Carl Reinhardt
Director of Special Investigations Unit – West
Anthem Blue Cross
- Implementing a streamlined claims process to prevent missing information and incorrect coding, and tracking patterns claim denials to mitigate future issues
- Highlighting causal factors such as front-end errors related to benefit information, coverage details, and missing or invalid claims data
- Discussing the value of automated denial management systems as a means to reduce administrative burden
Track 2: Revenue Cycle Management & Revenue Integrity
- Payment Integrity Begins at the Top
- The SIU’s Greatest Need-Data
- Recent Schemes & Trends
- Internet Based Providers
- Behavioral Health Providers
- Telehealth Providers
Carl Reinhardt
Director of Special Investigations Unit – West
Anthem Blue Cross
- Using an AI-first approach to enhance transparency and accuracy throughout the payment continuum
Mike Spellman
Senior Director, Consulting & Solution Design
Lyric
Lyric
Website: https://www.lyric.ai/
Lyric is a platform-based healthcare technology company, committed to simplifying the business of care by preventing inaccurate payments and reducing overall waste in the healthcare ecosystem. Lyric, formerly ClaimsXten, is a market leader with 35 years of pre-pay editing expertise, dedicated teams, and top technology. Our solutions leverage the power of technology and advanced analytics to maximize value. Discover more at Lyric.ai.
In healthcare to optimize skills used to improve the value of products, it is essential to remove clinical and financial silos. Collaborating and aligning revenue teams with value analysis teams provide a platform to tell the entire business story in healthcare, decrease cost, and increase revenue.
Relationships in this arena generate opportunities to find billing and charging errors, and implement best practices into workflow, procedures, and buying trends. Collaboration benefits the teams by offering vital evidence that helps providers make judicious choices about the products they may want to bring into facilities. A revenue cycle analyst can aid in the discovery of problems with processes or old ways of how and where procedures are performed. Using dashboards, reports, and charging and reimbursement data can be seamlessly be integrated into existing value analysis processes making it easy to collaborate on the best ways to achieve your revenue targets.
Track 2: Revenue Cycle Management & Revenue Integrity
Lori Jensen
Director of Value Analysis
University of Utah Health
- Developing a Payment Integrity Program from the ground up for a brand new Medicare Advantage Health Plan
- Covering both the opportunities and the challenges of building and effectively managing PI programs that prevent, avoid, or recover billing errors, payment errors and other party liability errors
- Listing of suggestions/ advice from our success, and lessons learned
Josh Miller
Director, Payment Integrity
Prominence
- Strengthening payer-provider relationships through improved communication around claims adjudication, providing transparency into denials, accelerating payments, automating data exchange, and reassessing denial reversals
A discussion with leading payers and providers focused on strengthening relations and strategies for aligning incentives and goals between payers and providers
- Discussing Value-based contracting and alternative payment models
- Examples of successful payer-provider relations
Janell Zuckerman
Director, Provider Network Development
Select Health
Janell Zuckerman has been at Select Health since 2021 as the Provider Network Development Director for Idaho. She leads the strategy and operations for network development including provider relations, contracting, and performance. Her focus is on building partnerships with regional clinically integrated networks and hospitals, and improving interaction models between payers and providers. She has successfully developed a direct Select Health network in Idaho and new clinically integrated network agreement, with new product launches across Southern Idaho for commercial and Medicare lines of business.
Janell has 15 years of experience in areas of acute care and ambulatory operations, clinically integrated networks, value-based care, and public health and policy, with time at St. Luke’s Health System and the YMCA. In 2023 she was an Idaho Business Review’s Women of the Year honoree. She is a board member and vocal artist with Opera Idaho and association member with HFMA and ACHE. She is a purpose-driven leader and serves as a connector across the health care ecosystem.
Janell is an Idaho native and lives with her husband and two children in Boise, Idaho. She holds a B.A. in English from Tufts University and Masters in Health Administration from Ohio University.
Stina Redford
Director of Payment Innovation
Blue Cross of Idaho