identification, predictive modeling, member prioritization, quality rating forecast, and intervention planning. Hemanth joined Inovalon in October 2010.

Before joining Inovalon, Hemanth Doma worked in several technology roles such as software development, technology consulting, data analysis, and product management from 2001 to 2010 at various technology companies including IBM, RedHat, and Arlington VA based technology company, Expert Choice.

Hemanth Doma received his master’s in Business Administration from Kenan-Flagler Business School, University of North Carolina and received his bachelor’s degree in Computer Science from Bangalore University, India.

Diane Escandell RN, CPC, Senior Director, Provider Engagement

Pulse8

Diane is a Registered Nurse, and has over 25 years of healthcare experience, which includes 16 years of population management in an integrated delivery system. Diane has extensive experience as a registered nurse with proven leadership and professional experience in health plan risk adjustment, quality, and case management. Diane earned her diploma of Nursing from Jackson School of Nursing in Miami, Florida. Diane is also a Certified Professional Coder (CPC) and a Certified Case Manager.

Sanji Fernando Senior Vice President AI & Analytics Platforms

OptumLabs

As senior vice president of AI and analytics platforms at Optum Labs, Sanji is responsible for the design and development of leading-edge AI models and analytics for the UnitedHealth Group enterprise, as well as the platforms needed to accelerate the development and deployment of these solutions.

Previously, Sanji led the OptumLabs Center for Applied Data Science (CADS). The CADS team applied breakthroughs in AI and machine learning to solve complex health care challenges for UnitedHealth Group by developing and deploying new software product concepts.
Prior to joining UnitedHealth Group in 2014, Sanji worked at Nokia, where he created their first data science team. Before that, Sanji spent nine years at Nokia in various corporate roles with Nokia’s Multimedia Division, Nokia Research Center and Nokia Ventures. Sanji was also a co-founder and VP of Engineering at Vettro, a venture-backed mobile software company. Sanji began his career in consulting with Viant and Accenture.

Sanji is a graduate of Trinity College with a bachelor’s degree in computer science. He lives in the Boston area with his wife and their three boys. In his free time, Sanji enjoys coaching his sons in basketball and baseball.

Paul Gandolfo Vice President and Finance Officer – Value Based Payment and Risk Adjustment Programs

Excellus

Paul Gandolfo is the Vice President, Population Health Engagement Strategic Programs with responsibility over Value-Based Payment, Risk Adjustment, and Affordability Programs at Excellus BlueCross BlueShield, a large regional health insurance plan based in Central and Western New York with over 1.5 million members and $5B in revenue.  

In this role, Paul is responsible for overseeing the success of Excellus Health Plan’s Value-Based Payment programs, the medical cost management program development life cycle, as well as all components of the organization’s Risk Adjustment programs for Medicare, Medicaid, and Commercial lines of business.

Paul joined Excellus BlueCross BlueShield in November 2017.  Prior to his role at Excellus, Paul held leadership positions at EmblemHealth and BlueCross BlueShield of Western New York.  Over the course of his tenure at those organizations, his responsibilities included at any point in time, network management, risk adjustment, medical economics, and line of business financial leadership. 

Paul is a licensed Certified Public Accountant (CPA) in the State of New York and started his career in the public accounting industry, managing auditing and consulting engagements in New York City for Life and Health insurance customers.       

Paul obtained his Bachelor of Science in Accounting and Management Information Systems from the Binghamton University School of Management.

Paul and his wife, Sydney, reside in Brighton, New York and have two children, Joanna and Louise.

Colleen Gianatasio Director of Ambulatory CDQI

Mount Sinai Health Partners

Colleen Gianatasio CPC, CPC-P, CPMA, CPC-I, CRC, CCS, CCDS-O has over 20 years of experience in all aspects of the business of healthcare. As Director of Ambulatory CDQI for Mount Sinai Health Care Partners she is responsible for 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 is President - elect of the AAPC National Advisory Board.

Wayne Gibson Senior Managing Director, Health Solutions Practice

FTI Consulting

Wayne Gibson is a Senior Managing Director at FTI Consulting and is based in Washington, DC. He is part
pf the Health Solutions segment. He has 20 years of experience applying economic and financial
modeling, data‐intensive analysis, and complex claims analyses across numerous industries and in a
variety of operational, dispute and compliance matters.
He has assisted health plans, providers, pharmaceutical manufacturers and PBMs with in a variety of
matter types including operational improvement and compliance consulting, nationwide class‐action
litigation, Medicare and Medicaid false claims and sales and marketing investigations, investigations by
other government agencies, and arbitration matters. Significant types of matters Mr. Gibson has worked
on include:
Risk Adjustment Operational Improvement and Compliance Assessments – assisted Medicare Advantage
plans, ACA exchange‐based plans, trading partners/vendors, and providers under risk contracts in an
end to end assessment and redesign of work flows and data flows, policies and procedures, controls,
reporting and forecasting related to their Medicare Advantage and risk adjusted populations. Has also
performed reviews of systems and programming logic used to filter encounters to assess compliance
with Medicare Advantage and Managed Medicaid requirements. Has worked with clients to develop and
implement interim and ‘bridge’ applications that provided added functionality in managing populations
subject to risk adjustment. Has supported plans in RADV and other regulatory reviews.Has assisted in
contractual disputes regarding payments from health plans to provider groups under shared risk
agreements.
Medicare and Medicaid Investigations ‐ assisted a variety of clients including health plans,
pharmaceutical manufacturers, institutional providers, diagnostic lab testing companies, and their
outside counsel in responding to governmental investigations and in conducting internal investigations
related to Medicaid and Medicare false claims and fraud and abuse issues as well as how these issues
may impact statutory and SEC reporting. These investigations encompass issues such as reimbursement,
pricing, Medical Loss Ratios and cost reporting, and sales and marketing. As part of these investigations
has assisted clients and their counsel in discussions with the DOJ, OIG, state Medicaid and regulatory
agencies, and the SEC.
Compliance and Operational Reviews – assisted a variety of clients with compliance reviews related to
Medicare Advantage, Fee for Service Medicare and Medicaid programs. He has also performed other
contractually‐mandated reviews, and operational assessments of controls, data and information
systems, and relationships with third parties/sub‐contractors.

Mike Grodus Director of Healthcare Transformation

Medical Advantage Group

A highly effective health care manager with more than 25 years of experience working with providers and insurers, Michael Grodus, director of health care transformation at Medical Advantage, provides management services and performance improvement guidance for Professional Medical Corporation, a physician organization in Flint, MI. Under Mr. Grodus’ leadership, Professional Medical Corporation has earned tens of millions in value-based reimbursement for providers and the ACO is among the top in the nation for quality and cost savings. An expert in provider network development, reimbursement methods and contracting, as well as financial administration of physician organizations, hospitals and managed care entities, Mr. Grodus skillfully guides physician organizations toward more cost-effective care and reimbursement strategies that lead to value-based health care delivery. 

Prior to joining Medical Advantage, he was vice president of health care network strategy for the Capital District Physician Health Plan in Albany, New York, where he was responsible for provider network strategy and development, service area expansion, reimbursement and cost savings, as well as negotiating and contracting with a provider network of more than 70 hospitals, 14,000 physicians and ancillary providers. Mr. Grodus has also served as director of network development and contracting for Priority Health and previously held a similar position with M-Care. He also was controller and subsequently chief financial officer for the physician organization Oakland Physician Network Services, where he established and maintained the financial services department. He also held management positions at the Detroit Medical Center for seven years, serving as director of finance for Children’s Hospital of Michigan and as manager of finance for DMC Coordinated Health Care, the DMC’s managed care contracting entity, and three affiliated independent physician associations. 

Mr. Grodus received a bachelor of science degree in administration from the University of Michigan-Dearborn and a master’s in business administration from Wayne State University. 

Adam Gronsky Chief Innovation Officer

Health Fidelity

With a passion for synthesizing data into actionable information, Adam helps Health Fidelity clients realize their full potential through the careful application of technology guided by analytics. Adam came to Health Fidelity in April 2015 from UPMC’s Technology Development Center, where he concentrated on medical intelligence solutions for CDI, quality management, and risk adjustment that leveraged natural language processing.
With experience that spans all three sectors of health care – payer, provider and health system, he’s often one of our clients’ most trusted advisors, a role that motivates him to think beyond our current offerings and consider ways to reshape the way in which clinical risk is understood and managed. Health Fidelity’s culture of controlled innovation and exploration is what Adam enjoys most about his work.
A Pittsburgh native, Adam holds a Master’s degree in Health / Health Care Administration / Management from Duquesne University and manages the innovation team. In the future, Adam’s long-term ambition is to bring together and align business with technology and create the next model of healthcare delivery.

Marcia Guida, MS-CH, MBA, MS-HP, CPC Senior Director, Provider Technology Ecosystems

Aetna CVS Health

Marcia Guida is a healthcare executive with over thirty years of health plan and provider/practice management experience in value-based programming, health systems administration and health policy.  She has extensive health plan and provider experience with developing, building and managing provider relationships, provider engagement and payment reform activities in commercial, Medicare Advantage and Medicaid lines of business.  Ms. Guida is recognized as a leader in the development of strategy, implementation and operations of health care reform and value-based activity including medical/health home, population health, risk and accountable care models.   She also has extensive experience with the development of managed care contracts to support the transition to a value-based environment.

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.

Elizabeth Haynes Director, Risk Adjustment and Stars Govt Programs

Blue Cross Blue Shield of Kansas City

Liz Haynes is the Director Risk Adjustment & Stars- Government Programs at Blue Cross and Blue Shield of Kansas City (Blue KC). In this role, Liz manages the operations, oversight, strategic direction of Risk Adjustment and Star functions for Blue KC’s Medicare Advantage and Affordable Care Act health plans. These government-sponsored lines of business contribute significantly to Blue KC’s mission to provide affordable access to healthcare.

Liz has an extensive background in healthcare with experience ranging from bedside nursing to provider engagement on behalf of national payers. Prior to joining Blue KC in 2018, Liz served for seven years in Risk & Quality at Optum Insight and eleven years with BJC HealthCare.

Liz is a respected expert in government programs Provider Engagement, Stars and Risk Adjustment.  She manages comprehensive solutions for overall contract performance and is actively involved in several healthcare initiatives bridging health care and health insurance.  She has experience with taking several Medicare Advantage contracts to 4 Star.

Liz earned both a Bachelor & Master of Nursing from Chamberlain University with an emphasis in Informatics.

Josh Hetler Executive Vice President, Business Intelligence

DataLink Software

Josh Hetler is a customer-focused, healthcare technology leader with over eight years of experience in building software products to improve the workflows for healthcare professionals in value-based arrangements. Josh onboarded two of the nation’s three largest Medicare Advantage health plans onto DataLink’s Evoke360 platform, which currently includes over ten thousand active users, managing over six million members. While at DataLink, he has held the positions of Account Manager, Director of Account Management, Director of Product and Software Development, Vice President of Product and Vice President of Customer Success.

Ryan Heyborne, MD, MBA, FACEP Chief Medical Officer, Clinical Care

Matrix Medical Network

Ryan Heyborne, MD, MBA, FACEP is a national healthcare leader focused on population health and clinical transformation. Dr. Heyborne currently serves as the Chief Medical Officer of Clinical Care for Matrix Medical Network. His efforts focus on ensuring access to clinical care for at-risk individuals, and coordinating care across the continuum. Dr. Heyborne has served in many clinical leadership positions in managed care and healthcare delivery organizations, recently leading a clinically integrated network, and as the Chief Medical Officer of a regional medical center. After graduating from medical school at the University of Utah, he completed Emergency Medicine Residency training at Indiana University, and an MBA at Northwest Nazarene University. Dr. Heyborne continues to practice medicine, providing in-person and telemedicine patient care.

Jeslie Jacob Divisional Vice President, Provider Performance | Provider Analytics, Reporting and Connectivity

Blue Cross Blue Shield of Illinois

Jeslie Jacob currently serves as Divisional Vice President of Provider Analytics, Reporting & Connectivity at Blue Cross and Blue Shield of Illinois (BCBSIL). In this role, he is responsible for developing and executing the organization’s strategies to enable the adoption of enhanced reporting, analytics, and data exchange capabilities to improve health outcomes, reduce costs, and enhance the quality of care for more than 16 million members across five states.

Chris Johnson Managing Director, Product Management

Advantasure

Tejaswita Karve Director, Quality Improvement

Johns Hopkins HealthCare

Tejaswita Karve is the Director of Medicare STARS with the Johns Hopkins Health System. She has previously held roles at several Fortune 500 companies, including Accenture and CVS Health, as well as with Presbyterian Healthcare Services and most recently at UPMC Health Plan in Pittsburgh.

Karve holds a Ph.D. in Biochemistry and Cellular & Molecular Biology from Georgetown University.

Allison Kawamoto CPA

Blue Shield of California

Andy Kumar Vice President of Product Strategy

CIOX Health

Andy Kumar serves as the Vice President of Product Strategy for Ciox Health's CDAI business .With more than 10 years of experience driving innovation and solutions that are used by patients, providers and payers worldwide.

Michael Le MD, Chief Medical Officer

Landmark Health

“I grew up watching my father practice small town medicine, carrying a black bag, and doing home visits, and I loved the concept of bringing care to the sickest patients. At Landmark, I get to share this passion for home-based medicine with a top caliber team.”Dr. Le is the Chief Medical Officer of Landmark.Prior to joining Landmark, Dr. Le served as chief medical officer of Fidelis SeniorCare, a Medicare Advantage Special Needs Plan, where he designed and implemented an innovative care model for high-acuity dual eligibles. Through Dr. Le’s clinical delivery model, Fidelis reduced hospital utilization by 46% and ER utilization by over 80% when compared with comparable high-risk populations. The model also achieved a 30-day all-cause readmissions rate of 6.3% for a high-risk population of dual eligibles. Dr. Le’s innovative model of care was an instrumental component of Fidelis’ recent selection as a health plan awardee in the Michigan Duals Demonstration Project.Prior to Fidelis, Dr. Le served as senior medical officer at CareMore, a Medicare Advantage plan, where he was also a practicing Extensivist. At CareMore, Dr. Le ran all high-risk clinical programs, including the High-Risk Clinic, Social Worker Intervention Team, Palliative Care and Hospice Program, and the House Call Program. He also held enterprise-wide accountability for care management and clinical training and education.Prior to CareMore, Dr. Le was regional lead hospitalist at HealthCare Partners, a risk-bearing medical group, where he oversaw a 20% reduction in hospital bed days in his region. Dr. Le was the physician lead for HealthCare Partners’ high-risk Ambulatory Case Management program, which identified a subset of high-risk patients and managed them aggressively through a tailored and high-intensity home and office visit intervention program.In his free time, Dr. Le enjoys playing tennis, as he played at the collegiate level. His proudest accomplishment is his family: his wife, Tita, a Deputy Attorney General for the State of California, and their two beautiful daughters, Isabella and Victoria.Dr. Le received his Bachelor of Science at the University of California, Riverside, and his M.D. at the University of California, Los Angeles. He completed his residency in internal medicine at Cedars-Sinai. He also completed a fellowship from the Institute for Physician Leadership at the University of California, San Francisco.

Bryan Lee Vice President, Solutions

Apixio

Bryan Lee is VP of Solutions for Apixio, where he is focused on developing AI-driven solutions thatcreate alignment of value-based care incentives for complete, accurate, and timely risk adjustmentinitiatives. Bryan is a seasoned healthcare executive with over 30 years’ experience working withpayers and providers on government programs, operations, compliance, and payment practices.He possesses a deep understanding of how to build, implement, and leverage technology toachieve performance improvements.

Nicole Clarke Luck Senior Vice President - Strategic Initiatives & Finance

Memorial Hermann Physician Organization

Nicole Clarke Luck is the Senior Vice President, Strategic Initiatives and Finance for Memorial Hermann’s Physician Enterprise including the Accountable Care Organization, Independent Physician Network (MHMD), Employed Medical Group (MHMG), Population Services Organization and Post-Acute Services.
Nicole is responsible for the strategic and operational finance functions within the physician enterprise which includes evaluation of financial contracting decisions regarding commercial ACO and MSSP arrangements, valuation and due diligence of physician acquisitions, physician compensation structures, financial modeling and monthly operational financial management.
In addition, Ms. Clarke Luck is responsible for Strategic Initiatives within the physician enterprise including evaluation of joint ventures, strategic partnerships and physician alignment vehicles. In 2018, Ms. Clarke Luck developed the first Health Care Collaborative in the state of Texas which allowed for the joint venture of independent physicians, a business expert and a provider system to jointly take risk on given populations. She also partners extensively to improve alignment and performance with Apex Health Solutions regarding Memorial Hermann’s Health Plan.
In addition, Ms. Clarke Luck is responsible for the oversight of operational performance and business development activities related to direct to employer solutions as well as providing oversight and direction of business intelligence, analytics and development of value based payment models.
Ms. Clarke Luck has been an executive sponsor in the alpha development of Cerner’s HealtheIntent population health enterprise data warehouse along with several of its adjacent applications to facilitate population health management of which Memorial Hermann uses daily.
Nicole graduated from James Madison University with BS in Health Care Administration and Business. She has worked in various facets of healthcare finance including corporate finance and budgeting. Nicole also has extensive experience in healthcare investment banking as well as private equity focused on investments and the monetization/securitization of pharmaceutical royalty streams.
In 2010, after eight years in investment banking and private equity Nicole returned to Memorial Hermann as Director of Finance for Memorial Hermann Medical Group with primary responsibility to lead M&A efforts to value and strategically increase Memorial Hermann’s employed footprint increasing its size from 80 providers to 800 over a ten-year period.
Nicole is married to John Luck and has two boys, Colin (10) and Noah (7). She enjoys traveling, playing golf, snow skiing, and spending time with her family.

Donna Malone Director Coding & Provider Education

Tufts Health Plan

Donna has been on the job with the Tufts Health Plan in their enterprise risk adjustment division since August 2014, and is responsible for audit and coding review and provider education (CDI) management, development and implementation of department and vendor policies and procedures, government audits (CMS-RADV, HHS-RADV Audits), 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 16 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.Donna is frequently an invited speaker at RISE conferences. Additionally, she has contributed significantly to the design and implementation on both in-person workshops and the online courses offered by the RISE Institute. She is chair of the faculty and provides coaching, mentoring, and development support to the national faculty under contract with RISE. Whenever RISE implements an on-site training program on HCC coding and documentation, Donna is the first-person RISE turns to for the teaching role.

Gabriel McGlamery Senior Health Care Policy Consultant 

Florida Blue Center for Health Policy

Gabriel McGlamery is in charge of Federal regulatory policy for Florida Blue’sindividual market business. This means analyzing, influencing, and general problemsolvingfor the insurer covering roughly 10% of Marketplace enrollment. Prior to joiningFlorida Blue in 2012, Gabriel helped develop the rules for the ACA at HHS andgraduated with honors from the University of Connecticut School of Law.

Kyle Mendez Senior Director of Revenue Management

Landmark Health

Kyle Mendez, MBA, is the Senior Director of Revenue Management at Landmark Health. In this role, Kyle oversees both Quality and Risk Adjustment operations nationally. In his previous role at Landmark, Kyle was responsible for building Landmark’s quality program and introduced many quality initiatives in the process, such as point-of-care testing, training programs, and a care-gap closure module in Landmark’s EMR. Kyle has over 15 years of experience working for managed care organizations, health plans, and medical groups. Kyle achieved his Master of Business Administration, with a concentration in healthcare, from the University of California, Irvine.

David Meyer SVP, Quality Outcomes and Informatics

NationsBenefits

Rachel Nelson CPC, Director, Payer Solutions

GeBBS Healthcare Solutions

Rachel Nelson serves as the Director of Payer Solutions with GeBBS HealthCare Solutions. In this role, she works with government payers and risk bearing providers to help facilitate their strategic partnership with GeBBS. Rachel has over 14 years of Healthcare experience with 11 of those years specialized in risk adjustment, quality and operations. Within her career, she has been instrumental in developing end to end risk adjustment initiatives across all government payer and shared risk providers. Prior to joining GeBBS, Rachel was the Senior Director or Coding and Quality where she oversaw the entire coding division for both retrospective and prospective lines of business and well as all quality and oversite for 6 years for a risk adjustment company.

Joe Nicholson DO, Chief Medical Officer

CareAllies

Dr. Joe Nicholson provides strategic direction, operational oversight, and thought leadership for CareAllies’ clinical programs and operations, including ACO and social determinants of health strategies and operations. Additionally, he supports business development and provides clinical oversight for all companies and programs under CareAllies. 

Dr. Nicholson has held leadership roles at the Cancer Treatment Centers of America and Blue Cross and Blue Shield (BCBS) of Oklahoma, a subsidiary of Health Care Service Corporation (HCSC), and was instrumental in helping to establish Oklahoma’s health information exchange, partnering with the state of Oklahoma and Oklahoma University.

He earned his medical degree at Oklahoma State University – College of Osteopathic Medicine. He completed his residency in family medicine at Oklahoma University College of Medicine – Tulsa. He is board certified by the American Board of Family Medicine and a veteran of the U.S. Army.

Samantha Olds Frey Executive Director

Illinois Association of Medicaid Health Plans

Ryan Peterson Senior Vice President Strategy & Growth

Reveleer

Ryan comes to Reveleer as SVP, Strategy & Growth and is tasked with leading the company's go-to market strategy. Throughout his thirteen years in business development, Ryan has demonstrated success at growing new territories and markets and launching innovative services across several industries.Most recently, Ryan was Vice President, Business Development for Advantmed (formerly RecordFlow) and helped them exponentially grow their nationwide footprint of assisting MCOs with their Risk Adjustment and Quality Improvement needs. Prior success also includes assisting boutique culinary services, CulinArt (acquired by Compass Group USA) expand to the West Coast.Ryan’s education includes an MBA from the University of Wisconsin, Eau Claire and a BA, English from Kent State University. And though he occupies most of his time in various airports across the country, Ryan prefers to spend his free time in Orange County, CA where he enjoys reading, running and being outdoors.

Dawn Peterson Director of Risk Adjustment and HEDIS Operations and Analytics

Martin's Point

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 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.

Hiep Pham CFO

Clever Care

Hiep Pham is the Chief Finance Officer and one of the founders of Clever Care Health Plan. Hiep has extensive experience in health care finance spanning over 14 years, with heavy focus on financial oversight, regulatory compliance and audits, and risk management.
Prior to founding Clever Care, Hiep served as CFO of Blue Cross® Blue Shield® Arizona Advantage, where he successfully reconciled and recouped $15 million of CMS payment errors. Hiep also spent nine years as a Vice President of Financial Planning & Analysis at SCAN Health Plan and five years as a Finance Manager at Mitsubishi Motors North America.
Hiep earned his Master’s degree in Business Administration from the University of Southern California and his Bachelor of Arts degree in Accounting from California State University at Fullerton.

Hassan Rifaat, MD Chief Executive Officer

Vatica Health

Dr. Rifaat is the Chief Executive Officer at Vatica Health and has over 25 years of experience leading healthcare organizations. He served as CEO of Windsor Health Group with 300,000+ members, held senior executive positions at Humana, and served as SVP at Coventry Health Care for over 1.5 million members across 11 states.

Jackie Rivera, PMP Population Health Strategy Lead

Humana

Jay Scholes Regional Director of Sales

Pulse8

Jay currently leads the sales efforts in the West region for Pulse8, a leader in the healthcare industry providing an integrated approach to supporting risk adjustment and quality programs for health plans and providers. 

Jay is an enthusiastic and energetic sales executive with deep rooted ties to the healthcare industry and over 20 years of experience in various roles and healthcare segments. Jay currently works with Medicare Advantage, Commercial, and Medicaid plans to help improve the overall care of members through strategic partnerships in an ongoing effort to improving health plan performance and profitability.

Laura Sheriff 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.

Chris Simmons Vice President, Clinical Analytics

Pulse8

Neema Stephens MD, National Medical Director for Health Equity

Cigna

Dr. Neema Stephens is a native Texan and board certified in Internal Medicine and Nephrology. She completed medical school and Nephrology fellowship training at the University of Texas Medical School at Houston. She completed additional fellowship training in Transplant Nephrology at Emory University School of Medicine. Prior to joining Cigna, she worked in the academic setting as a transplant nephrologist at the University of Texas Health Science Center San Antonio. She joined Cigna 5 years ago, and has worked in utilization management with special focus on pharmacy initiatives, chronic kidney disease and transplant case management programs. Dr. Stephens has a special interest in addressing health disparities and social determinants of health. She is the National Medical Director for Health Equity at Cigna. She is based in Houston, TX, where she lives with her husband, Gary, and three young children.

Tracy Tran Director of Risk Adjustment and Encounter Data

Clever Care

Kris Volrath Vice President, Platform Design & Operations

Inovalon

Mr. Volrath serves as the Vice President, Products and Services, and is responsible for product revenue, design, strategy, and product execution across multiple product portfolios, including Quality Spectrum®, Data Visualization and Reporting, and the Inovalon ONE® Platform. In this role, Mr. Volrath and his team partner with clients to provide deep insights into quality measurement, drive quality improvement strategy and execution, deliver integrated member and provider engagement solutions, analyze and visualize information for rapid consumption, and achieve meaningful quality outcomes for Medicare Advantage, state-based Medicaid, and Commercial Health Insurance Exchange plans. Mr. Volrath has more than 16 years of experience in fields of healthcare technology, commodities, financial services, software engineering, data analytics, enterprise architecture, and portfolio management, holding a variety of leadership positions responsible for product and technology strategy. Prior to joining Inovalon, Mr. Volrath worked for Constellation Energy, a leading national supplier of energy products and services, where he was responsible for multiple delivery groups leading complex program initiatives, executing upon mergers and acquisitions, and driving innovation. Mr. Volrath previously held positions focused on financial services and software engineering at Accenture and Legg Mason.Mr. Volrath received his bachelor’s degree in Management Information Systems with a concentration in Finance from Salisbury University’s Perdue School of Business in Salisbury, Maryland.

Rex Wallace Principal

Rex Wallace Consulting

Rex Wallace is the founder and principal of Rex Wallace Consulting, LLC, a firm that specializes in improving Star Ratings for Medicare Advantage health plans. Rex assesses plans and guides them in the development and implementation of-leading strategies to drive material Quality Improvement. Since its inception in 2017, RWC has helped multiple Medicare Advantage contracts achieve significant improvements in Star Ratings, including single-year full-Star improvements. Prior to launching RWC, Rex spent twenty-three years in strategic healthcare roles, with a strong focus on Medicare Advantage. Most recently, he led Stars for a large, multi-state plan that consistently achieved 4 and 4.5 Stars across its multiple contracts.

Terry Ward Senior Vice President, Payer Solutions

Apixio

With more than 25 years of health care leadership experience in a variety of operational disciplines including client service, account management, product management, and solution innovation, Terry Ward has a 360 view of the challenges and opportunities in the health care industry. Terry has a unique blend of operational detail, product management discipline, and strategic vision with a customer minded focus. He has created a successful track record of designing and delivering unique and meaningful solutions to the market to address client demand to improve quality while driving efficiency in a collaborative and transparent manner. His ability to develop and deploy insightful initiatives has allowed Terry to succeed in key leadership positions with industry-leading companies such as McKesson, UnitedHealth Group, Solucient, Change Healthcare, and now Apixio.

Susan Waterman Trainer, Director, Risk Adjustment

Scott & 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 coding and compliance management, auditing and provider training, system management, and consulting services.

Julia Weatherly Sr. GM Stars Program Analyst

Independence Blue Cross

Daniel Weaver Vice President, Stars, Quality, & Risk Adjustment

Gateway Health

Daniel Weaver is an established leader with extensive experience developing and implementing intervention strategies to improve Medicare Stars performance. With demonstrated success through innovative programs, Daniel led a Stars Quality team at Highmark for 6 years where they consistently delivered market-leading performance and forward-thinking engagement with providers and members. Daniel moved to Gateway Health Plan to help an underperforming DSNP plan achieve 4 Stars, boost Quality Improvement performance across multiple State pay for performance programs, and expand Risk Adjustment programs.

Karena M. Weikel Chief Actuary

Geisinger Health Plan

Karena Weikel is directly accountable to the President of Geisinger Health Plan. She is a risk professional with 19 years of healthcare experience. Karena is responsible for managing Geisinger’s overall cost of care (expense, vendor), trend mitigation, vendor relations, underwriting, provider and medical economics, risk adjustment, operational and regulatory reporting, pricing and rate filing, trend analysis, reserve and organization-wide financial analytics for all lines of business (Commercial, Medicare Advantage, Medicaid).

Josh Weisbrod Vice President of Risk Adjustment

Network Health

Josh Weisbrod currently serves as the Vice President – Risk Adjustment at Network Health in Menasha, WI. He brings over 20 years of health insurance, healthcare analytic and human service experience to Network Health. Josh specializes in government programs, health plan operations, risk adjustment and data analytics. Prior to his work at Network Health, he served as Director of Government Programs for a regional Wisconsin health plan serving the state’s Medicare, Medicaid and Marketplace participants. Josh previously served as the Director of Operations for the Wisconsin Health Insurance Risk-Sharing Plan (HIRSP), the state’s high-risk insurance plan. HIRSP also administered the federal high-risk insurance plan in Wisconsin prior to the implementation of the Affordable Care act. Josh has taught part-time at the college level for over 11 years and has extensive experience training health insurance and human service professionals.

Howard Weiss Associate Vice President, Policy

EmblemHealth

Howard Weiss currently works in the Government Affairs & Policy Department at EmblemHealth, a nonprofit health plan headquartered in New York City serving 3.2 million enrollees in New York, Connecticut, and Massachusetts. Weiss is responsible for analyzing federal and state legislation and regulation across all business areas and developing advocacy to support EmblemHealth’s goals. Prior to joining EmblemHealth in October 2016, Weiss worked at America’s Health Insurance Plans (AHIP) in Washington, DC for more than 15 years, focusing on Medicare Advantage, Part D, and Medicaid policy. Weiss received a BA in Political Science from the University of Michigan and an MA in Public Policy from the University of Chicago, both many years ago.

Theresa West Vice President, Community Solutions

Signify Health

Courtney Yeakel Chief Product Officer

Pulse8

Courtney Yeakel is a results‐driven leader with a progressive track record of technical and managerial
successes with complex government risk‐adjustment and payment programs. With nearly a decade of
experience in government program’s health insurance, Courtney led enterprise‐wide corporate
initiatives focusing on the health plan’s risk adjustment strategy at both the federal and state levels. She
was responsible for the execution and oversight of Medicare, Medicaid, and ACA encounter data
submissions, intervention strategies, and financial reporting. Courtney has developed and led crossfunctional
operational teams to ensure both compliance and accurate revenue management. Prior to
joining the Pulse8 team, in addition to risk adjustment, Courtney focused on the analysis of multiple
data sets within government programs, including Medicare Secondary Payer, Prescription Drug Event
data, federal & state payment reconciliations, cost share reduction, and data governance initiatives.
Under her direction, the programs experienced significant process improvements that yielded
substantial financial returns for the health plan by lowering administrative costs while increasing quality.
Courtney is Lean Six Sigma‐certified and a graduate of St. John Fisher College with a Bachelor of Arts in
Economics, along with a Master of Business Administration degree from Penn State University.

Rita Young Senior Vice President Clinical Innovations

Reveleer

Rita Young, RN, BSN, CRNC has worked in Managed Care for over 25 years and has extensive knowledge in project management, chart retrieval, documentation management, clinical abstraction and risk adjustment coding. She is leading Reveleer activities as the Senior Vice President of Clinical Innovation. Rita joins us from nearly 15 years with Altegra Health and Outcomes Health Information Solutions, building one of the largest scale, quality operations in the business where she served as the Chief Operating Officer for Chart Retrieval and Clinical Review Services. Rita and her team were responsible for all chart retrieval and clinical review in both the US and Offshore.Rita is a graduate of Eastern Kentucky University where she earned her Bachelor of Science in Nursing. Prior to entering the business arena, Rita was a trauma nurse for nearly 15 years. She is from Kentucky, but currently resides in the sunny state of Florida.