| Page 912 | Kisaco Research

Learn how health plans can realize cost avoidance savings of $4.00-$7.00 PMPY (per member per year), by adopting proactive AI-based provider education, including a provider self-monitoring portal. For a mid-size health plan with 500k members, $2M-$3.5M in cost avoidance could be realized annually. As the payment integrity industry continues to ‘shift left’ through pre-claim submission efforts, it seeks AI-driven tools to maximize coding accuracy and increase savings. Health plans can benefit from automation to address resource constraints, identification of previously undetectable emerging coding issues, and collaboration and trust with their provider network. Join us to hear about our health plan partner journeys to pre-pay cost avoidance without provider abrasion. 

Track 1

Author:

Jesse Montgomery

VP of Analytics and Data Science
Codoxo
... read more

Jesse Montgomery

VP of Analytics and Data Science
Codoxo

Author:

Rena Bielinski

VP Customer Success
Codoxo
... read more

Rena Bielinski

VP Customer Success
Codoxo
Track 1

Author:

Lawrence M. Simon, MD, MBA, FACS

Interim Senior Medical Director
Blue Cross and Blue Shield of Louisiana (BCBSLA)

Dr. Larry Simon is the Interim Senior Medical Director and Managing Medical Director for Medical Policy and Medical Appeals for Blue Cross and Blue Shield of Louisiana (BCBSLA), where he also serves as the Medical Director for Coding and Reimbursement and Chair of the Credentialing and Medical Quality Management Committees.  He is a member of the AMA CPT Editorial Panel, serving on the Executive Committee and as Co-Chair of the Molecular Pathology Advisory Group and Genomic Sequencing Procedures Workgroup.  He also chairs the Medical Director’s Forum for both the Louisiana Association of Health Plans and the National Anti-Fraud Advisory Board of the Blue Cross and Blue Shield Association.  Prior to joining BCBSLA, Dr. Simon served in numerous leadership roles for the American Academy of Otolaryngology, the American Medical Association, the American College of Surgeons, and the Louisiana State Medical Society. 

Dr. Simon is an alumnus of Louisiana State University, Baylor College of Medicine, Rady Children’s Hospital, and the BI Moody College of Business Administration at the University of Louisiana.  A diplomate of the American Board of Otolaryngology and a Fellow of the American College of Surgeons, Dr. Simon has over 15 years of experience in Health Policy and Healthcare Reform, and he has presented over 170 lectures and seminars on these topics. 

A Rotarian, an animal rescuer, a member of multiple civic boards, and a patron of the arts, Dr. Simon enjoys spending his time outside of work serving his community, helping the animal shelters and abandoned dogs of Louisiana, and travelling and enjoying life with his wife and their family and friends.

... read more

Lawrence M. Simon, MD, MBA, FACS

Interim Senior Medical Director
Blue Cross and Blue Shield of Louisiana (BCBSLA)

Dr. Larry Simon is the Interim Senior Medical Director and Managing Medical Director for Medical Policy and Medical Appeals for Blue Cross and Blue Shield of Louisiana (BCBSLA), where he also serves as the Medical Director for Coding and Reimbursement and Chair of the Credentialing and Medical Quality Management Committees.  He is a member of the AMA CPT Editorial Panel, serving on the Executive Committee and as Co-Chair of the Molecular Pathology Advisory Group and Genomic Sequencing Procedures Workgroup.  He also chairs the Medical Director’s Forum for both the Louisiana Association of Health Plans and the National Anti-Fraud Advisory Board of the Blue Cross and Blue Shield Association.  Prior to joining BCBSLA, Dr. Simon served in numerous leadership roles for the American Academy of Otolaryngology, the American Medical Association, the American College of Surgeons, and the Louisiana State Medical Society. 

Dr. Simon is an alumnus of Louisiana State University, Baylor College of Medicine, Rady Children’s Hospital, and the BI Moody College of Business Administration at the University of Louisiana.  A diplomate of the American Board of Otolaryngology and a Fellow of the American College of Surgeons, Dr. Simon has over 15 years of experience in Health Policy and Healthcare Reform, and he has presented over 170 lectures and seminars on these topics. 

A Rotarian, an animal rescuer, a member of multiple civic boards, and a patron of the arts, Dr. Simon enjoys spending his time outside of work serving his community, helping the animal shelters and abandoned dogs of Louisiana, and travelling and enjoying life with his wife and their family and friends.

 

Lawrence M. Simon, MD, MBA, FACS

Interim Senior Medical Director
Blue Cross and Blue Shield of Louisiana (BCBSLA)

Dr.

Read full bio

Lawrence M. Simon, MD, MBA, FACS

Interim Senior Medical Director
Blue Cross and Blue Shield of Louisiana (BCBSLA)

Lawrence M. Simon, MD, MBA, FACS

Interim Senior Medical Director
Blue Cross and Blue Shield of Louisiana (BCBSLA)

Dr. Larry Simon is the Interim Senior Medical Director and Managing Medical Director for Medical Policy and Medical Appeals for Blue Cross and Blue Shield of Louisiana (BCBSLA), where he also serves as the Medical Director for Coding and Reimbursement and Chair of the Credentialing and Medical Quality Management Committees.  He is a member of the AMA CPT Editorial Panel, serving on the Executive Committee and as Co-Chair of the Molecular Pathology Advisory Group and Genomic Sequencing Procedures Workgroup.  He also chairs the Medical Director’s Forum for both the Louisiana Association of Health Plans and the National Anti-Fraud Advisory Board of the Blue Cross and Blue Shield Association.  Prior to joining BCBSLA, Dr. Simon served in numerous leadership roles for the American Academy of Otolaryngology, the American Medical Association, the American College of Surgeons, and the Louisiana State Medical Society. 

Dr. Simon is an alumnus of Louisiana State University, Baylor College of Medicine, Rady Children’s Hospital, and the BI Moody College of Business Administration at the University of Louisiana.  A diplomate of the American Board of Otolaryngology and a Fellow of the American College of Surgeons, Dr. Simon has over 15 years of experience in Health Policy and Healthcare Reform, and he has presented over 170 lectures and seminars on these topics. 

A Rotarian, an animal rescuer, a member of multiple civic boards, and a patron of the arts, Dr. Simon enjoys spending his time outside of work serving his community, helping the animal shelters and abandoned dogs of Louisiana, and travelling and enjoying life with his wife and their family and friends.

Track 1

Author:

Ram Davaloor

President & GM Platforms
Lyric
... read more

Ram Davaloor

President & GM Platforms
Lyric

Author:

Colleen Gianatasio

Director, Clinical Documentation Integrity and Coding Compliance
CDPHP

Colleen is a strategic clinical documentation, coding and compliance, and risk adjustment expert with 10+ years of experience driving increases in provider engagement. She has thoughtfully built clinical documentation improvement programs from scratch to target accurate risk scores, increases in provider satisfaction, and cost-savings.

Beyond her role at CDPHP, Colleen is also currently the president of the AAPC National Advisory Board.

... read more

Colleen Gianatasio

Director, Clinical Documentation Integrity and Coding Compliance
CDPHP

Colleen is a strategic clinical documentation, coding and compliance, and risk adjustment expert with 10+ years of experience driving increases in provider engagement. She has thoughtfully built clinical documentation improvement programs from scratch to target accurate risk scores, increases in provider satisfaction, and cost-savings.

Beyond her role at CDPHP, Colleen is also currently the president of the AAPC National Advisory Board.

Author:

Tina Azar

VP COS and Sales Enablement
Machinify
... read more

Tina Azar

VP COS and Sales Enablement
Machinify
 

Alan Coulter

VP of Business Development
Performant

Alan Coulter

VP of Business Development
Performant

Alan Coulter

VP of Business Development
Performant
 

Debra Hamer

Director, FWA Analytics
CERIS

Debra Hamer

Director, FWA Analytics
CERIS

Debra Hamer

Director, FWA Analytics
CERIS
Track 1

Author:

Mike Spellman

Senior Director, Consulting & Solution Design
Lyric
... read more

Mike Spellman

Senior Director, Consulting & Solution Design
Lyric

Author:

Kelly Bennett, JD, CFE, AHFI

State Medicaid Fraud and Abuse Leader
Independent

Kelly Bennett graduated from the University of Tampa and Florida State University College of Law.  She has been a member of the Florida Bar since 1997 and is a Certified Fraud Examiner and an Accredited Health Care Fraud Investigator.  She has worked at the Florida Agency for Health Care Administration since 2001 and has served in several roles, including as a Senior Attorney within the Medicaid Division of the Office of the General Counsel, the Assistant Bureau Chief for the Bureau of Medicaid Program Integrity, the Agency’s Medicaid
Fraud Liaison, and is currently the Chief of Medicaid Program Integrity, where she has served since July of 2014.  She is currently the President for the National Association for Medicaid Program Integrity and is an active participant in training and collaboration initiatives with the National Health Care Antifraud Association.

... read more

Kelly Bennett, JD, CFE, AHFI

State Medicaid Fraud and Abuse Leader
Independent

Kelly Bennett graduated from the University of Tampa and Florida State University College of Law.  She has been a member of the Florida Bar since 1997 and is a Certified Fraud Examiner and an Accredited Health Care Fraud Investigator.  She has worked at the Florida Agency for Health Care Administration since 2001 and has served in several roles, including as a Senior Attorney within the Medicaid Division of the Office of the General Counsel, the Assistant Bureau Chief for the Bureau of Medicaid Program Integrity, the Agency’s Medicaid
Fraud Liaison, and is currently the Chief of Medicaid Program Integrity, where she has served since July of 2014.  She is currently the President for the National Association for Medicaid Program Integrity and is an active participant in training and collaboration initiatives with the National Health Care Antifraud Association.