| Page 164 | Kisaco Research
Engage in focused, small-group discussions where payers and providers connect over specific topics, share perspectives, and explore solutions from both sides—offering a balanced, holistic view of key challenges and opportunities.
  • Payment Integrity 102 Panel (come with your burning questions) (Charlie Jensen)
  • Interpreting Contracts - The Decisive Moment For Smooth Collaboration (Maya Turner)
  • Machinify Roundtable
  • AMS Roundtable
Medical Cost Containment

Denial management isn’t just about fighting back—it’s about understanding why denials happen and fixing the root causes upstream. This session will focus on how hospitals and health systems can use audit findings and denial data to identify coding gaps, documentation weaknesses, and process breakdowns that lead to preventable denials. Learn how to close these gaps through stronger internal collaboration across revenue cycle, coding, and clinical teams, while also using data-driven insights to foster more productive payer relationships.


Learning Objectives:

  • Learn how to analyze denial patterns and audit results to uncover documentation, coding, and process issues—enabling proactive prevention rather than reactive rework.
  • Discover best practices for improving internal workflows, fostering collaboration between clinical and revenue cycle teams, and ensuring that claims reflect accurate, defensible coding and clear clinical intent.
Revenue Cycle Management

Author:

Betye Ochoa

Director, Revenue Cycle Redesign
NorthShore University HealthSystem
... read more

Betye Ochoa

Director, Revenue Cycle Redesign
NorthShore University HealthSystem

Author:

Kimberly D Conner

Subject Matter Expert
Independent
... read more

Kimberly D Conner

Subject Matter Expert
Independent

Author:

Colleen Cochran

Physician Revenue Cycle Manager
The Christ Hospital Network

Senior Revenue Cycle Manager with over 15 years of experience in revenue cycle management across health care networks like Mercy Health and The Christ Hospital Network. Key achievements include Increased revenue capture by 30% through process improvements and strategic initiatives. Reduced days in accounts receivable by 15%, enhancing cash flow management. Managed a high-performing teams consisting of 45+ professionals, fostering a culture of accountability and continuous improvement. My core competences are the result of my achievements throughout my 30+ years experience working in Physician revenue cycle with my main focus on Accounts Receivables.
- Data-Driven: Successfully identifies key trends, analyzes metrics, and implements strategic initiatives to drive measurable
results and enhance decision-making processes based on data-driven insights.
- Communication: Equipped with interpersonal communication skills and able to smoothly blend and interact with top
management, peers, and teams from diverse backgrounds.
- Leadership: Demonstrated success as a leader inherent in eliciting a team's best quality with a commitment to the highest
service levels. Leads by example with ethics and integrity.
- Critical Thinking: Use resources to make responsible decisions in a high-energy environment, adapt quickly to change and
time management, and prioritize tasks to meet deadlines

... read more

Colleen Cochran

Physician Revenue Cycle Manager
The Christ Hospital Network

Senior Revenue Cycle Manager with over 15 years of experience in revenue cycle management across health care networks like Mercy Health and The Christ Hospital Network. Key achievements include Increased revenue capture by 30% through process improvements and strategic initiatives. Reduced days in accounts receivable by 15%, enhancing cash flow management. Managed a high-performing teams consisting of 45+ professionals, fostering a culture of accountability and continuous improvement. My core competences are the result of my achievements throughout my 30+ years experience working in Physician revenue cycle with my main focus on Accounts Receivables.
- Data-Driven: Successfully identifies key trends, analyzes metrics, and implements strategic initiatives to drive measurable
results and enhance decision-making processes based on data-driven insights.
- Communication: Equipped with interpersonal communication skills and able to smoothly blend and interact with top
management, peers, and teams from diverse backgrounds.
- Leadership: Demonstrated success as a leader inherent in eliciting a team's best quality with a commitment to the highest
service levels. Leads by example with ethics and integrity.
- Critical Thinking: Use resources to make responsible decisions in a high-energy environment, adapt quickly to change and
time management, and prioritize tasks to meet deadlines

Payment Integrity

Author:

Matt Perryman

Chief Analytics & Insight Officer
Alivia Analytics
... read more

Matt Perryman

Chief Analytics & Insight Officer
Alivia Analytics

Author:

Novelette Wallace, MPH, PMP, CSSBB

Head of Payment Integrity
Johns Hopkins Healthcare

Novelette Wallace is a distinguished Payment Integrity Leader with a rich background spanning over 30 years in the healthcare industry. Her extensive experience includes leadership roles within payment integrity, where she has played pivotal roles in both payment integrity vendor organizations and health plans. Throughout her career, Novelette has demonstrated a remarkable ability to build and lead Payment Integrity departments from their inception. Her expertise has been instrumental in establishing robust processes and strategies to identify and recover inaccuracies in claims, contributing significantly to cost of care savings for health plans year after year.

Novelette has held key leadership positions with industry-leading organizations, including Performant Corp, United Healthcare, and Aetna (previously Coventry). In each role, she has consistently delivered results by optimizing payment integrity processes and driving operational excellence. Currently serving as the Assistant Vice President (AVP) of Payment Integrity for Johns Hopkins Health Plans, Novelette continues to bring her wealth of knowledge and leadership acumen to the forefront. Her dedication to achieving and surpassing cost of care savings goals exemplifies her commitment to advancing the financial health and efficiency of healthcare organizations.

With a proven track record of success and a comprehensive understanding of payment integrity within the healthcare landscape, Novelette Wallace stands as a respected leader in the industry, contributing significantly to the success of the organizations she serve

... read more

Novelette Wallace, MPH, PMP, CSSBB

Head of Payment Integrity
Johns Hopkins Healthcare

Novelette Wallace is a distinguished Payment Integrity Leader with a rich background spanning over 30 years in the healthcare industry. Her extensive experience includes leadership roles within payment integrity, where she has played pivotal roles in both payment integrity vendor organizations and health plans. Throughout her career, Novelette has demonstrated a remarkable ability to build and lead Payment Integrity departments from their inception. Her expertise has been instrumental in establishing robust processes and strategies to identify and recover inaccuracies in claims, contributing significantly to cost of care savings for health plans year after year.

Novelette has held key leadership positions with industry-leading organizations, including Performant Corp, United Healthcare, and Aetna (previously Coventry). In each role, she has consistently delivered results by optimizing payment integrity processes and driving operational excellence. Currently serving as the Assistant Vice President (AVP) of Payment Integrity for Johns Hopkins Health Plans, Novelette continues to bring her wealth of knowledge and leadership acumen to the forefront. Her dedication to achieving and surpassing cost of care savings goals exemplifies her commitment to advancing the financial health and efficiency of healthcare organizations.

With a proven track record of success and a comprehensive understanding of payment integrity within the healthcare landscape, Novelette Wallace stands as a respected leader in the industry, contributing significantly to the success of the organizations she serve

Author:

Lacey Crowl

VP of Health Plan Operations
Longevity Health Plan

Lacey Crowl is the Director of Claims Operations for Longevity Health Plan, responsible for the accuracy of claims processing focused on Medicare members. Lacey has experience in the Commercial, Medicare and Medicaid environments, developing prospective and retrospective payment integrity solutions for both clinical and claim coding reviews. She has operated within various claims processing platforms to develop, code and implement new audit concepts while operating within the Managed Care space.

... read more

Lacey Crowl

VP of Health Plan Operations
Longevity Health Plan

Lacey Crowl is the Director of Claims Operations for Longevity Health Plan, responsible for the accuracy of claims processing focused on Medicare members. Lacey has experience in the Commercial, Medicare and Medicaid environments, developing prospective and retrospective payment integrity solutions for both clinical and claim coding reviews. She has operated within various claims processing platforms to develop, code and implement new audit concepts while operating within the Managed Care space.

As value-based care continues to reshape payment models, many health systems struggle to balance financial performance with care quality goals. This session will offer practical strategies to use denial data, coding insights, and care coordination metrics to strengthen value-based outcomes—without sacrificing revenue. This discussion will highlight how to engage teams, optimize processes, and identify sustainable financial opportunities within value-based contracts.


Learning Objectives:

  • Learn how to use denial patterns and audit insights to improve documentation, coding accuracy, and contract performance.
  • Gain strategies to foster physician buy-in and leadership collaboration, finding “win-win” solutions that support both revenue integrity and value-based care success.
Revenue Cycle Management

Author:

Corella Lumpkins

Manager of Coding, Compliance and Provider Education
Loudoun Medical Group P.C.

Corella Lumpkins is the Manager of Coding, Compliance & Provider Education at Loudoun Medical Group (LMG) - one of the largest and most diverse physician-owned, multi-specialty Accountable Care Organizations in Northern Virginia/DC suburbs. As a subject matter expert, Corella has over 35 years of experience working in every area of the healthcare revenue cycle. Corella holds a bachelor’s degree and eleven certifications with an extensive background in auditing, billing, coding, implementing corporate compliance programs, CDI, education, denial and practice management. Prior to joining LMG, Corella has held leadership roles at Lifebridge, Medstar, Johns Hopkins and the University of Maryland health systems.

Corella is an author, adjunct faculty member and national speaker currently serving on both the AAPC National Advisory Board and Association of Clinical Documentation Integrity Specialists (ACDIS) Leadership Council. Corella works closely with providers in navigating patient-centric value-based care. 

... read more

Corella Lumpkins

Manager of Coding, Compliance and Provider Education
Loudoun Medical Group P.C.

Corella Lumpkins is the Manager of Coding, Compliance & Provider Education at Loudoun Medical Group (LMG) - one of the largest and most diverse physician-owned, multi-specialty Accountable Care Organizations in Northern Virginia/DC suburbs. As a subject matter expert, Corella has over 35 years of experience working in every area of the healthcare revenue cycle. Corella holds a bachelor’s degree and eleven certifications with an extensive background in auditing, billing, coding, implementing corporate compliance programs, CDI, education, denial and practice management. Prior to joining LMG, Corella has held leadership roles at Lifebridge, Medstar, Johns Hopkins and the University of Maryland health systems.

Corella is an author, adjunct faculty member and national speaker currently serving on both the AAPC National Advisory Board and Association of Clinical Documentation Integrity Specialists (ACDIS) Leadership Council. Corella works closely with providers in navigating patient-centric value-based care. 

Author:

Lourdes Centeno Fanjoy

Payment Policy Manager
Mass General Brigham

With over 15 years of experience in revenue cycle management, compliance, payer policy advising, and executive presentations, Lourdes is a results-oriented leader dedicated to optimizing operational strategies and driving corporate success. Her resource allocation, process redesign, and capacity planning skills enable her to enhance profit margins and achieve strategic goals. Lourdes brings expertise in Medicare and Medicaid reimbursement policies, ensuring effective and compliant financial practices.

... read more

Lourdes Centeno Fanjoy

Payment Policy Manager
Mass General Brigham

With over 15 years of experience in revenue cycle management, compliance, payer policy advising, and executive presentations, Lourdes is a results-oriented leader dedicated to optimizing operational strategies and driving corporate success. Her resource allocation, process redesign, and capacity planning skills enable her to enhance profit margins and achieve strategic goals. Lourdes brings expertise in Medicare and Medicaid reimbursement policies, ensuring effective and compliant financial practices.

Hospice care is meant to support patients in their final months of life, yet inappropriate or prolonged utilization continues to raise clinical, ethical, and payment integrity concerns. This session will provide critical insights into what constitutes appropriate hospice enrollment, how to identify red flags for overutilization, and strategies hospitals and health plans can use to ensure hospice services align with medical necessity.


Learning Objectives:

  • Understand the clinical criteria for appropriate hospice enrollment and identify common patterns of misuse that may lead to unnecessary costs and compliance risks.
  • Gain tools and best practices for conducting eligibility reviews, improving documentation scrutiny, and collaborating across teams to prevent improper payments while supporting appropriate patient care.
Payment Integrity

Author:

Michael Devine

Director Special Investigations Unit
L.A Care
... read more

Michael Devine

Director Special Investigations Unit
L.A Care

Author:

Peter Monson

SIU Director
UCare HP
... read more

Peter Monson

SIU Director
UCare HP

Author:

Mandi Heiple

Director of Payment Integrity
Medica
... read more

Mandi Heiple

Director of Payment Integrity
Medica

Diagnosis codes and modifiers aren’t just billing details—they tell the story that determines how your claims are paid. When these elements don’t align, hospitals face denials, delays, and compliance risks. This session will break down how to accurately connect coding choices with billing practices to ensure claims reflect true clinical intent, reduce audit exposure, and secure appropriate reimbursement.


Learning Objectives:

  • Recognize the most common coding and modifier missteps that lead to denials and learn how to avoid them through stronger documentation and coding practices.
  • Implement strategies to bridge gaps between clinical, coding, and billing teams—ensuring consistent, compliant claims that tell the right story from documentation to payment.
Revenue Cycle Management

Author:

Stephanie Sjogren

Director, Coding and Provider Reimbursement
EmblemHealth/Connecticare

Stephanie Sjogren is a director of coding and provider reimbursement, working with payment integrity to ensure proper claims adjudication and to prevent fraud, waste, and abuse. Prior to joining ConnectiCare/EmblemHealth, she performed provider audits and education at a women’s healthcare group. Sjogren has also worked with physicians and staff to integrate and use electronic health record systems effectively and to stay in compliance with the Centers for Medicare & Medicaid Services’ rules and regulations. Her areas of specialty are payment integrity, auditing, and clinical documentation improvement. 

... read more

Stephanie Sjogren

Director, Coding and Provider Reimbursement
EmblemHealth/Connecticare

Stephanie Sjogren is a director of coding and provider reimbursement, working with payment integrity to ensure proper claims adjudication and to prevent fraud, waste, and abuse. Prior to joining ConnectiCare/EmblemHealth, she performed provider audits and education at a women’s healthcare group. Sjogren has also worked with physicians and staff to integrate and use electronic health record systems effectively and to stay in compliance with the Centers for Medicare & Medicaid Services’ rules and regulations. Her areas of specialty are payment integrity, auditing, and clinical documentation improvement. 

Industry benchmarks to measure the impact of payment integrity currently don't exist, making it challenging to optimize performance and areas of opportunity. Standards are extremely complicated due to varied member populations and an inconsistent approach to calculating metrics.
In this groundbreaking panel discussion, learn how a Working Group of payer and vendor SMEs have been collaborating over the last six months to develop a standard approach to calculating savings PMPM across LOB and audit programs. This session will share standard definitions and calculations, so attendees can understand how to calculate and compare their savings PMPM.
Payment Integrity
Moderator

Author:

Natalie Clayton

Head of Market Intelligence
Kisaco Research
... read more

Natalie Clayton

Head of Market Intelligence
Kisaco Research

Author:

Monique Pierce

Payment Solutions & Operations
Cohere Health

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.  

... read more

Monique Pierce

Payment Solutions & Operations
Cohere Health

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.  

Author:

Dr Priscilla Alfaro, MD, FAAP, CPC, CPMA, COC, CIC, CFE

VP Payment Integrity
Blue Cross NC

Dr. Priscilla Alfaro is a seasoned healthcare professional with extensive experience in executive medical management, fraud prevention, and healthcare analytics. A certified medical coder, fraud examiner, and auditor, she has a proven track record of improving healthcare efficiency and preventing fraud, waste, and abuse across various roles and affiliations, including the Texas HHS and Anthem.

... read more

Dr Priscilla Alfaro, MD, FAAP, CPC, CPMA, COC, CIC, CFE

VP Payment Integrity
Blue Cross NC

Dr. Priscilla Alfaro is a seasoned healthcare professional with extensive experience in executive medical management, fraud prevention, and healthcare analytics. A certified medical coder, fraud examiner, and auditor, she has a proven track record of improving healthcare efficiency and preventing fraud, waste, and abuse across various roles and affiliations, including the Texas HHS and Anthem.

Curated meetings based on your RCM/PI painpoints and investments -30 minutes each -3 meetings per registered individual -All those not scheduled to take meetings will be encouraged to take part in interactive sessions, competitions and activities in the exhibition room.

Medical Cost Containment