- Unveiling the audit landscape and understanding the importance of timely responses
- Expediting audit responses through the establishment of a dedicated audit response team, implementing
standardized documentation and track systems, and utilizing advanced technologies
- Discussing the value of analyzing audit findings and leveraging them as opportunities for continuous
improvement in revenue cycle management
- Providing an overview of the No Surprises Act, an explanation of key provisions, and the impact it has had on
provider billing practices
- Highlighting how the No Surprises Act has influenced provider-payer interactions and insights into new
payment methodologies introduced by the act to resolve billing disputes
- Examples of how providers have adapted their practices to comply with the act
- Elucidating the impact of value-based care on revenue cycle management, including the need for new
metric, payment models, and performance measures
- Revisiting existing RCM approaches and understanding how RCM can be optimized based on value
- Case studies of successful revenue cycle management transformations based on VBC principles
Aaron Browder is Staff Vice President, Elevance Health and President, Carelon Subrogation, formerly Meridian Resource Company (Meridian), where he and his team are responsible for overseeing the successful implementation and execution of our clients’ end-to-end subrogation programs. With a nearly 20-year career in subrogation, Aaron possesses a deep knowledge of healthcare subrogation. He has held a wide range of management positions throughout his tenure at Meridian, most recently serving as Staff Vice President. Prior to joining Meridian, Aaron gained experience in the financial services and insurance industries with Arthur Andersen, LLP/KPMG, LLP, and Travelers Property Casualty.
Aaron holds a Bachelor of Arts degree from Indiana University and a Master of Business Administration from Butler University. He served on the Board of Directors for the National Association of Subrogation Professionals and has been a national presenter and author on issues related to subrogation.
Kyle Pankey has over two decades of experience working within the healthcare and payer operations, with over 10 years specifically tied in to the payment integrity space. Kyle lives in Chattanooga, TN and has served as Carelon Subrogation’s growth leader since mid-2022.
The health of the healthcare system improves when spending is responsible and accurate. Today, platform technology and advanced analytics are paving the way to make that more efficient and more proactive than ever before. Backed by decades of experience, Carelon’s Payment Integrity solutions bring together breakthrough technology and human expertise to help speed your ability to drive cost savings and value for your stakeholders.
- Outlining how PI functions can adapt to help position providers for success in VBC partnerships
- Exploring new approaches to reimbursement, such as bundled payments, shared savings, and risk-sharing
arrangements
CERIS has 30 years of prepay and post pay claim review and repricing experience with a 97% client retention rate. Our solutions are deep, consistent, and defensible reviews, which make CERIS the partner of choice for health plans, Medicare and Medicaid plans, and third-party administrators. CERIS’ longstanding review services and clinical expertise offer incremental value and are grounded in a sincere dedication to our valued partners. CERIS' mission is to continue to grow and deliver long term Payment Integrity services for our partners and to help them save.
- A discussion between key payers and providers to communicate share challenges and concerns
- Case studies of successful payer-provider initiatives and effective provider engagement strategies
- Progressing mutually beneficial initiatives in a collaborative manner
Monique started her Payment Integrity career in COB at Oxford HealthPlans. After the merger with UnitedHealthcare, she led multiple teams and was responsible for creating innovative programs. Monique joined SCIO Health Analytics in 2014 and was responsible for system and process improvements before being promoted to VP of client engagement and business optimization In 2020, Monique joined start-up Devoted Health and created a full suite of programs from the ground up. Based on a passion for metrics and measuring performance, she centralized and standardized all programs reducing implementation time and maximizing savings. Today, Monique is driving opportunities to improve claim payment by designing and developing new prior auth and claim reconciliation products at Cohere Health.
