John M. Barkley Vice President, Enterprise Risk Adjustment & Data Integrity
John Barkley is the Vice President of Enterprise Risk Adjustment and Data Integrity for Emblem Health. John has been with the Emblem Health enterprise for 12 years leading the risk adjustment operations for ConnectiCare and Emblem. Prior to joining Emblem was with Aetna for 21 years in various financial roles with the last six years leading risk adjustment operations.
John started his career as a CPA working in public accounting for Deloitte.
John has been an attendee and presenter at RISE conference's for several years now. When not executing risk adjustment operations he enjoys boating, kayaking and fishing on Cape Cod Massachusetts where he lives.
As ReferWell’s Chief Revenue Officer, Chad Baugh oversees all revenue-generating activities for the company, including sales, marketing, product pricing and customer strategy.
His more than 20-year career in healthcare includes revenue management at Teladoc Health, where he delivered triple digit revenue growth within the large and midsize health plan market segment. He has served in leadership roles at Best Doctors, Edifecs, Allscripts, dbMotion and GE Healthcare.
Chad holds an MBA in Strategy, Finance and Entrepreneurship from the University of Chicago Booth School of Business. He is a Veteran of the United States Marine Corps.
Mia Bell Sr. Manager, Medicare & Commercial Risk Adjustment
Blue Cross Blue Shield of Massachusetts
Mia was born and raised in Baton Rouge, Louisiana. She is married with 3 children with a career in healthcare. Mia’s has more than 20 years in the healthcare industry in the areas of Risk Adjustment, Quality, Value Base Contracting and Provider Relations. She is currently a Sr. Manager of Risk Adjustment Operations for Blue Cross Blue Shield of Massachusetts, where she works to improve medical record collection, oversee risk adjustment coding, and manages member programs to close quality gaps. In her spare time, Mia works with up-and-coming healthcare professionals to educate and train in the areas of Medical Billing and Coding, understanding quality measures and positive impacts of quality care provided to members. As an Innovator and agent for change within healthcare, Mia has helped many health plans restructure and realign their Risk Adjustment & STARS programs by helping each adapt to new technology to help improve program success and ultimately drive quality of care and reduce the cost of care.
Outside of healthcare, Mia is a published author, Mentor and Coach and is active in community and faith based organizations in her hometown of Baton Rouge, Louisiana.
ACD Physician Assistant, SCMG Internal Medicine APC Lead
Kaitlyn Bertrand ACD Physician Assistant, SCMG Internal Medicine APC Lead
Since joining Scripps Clinic Medical Group in 2018, Kaitlyn has excelled in direct patient care within the internal medicine department. She was appointed as the Internal Medicine APC lead in 2021. In this role, Kaitlyn successfully oversees a team of 35+ Nurse Practitioners (NPs) and Physician Assistants (PAs), ensuring optimal patient outcomes and fostering a collaborative work environment.
In the spring of 2022, Kaitlyn transitioned to the Risk Adjustment program at Scripps, specifically focusing on the Accurate Coding and Documentation Program. As a member of this initiative, she trains and supports clinicians across the Scripps primary care system in best practices for coding and documentation practices to help improve accuracy and compliance, enhance patient care, and improve reimbursement for the organization.
In 2022 she became a certified Epic Physician Builder to help improve proficiency in utilizing Epic electronic health record (EHR) systems to optimize workflows and enhance patient care delivery.
Kaitlyn's contributions extend beyond training and support. With her team, she has helped successfully launch three Annual Health Assessment Clinics, facilitating comprehensive wellness evaluations for patients. Additionally, she worked on developing and implementing an optimized standard workflow for Medicare wellness visits, streamlining processes and improving efficiency.
Passionate about quality improvement, Kaitlyn actively participates in workgroups aimed at enhancing various quality metrics. Her involvement in initiatives targeting breast cancer screenings, cervical cancer screenings, hypertension, and diabetes.
Vandna Pandita, MPH is the Vice President of HEDIS® Strategy and Analytics for the AmeriHealth Caritas Family of Companies [ACFC]. In her role, Vandna is leverages her experience in quality and risk adjustment operations to support members and providers as it relates to performance reporting and the member and provider experience. Her area of influence spans analytics, plan operations and digital integration of data and processes in the transition to interoperability.
Prior to AmeriHealth, Vandna has worked for several national health plans, including Aetna, several Blue Cross Blue Shield plans, the Blue Cross Blue Shield Association and Centene. She has successfully led several health plans through NCQA Accreditation, managed HEDIS® reporting, improvement and outreach, and helped develop and implement a successful provider profiling and performance measurement program. In addition to her health plan experience, Vandna managed Risk Adjustment Client Operations for Evolent Health, is a former certified HEDIS® Compliance Auditor and led project management and client solutions for a retrieval, abstraction/coding and analytics vendor supporting health plans and provider groups in their efforts to optimize revenue and improve quality within their populations.
Vandna attended the University of California at Berkeley as an undergraduate and received her Master’s in Public Health from the University of California at Los Angeles.
Vandna has moved from coast to coast, spending the better part of the last 25 years working on her southern drawl in Atlanta, Georgia. These days you can find her running the streets of Atlanta, cooking for friends or working on her newest hobby, making wobbly pottery.
Stephen Bittinger Health Care Audit & Integrity Partner
Stephen Bittinger is a partner in the firm's Charleston and Washington, DC offices. He is a member of the health care/FDA practice group. Stephen focuses his practice on health care reimbursement compliance, defense and litigation, with an emphasis on government and private payer disputes on behalf of providers, suppliers, and manufacturers involved in the U.S. health care system nationally and from abroad. He has extensive experience representing large provider groups, home health agencies, medical facilities, ancillary service providers, medical labs, revenue cycle management companies, and drug and device manufacturers in matters including Medicare and Medicaid audits, private payer audits, federal regulatory termination and exclusion proceedings, False Claims Act defense, and health care revenue disputes. Stephen is one of the leading attorneys in the country on the law regarding the use of statistical sampling and extrapolation in the review and analysis of health care claims. He has served as an expert witness regarding federal reimbursement law in civil and criminal proceedings. Stephen has represented many providers with federal agency matters, including the Centers for Medicare and Medicaid Services (CMS) Center for Program Integrity (CPI), the Department of Health and Human Services Office of Inspector General (HHS-OIG), the Department of Veteran Affairs (VA), and Health Care Fraud division of the Department of Justice (DOJ).
Gerri Cash Vice President Medicare & FEP Quality Improvement Performance
Gerri Cash is the Vice President Medicare and FEP Quality Improvement Performance at Blue Cross Blue Shield of Arizona. With a focused expertiseto Stars/Quality and Member Experience, Gerri is getting member the care and making it easy. Whether member or provider facing activities, the member is always the center of decision making process.
Keslie joined BeneLynk 4 years ago bringing over 25 years of comprehensive managed care and healthcare technology experience. Previously, Keslie spent 13 years as Vice President of Sales at Change Healthcare and its predecessor companies Altegra Health and Social Service Coordinators, helping plans improve risk-adjusted revenue and quality performance scores through social care programs including dual advocacy, Medicaid retention, and health education campaigns. Earlier in her career, Keslie led marketing for both commercial and Medicare plans, with a focus on provider risk-sharing payment models tied to quality and member surveys. Keslie's passion lies in working on strategies thatput members at the center, are efficient and meaningful while ensuring her clients are provided with the services to drive accurate risk-adjusted and quality performance revenue.
In Keslie’s free time she volunteers at the local shelter and enjoys fishing.
Keslie holds a B.S. in Business Administration from Regis University in Denver, CO, and attended the MBA/Masters in Healthcare Administration program at Sacred Heart University in Fairfield, CT.
Wynda Clayton is a Risk Adjustment Director at Providence Health Plans in Beaverton, OR. She received her Health Information Degree from College of Saint Mary’s, her BS in Health Care Management from Bellevue University and her MS from Clarkson College. Wynda has been in the health care field for over 25 years with experience on all phases from compliance to billing and reimbursement to coding to Quality Assurance to being a RADV Auditor to risk adjustment and providing physician education. Wynda is very enthusiastic and loves basketball, traveling and helping those unfortunate. To help is not always meaning to give, but it also means to teach others how to make a difference in their lives. Currently Wynda resides in Portland, OR with her husband Kevin. She can be contacted at Wynda.Clayton@providence.org.
Jennifer joined Aetna in 2022 and brings over 10 years of government programs experience. She is focused on partnering with value-based clinicians to identify the full burden of illness to cover the cost of health care. Previously, she worked in digital product management role curating clinical workflows to meet Medicare Advantage, Medicaid and Affordable Care Act patient's needs. Jennifer is passionate, annoyingly positive and eager to collaborate for improved health outcomes.
In Jennifer's free time, you can find her on the golf course, playing tennis, or riding her bike. She enjoys spending time with her husband, two daughters and wiener dog.
Jennifer holds a masters in public administration from Arizona State University.
Phil Collins is a seasoned professional with extensive experience in the managed care industry. As the Senior Director of Quality at FarmboxRx, he plays a pivotal role in overseeing performance analytics and collaborating with health plans to develop and implement quality improvement strategies in programmatic design.
With a career spanning over 12 years, Phil has honed his expertise within MCO’s, including prominent names like Molina Healthcare and Atrio Health plan. During his tenure, he specialized in HEDIS measures, bringing in-depth knowledge and understanding of these essential quality metrics. He has actively participated in the chart review and data collection processes for Hybrid measures, ensuring accurate and comprehensive data analysis to support decision-making and performance evaluation.
A skilled analyst, Phil excels in producing reports that highlight current and projected HEDIS and CMS rates. These reports provide invaluable insights into the performance of health plans, enabling strategic decision-making to achieve higher HEDIS scores and Star Ratings.
Carmela Costiniuk Vice President, Population Health and Clinical Transformation
Catholic Medical Partners
Carmela Costiniuk is Vice President of Population Health and Clinical Transformation at Catholic Medical Partners, the largest network of independent practice physicians in Buffalo, NY, with nearly 900 physician members. She develops and implements population health and operational strategies and oversees the operations team, which provides direct support to physician practices to improve quality performance and care coordination across the health continuum.
A native of Canada, Carmela earned her Bachelor of Science degree in Occupational Therapy from the University of Toronto and her Masters in Health Services Administration from D’Youville University where she is currently completing her Doctoral Degree in Health Administration.
Carmela has held various administrative positions in home and community based care, acute care, long-term care, and the Local Health Integration Network (LHIN) Ontario Ministry of Health.
John has over 25 years of entrepreneurial and executive experience in the healthcare space, building relationships across major, national health plans and large regional healthcare systems. John’s newest venture, Porter, designed to reach beyond standard home interventions, is the only quality stars and risk adjustment-focused care coordination program. John previously founded Pulse8, a healthcare analytics and technology company delivering complete visibility into the efficacy of risk adjustment and quality management programs, and led them to a successful acquisition by a publicly traded health IT company. John was recently granted a patent by the United States Patent and Trademark Office for a method and apparatus for risk adjustment.
Deb Curry Director, Risk Adjustment & Recoveries Actuarial Services
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.
Mark Dabney is the Director of Risk Adjustment at the not-for-profit healthplan Community Health Plan of Washington (CHPW), supporting risk adjustment operations, submissions, and analysis for Medicare, ACA, and Medicaid lines of business. He has over 16 years of experience in risk adjustment programs and over 20 years of health care industry experience spanning a wide spectrum, from call center representative to supporting the implementation of the ACA program for millions of members across Kaiser Permanente, including serving as risk adjustment lead for Medicare, Medicaid, and ACA programs in the Mid-Atlantic States. Prior to joining CHPW in late 2021, he helped implement risk adjustment operations and value-based programs at kidney care provider Somatus, driving revenue bearing care assessment partnerships.
Outside of work, Mark and his wife enjoy pub trivia nights and board games. Mark is an avid music and movie buff, and tolerable musician and home recording fan. He lives in the Seattle area.
Dr. Shannon Decker is principal at VBC One, a consulting firm assisting physician groups, health plans and vendors maximize the performance of their value based contracts and offerings. Dr. Decker has more than 20 years experience in health care and most recently led teams in risk, quality, data and analytics, telehealth, COVID response and delegation compliance. Of her more than 20 years of experience in healthcare--15 include working with risk adjustment, quality 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, and a prolific national public speaker, her interests include the study of human behavior and how theories on motivation and learning may be brought to bear on population health management.
Greg Demske is a partner in Goodwin’s Complex Litigation & Dispute Resolution and Healthcare practices. He advises healthcare and life sciences companies on healthcare compliance, transactions, regulatory issues, and government enforcement matters. Prior to joining Goodwin, Greg served from 2012 to 2022 as Chief Counsel to the Inspector General, Department of Health and Human Services (HHS), where he led the provision of all legal services and advice for the HHS Office of Inspector General (OIG), including all aspects of: representation of HHS in False Claims Act cases involving HHS (including Medicare and Medicaid); exclusions from participation in Federal health care programs; Corporate Integrity Agreements; civil monetary penalties; self-disclosures to OIG; Anti-Kickback Statute safe harbor regulations and advisory opinions; compliance guidance to the healthcare industry; and legal advice to OIG on audits, evaluations, and investigations. Prior to becoming Chief Counsel, Greg served in a variety of management and staff positions in OIG and received multiple awards, including the Attorney General’s Award for Fraud Prevention and the HHS Secretary’s Award for Distinguished Service. Greg received a bachelor’s degree from Miami University and a law degree from Ohio State University.
His background is in management and operational processes for 15 years, and began working in the Risk Adjustment arena 12 years ago. Ryan has proven himself by helping Medical Groups raise their RAF scores to their proper levels. He directed the movement of a 10,000 member group up 43% over a two year period, and an 1800 member group up 53% in the first year. Ryan achieves these results through chart documentation audits, provider and staff documentation training, and provider relationship building. In his most current role Ryan works with multiple groups to optimize their RAF score, while at the same time achieving CMS 5 Star quality. Ryan explains to these groups that getting their RAF score to the correct level will not only drive revenue, but it will also lead to better patient care with improved documentation habits. Ryan is a Certified Risk Adjustment Coder (CRC) credential through the AAPC.
Julianne Eckert is the Senior Director of Clinical Quality Programs at Clover Health, a physician enablement company focused on seniors who have historically lacked access to affordable, high-quality healthcare. She is responsible for creating an innovative data driven strategy that breaks the traditional model of healthcare to make it easier for providers and patients to deliver and receive healthcare.
She has spent her life using her personal and clinical career experiences to help drive her mission as a patient advocate by leading health plan quality improvement strategies to prevent vulnerable populations from falling through the cracks with data stories and forward thinking programs which enable patients to easily navigate the complex matrices of healthcare and insurance. She has sweeping subject matter experience in CMS Innovation models, Stars QI programming, NCQA HEDIS/CAHPS/HOS, health equity, as well as, national and international leadership in driving laser focused strategies to improve health plan performance and member outcomes/experience.
She has held multiple Board Advisory roles and currently serves on the Board of Advisors for curriculum development for Pace University’s Design Thinking Executive Program which meets high academic standards, with a challenging interdisciplinary curriculum designed to prepare top executives to solve real-world challenges in designing innovative practices. She holds multiple certifications in Organizational Change Management, Case Management and also Managed Care. She is an avid mentor and career coach believing it is her mission to develop our next generation of leaders.
Colleen Gianatasio Director Clinical Documentation Integrity and Coding Compliance
Capital District Physician’s Health Plan (CDPHP)
Colleen Gianatasio CPC, CPCO, CRC, CDEO, CPC-P, CPMA, CPPM, CCS, CCDS-O, and AAPC Approved Instructor has over 20 years of experience in the health insurance field. She has experience in customer service, claims, quality, and coding. As Director, Clinical Documentation Integrity and Coding Compliance, Colleen’s primary responsibilities are provider engagement and clinical documentation improvement for accurate coding and reimbursement. 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 serves as President of the AAPC National Advisory Board.
Music has always played an important role in Sal Gonzalez’s life. He grew up in the impoverished neighborhood of East Los Angeles, and as a teenager, music kept him out of trouble. So did his decision to serve in the U.S. Marine Corps after the terrorist attacks on September 11, 2001. “That tragedy inspired me to join the military,” says Sal. “The fact that I come from a family of immigrants also made me want to join. I wanted to give back for all this country has given us.” Sal enlisted in the infantry and was assigned to the 2nd Battalion, 5th Marines. In 2004, he was a machine gunner in Ramadi, Iraq, when his truck was hit by an improvised explosive device (IED). The blast left Sal with a traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and ultimately caused him to lose his left leg below the knee. “Losing a leg is tough,” says Sal. “But the invisible wounds — PTSD and the brain injury — were even tougher.” While he was still in a Maryland hospital, Sal received a Wounded Warrior Project® (WWP) backpack full of comfort items and a promise that if he needed anything, WWP would be there to help. That gesture meant a lot to Sal, and once he got out of the hospital, he decided to get more involved. One of his first events with WWP was a multi-day mental health workshop called Project Odyssey® — and it changed his life. Despite his injury, he was able to rock climb with the group; and it proved he could still do anything he set his mind to. “Wounded Warrior Project helped change my whole mentality,” says Sal. “Instead of feeling sorry for myself and letting the loss of my fellow marines consume me, I wanted to thrive. I wanted to live a happy, important, impactful life in memory of the warriors who didn’t make it home.” With WWP by his side, Sal set out to help as many warriors as possible by sharing his experience and encouraging them to seek help. He also continued playing music — not only to process his own emotions and continue his recovery, but also to inspire other injured veterans to continue living their lives. “Having music as a tool for my recovery, I was able to let go of a lot of pain,” says Sal. “It kept me going. It’s my life. It’s who I am, and I want to show other warriors that it’s possible to follow your dreams and be normal.” Sal remains grounded in his passion to help other warriors, even as his music career hits new highs. His talent has started to earn him national attention, including appearances on NBC’s “America’s Got Talent” and the television show “Nashville.” He also released his first EP, “Heroes,” in 2020. While many musicians strive to become famous, Sal is happy with his life right now. “I get to play music for a living,” says Sal. “I’m able to support my awesome wife and son by doing something I love. For most musicians, that’s living the dream.”
Danielle Green Experienced Health Care Perspective
U.S. Army Veteran
Ordinarily, high-level NCAA basketball players don’t join the military after graduating from college — but Danielle Green is far from ordinary. Her call to serve others became her driving force after her Division-One basketball career, and in 2004 she found herself on top of a rooftop in Iraq – injured – and praying she would survive. Luckily, she did, as her passion for serving others has led her to help countless people over the last 17 years. She’s counseled warriors in mental health, aided in veterans’ transition to civilian life, and now travels the country to share her powerful story in the hope that more veterans will reach out for the help they need. Please join me in welcoming a true all-star in the veteran community – a woman who has dedicated her life in service of others – Danielle Green.
Mary Inman Partner in Whistleblower Practice Group
Mary Inman is a partner in Constantine Cannon’s London and San Francisco Offices. After 20+ years representing whistleblowers in the U.S., she moved to London in July 2017 for four years to launch the firm’s international whistleblower practice and now splits her time between the London and San Francisco offices. She specializes in representing whistleblowers from the U.S., U.K., Europe and worldwide under the American whistleblower reward programs, including the federal and various state False Claims Acts and the SEC, CFTC, IRS, DOT and Treasury Department AML and sanctions whistleblower programs. Ms. Inman’s efforts to export the American whistleblower programs to the United Kingdom, including her efforts on behalf of a successful British whistleblower, were featured in a recent New York Times article “Law Firm Sees Britain as Hunting Ground for U.S. Whistleblower Cases.” Ms. Inman’s successful representation of three whistleblowers exposing risk adjustment fraud in the Medicare Advantage program was featured in the February 4, 2019 issue of the New Yorker magazine in an article entitled “The Personal Toll of Whistle-Blowing.” Ms. Inman represents renowned SEC whistleblower Tyler Shultz who exposed the now infamous Silicon Valley blood testing start-up Theranos, and regularly speaks on lessons to be learned from this scandal surrounding corporate governance.
Highly adaptable Fortune 5 Managed Care executive with 20 years of experience in adding value through a “we not me” approach, building relationships and best-in-class teams, identifying and cultivating talent, communicating for impact, thought leadership and driving towards results. High sense of urgency & emotional intelligence level.
Bre Krebs is an integral part of Apixio as she oversees the relationships and supports the services delivered to Apixio’s clients. With over 20 years in healthcare, Bre has a strong understanding of the core components that drive customer success and uses this ability to work with external vendors and cross-functionally to ensure business deliverables and client needs are aligned. Prior to joining Apixio in 2015, Bre was a VP of Development at Quirk Healthcare Solutions, where she created, trained, and mentored technical teams in India, Ukraine, Mexico, and the United States to provide development services and support for clients and internal software solutions for Quirk Healthcare. At Muir Medical Group IPA, Bre provided technical leadership to identify areas for system improvements and ensure projects met customer expectations and budget parameters. Bre holds a Bachelor of Arts degree in Sociology from the University of Oregon.
Jenni Monfils AVP, Risk Adjustment Coding and Compliance
Jenni has over 20 years of healthcare experience. Her expertise spans many areas including professional medical coding, revenue cycle processes, documentation improvement, RADV audit success, compliance and risk adjustment operations. Jenni is currently the Director of Risk Adjustment Coding and Compliance for a healthcare plan and services organization based in Minnesota. Her primary responsibility is coding and compliance oversight of the risk adjustment activities, risk adjustment education and project lead for all risk adjustment audits.
Nick Morrison Perspective on Access to Care in Rural Areas
U.S. Marine Corps Reserve Veteran
Nick Morrison’s Humvee was hit by improvised explosive devices on two separate occasions while he was deployed to Iraq with the U.S. Marine Corps. But it was a vehicle he wasn’t in that is responsible for the severity of his post-traumatic stress disorder (PTSD) and survivor’s guilt. He was just 500 meters behind that vehicle when it was blown to pieces, killing four of the occupants. He and his unit then faced the grim task of collecting the dead and cleaning up the debris. “On any other given day, I should have been in that vehicle,” Nick says. “That was a really hard thing for me to wrap my mind around — I felt like I cheated death and that I needed to pay for it or it was going to catch up with me. I felt guilty that I came home and they did not.” Nick’s experience overseas was plagued by an enemy he could not see. When he came home, he felt like he was still looking for the enemy. “Eventually, I think I made people at home the enemy,” Nick says. “I made stangers on the street the enemy, I made my friends the enemy, and then my family.” As his PTSD symptoms became more severe, his life began to unravel. Unchecked emotions led to uncontrolled crying and emotional outbursts. He couldn’t sleep and was drinking heavily. He isolated himself and, at times, stopped speaking. For the next fifteen years, Nick received various types of mental health therapy, but he credits treatment he received through the Wounded Warrior Project® Warrior Care Network® with providing the help he needed to get his life back. The three-week, intensive outpatient program gave Nick the information and opportunity to start developing new habits while participating in group sessions with other warriors. “We are indoctrinated within this military culture,” Nick says. “We get rewarded together. We get punished together. We got to deploy together and we come home together, hopefully. So, why not heal together?” Today, Nick draws on his own personal experiences to be a mentor for other warriors. “I know how hard this journey has been for me and I know there are others out there going through the same things who may give up,” Nick says. “I feel a compulsion and a drive to help other veterans figure out the things I have slowly learned so they, too, can begin to heal.”
Margaret Paroski President & CEO and Chief Medical Officer
Catholic Medical Partners
Dr. Paroski is the is the President & CEO and Chief Medical Officer of Catholic Medical Partners, an independent practice association with 900 physician members. A board certified neurologist, Dr. Paroski has held various administrative positions including Medical Director at Erie County Medical Center; Senior Associate Dean of Academic Affairs & Admissions and Interim Vice President of Health Affairs and Interim Dean at the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo; and Executive Vice President and Chief Medical Officer at Kaleida Health.
She began her medical career at the Buffalo VA Medical Center and held hospital appointments at the Buffalo Psychiatric Center, Roswell Park Cancer Institute, Kaleida Health, and Erie County Medical Center. In addition to her clinical and leadership roles, Dr. Paroski has been a faculty member in the Neurology department at the Jacobs School of Medicine and Biomedical Sciences for the past 37 years.
As President & CEO and Chief Medical Officer of Catholic Medical Partners, Dr. Paroski leads clinical integration and standardization efforts and physician relations among the organization’s medical and specialty practices. She is also responsible for engaging physician members in population health initiatives and value based payment model adaptation.
Kiran Rangarajan Chief Government Programs Revenue Officer
Blue Cross & Blue Shield of Rhode Island
Kiran Rangarajan is an accomplished leader in the Risk Adjustment domain with extensive experience in government programs and has worked for payors, provider groups, and vendor partners. Currently, he serves as the Chief Government Program Revenue Officer at BCBS Rhode Island developing strategic initiatives, managing operations, and driving revenue for the organization. Prior to BCBSRI, Kiran has worked for United Group, Southwestern Health Resources, North Texas Specialty Physicians, Inovalon, and Anthem successfully navigating the complexities of the health care industry and driving revenue optimization and operational efficiency.
Kiran Rangarajan has a PhD from Missouri University of Science and Technology in Engineering Management focusing on managing high-risk projects and implementing effective solutions. Kiran continues to be at the forefront of industry trends with an innovative mindset and ability to identify growth opportunities and implementing effective and sustainable solutions.
John Romans is the co-founder and CEO of Biomedix, LLC, a privately held company dedicated to advancing care models leveraging healthcare IT and diagnostic technology.
John has pursued his goal of improving healthcare through collaboration. In 2006, John led Biomedix as a founding member of the national P.A.D. Coalition and sponsoring partner of the American Podiatric Medical Association. In 2010, John Romans was invited by CA Governor Arnold Schwarzenegger to participate in the California P.A.D. Task Force and was named E&Y Entrepreneur of the Year in the Upper Midwest Region. John received the APMA Executive Director's Award as well as an honorary degree from the New York College of Podiatric Medicine in recognition of his dedication to the advancement of podiatric medicine. John currently serves on the board of the Heart Health Foundation and Dare to C.A.R.E., a nonprofit organization that promotes awareness of vascular disease, and is a past board member the Association of Black Cardiologists (ABC), an organization that strives to reduce disparities in cardiovascular health, as well as the Science Museum of Minnesota.
John received his BA from Williams College and MBA from Wharton. He has been a founding principal in several technology-based ventures with a track record of developing and implementing innovative business models in emerging telecom, energy and healthcare markets. John and his wife live in Saint Paul and are the proud parents of four children.
Eric Shapiro is a Principal of Risk Adjustment at Pareto Intelligence. He is responsible for the execution and oversight of risk adjustment consulting initiatives across government and state-sponsored programs (Medicare, Medicaid, and ACA).
Eric brings over 18 years of healthcare experience to Pareto, working closely with health plans, health services organizations, and independent physician associations. Eric has worked directly for NYU Langone Health, Healthfirst NY, Optum and CIOX Health. Eric holds a Bachelor of Science in Public Health from Indiana University with a concentration in Health Administration as well as a Master of Public Administration from New York University with a specialization in Healthcare Policy and Management.
Eric has extensive insight into risk adjustment activities including RA program design, clinical data acquisition, HCC coding operations, clinical documentation improvement strategy, RAF analytics, value-based care programming, encounter data submissions process, premium integrity and HCC/RADV compliance.
Laura Sheriff, RN, MSN, is currently working as Vice President Operations, Risk Adjustment for Southwestern Health Resources (SWHR). She also works as a consultant with physician groups and health plans to capitalize on risk adjustment performance and operations. Laura is an MSN with >13 years’ experience in Medicare, Medicaid, and Marketplace Managed Care and has led teams in risk, quality, telehealth, and population health analytics. Laura demonstrates effective leadership, innovative problem-solving techniques, and goal-oriented focus to execute business objectives and meet performance metrics. Laura has designed and coordinated activities including provider education, training, auditing, data mining, and data analysis to direct program success. Laura has a Master’s in Nursing Education and is also a certified professional coder and a certified risk coder. Laura is also a frequent speaker for RISE, a best-in-class organization for all things related to accountable care and government healthcare reform.
Director, Risk Adjustment & Value-based Care Program operations & Compliance
Barry Stelmach is the Chief Financial Officer for Catholic Medical Partners, the largest network of independent practice physicians in Buffalo, NY, with nearly 900 physician members. He is responsible for the overall financial operations and leads payor negotiations for the organization. Barry also oversees the development and evaluation of risk contracts between payors and providers for all lines of business. He has played a significant role in preparing practices for the shift from fee-for-service to value-based care and risk-based contracts.
A native of Buffalo, NY Barry earned his undergraduate degrees in Accounting and Economics and a Master of Arts degree from the State University of New York at Buffalo.
Mikal Sutton is Managing Director of Medicaid policy for the Blue Cross Blue Shield Association (BCBSA), a national federation of thirty-four independent, community-based and locally operated Blue Cross and Blue Shield (BCBS) companies. BCBSA covers 114 million lives across all lines of business in the U.S. and Puerto Rico. Twenty-four of the BCBSA Plans operate a Medicaid program in twenty-nine states and Puerto Rico with more that twelve million Medicaid members.
With almost 15 years of experience Sutton has collaborated with state and local agencies, organizations, and external stakeholders to build substantive policy solutions. Sutton oversees detailed Medicaid policy analysis and strategies to support BCBS companies, in collaboration with BCBSA’s legislative, regulatory, research and modeling teams. Since joining the Association in 2020, Sutton has worked on regulatory and policy development on a wide variety of program issue areas including maternal health, social determinants of health, long-term services and supports, expansion of Medicaid and the Public Health Emergency unwinding.
Sutton has worked on Medicaid policy in Illinois, policy initiatives with the Illinois Department on Aging and as a director of grant operations for a Robert Wood Johnson Foundation grant focused on growing the nursing pipeline in Illinois. Sutton has a master’s degree in political studies and a bachelor’s degree in communications from the University of Illinois at Springfield.
An Illinois native, Sutton earned a bachelor’s degree in communications and master’s degree in political studies from the University of Illinois, Springfield. She enjoys outdoor activities, listening to music and traveling with her family.
Department of Health and Human Services (HHS), Office of Inspector General (OIG)
Megan Tinker is the Chief of Staff of the Department of Health and Human Services (HHS), Office of Inspector General (OIG). She works closely with the Inspector General to develop and support a high-level vision, enhance OIG’s oversight, and promote the efforts of OIG’s highly skilled workforce, including auditors, agents, attorneys, and evaluators.
As the Chief of Staff, Ms. Tinker serves as the Deputy Inspector General for OIG’s Immediate Office, where she oversees OIG’s Office of Congressional Affairs, Office of Communications, and Office of Operations. Under Ms. Tinker’s leadership, OIG builds and strengthens relationships with legislative partners, amplifies OIG’s impact through constructive collaboration with the media, and ensures consistent levels of excellence in its internal processes and delivery of oversight products. Additionally, Ms. Tinker represents OIG leadership in cross cutting efforts involving HHS, OIG partners, other Government agencies, and external stakeholders.
Ms. Tinker joined OIG in 2004 as a Senior Associate Counsel in the Office of Counsel to the Inspector General (OCIG). During her tenure with OCIG, Ms. Tinker assumed increasingly important leadership responsibilities, including a role as the Senior Advisor for Legal Affairs from 2016 to 2020. From 2021 to 2023, Ms. Tinker served in the Office of Audit Services as an Assistant Inspector General, where she furthered her impressive track record by conceiving and spearheading innovative, collaborative, and high-impact work for OIG and the IG community.
Prior to OIG, Ms. Tinker was in the private practice of law and worked for several years as a congressional oversight staffer. Ms. Tinker graduated cum laude from American University Washington College of Law and with honors from the University of Richmond.
NFL Network Analyst, Hall of Fame Running Back, MVP and 5x Pro Bowl Selection
LaDainian Tomlinson NFL Network Analyst, Hall of Fame Running Back, MVP and 5x Pro Bowl Selection
NFL legend LaDainian Tomlinson, or "L.T.", has achieved iconic status both on and off the field while overcoming seemingly insurmountable odds along his journey of success; despite being overlooked for factors like size, durability, and collegiate level competition he persevered to become a triple Hall-of-Famer in College and NFL, an NFL MVP recipient and 2006 Walter Payton Man of The Year Award winner.
His compassion is evident in founding the Touching Lives Foundation in 2004 which works tirelessly for those less fortunate across numerous civic initiatives - from awarding scholarship money through grants to creating cultural awareness programs with US Veterans organizations.
Furthermore, L.T.'s work ethic even extends into social entrepreneurship where he leads many successful ventures such as the Tomlinson Center, 3SIXT Culture Management Software, LT21 Sports aimed at developing high production cultures within low socio-economic school districts via leadership development, mentor coaching sessions with students and staff that ultimately improved attendance by 12%, reduced recidivism rates by 61% whilst boosting academic performance scores to 18%!
Rising job market gaps will be filled thanks to Mr. Tomlinson’s' workforce program for tutoring, community engagement, and career experiences aligning corporations with students who must develop appropriate skills necessary to meet global employment challenges head on...providing opportunities for both our companies and students to ensure America’s future is intact.
Rex is a Quality Improvement expert who helps health plans achieve higher quality, operational excellence, and more meaningful engagement with all stakeholders. oPrior to founding RWC, Rex was a health plan leader accountable for Star Ratings, Medicare operations, and the member experience for a multi-state, 100,000+ member plan. He led the turnaround of all nine contracts from 3.5 Stars to either 4 or 4.5 Stars through enhanced data-enabled engagement with the organization, its members, and its providers. Rex has 30 years of industry experience leading functions such as member retention, market analysis, customer service, and operational improvement.
As BeneLynk’s Chief Product Officer, Terry synthesizes the voice of the customer, market feedback, elements of technical design with regulatory requirements and emerging trends to execute a meaningful/aggressive roadmap, drive innovation to a vision, maximize growth and customer success. Terry has more than 30 years of health care leadership experience with a proven history of integrating industry expertise, leadership, creativity, and collaboration to drive excellence in solution innovation, operational execution, and organizational improvement. Innovation, collaboration, and customer success has been the center piece in each of leadership positions Terry has successfully performed in such companies as McKesson, UnitedHealth Group, Change Healthcare, Apixio/Centene and now BeneLynk.
Terry has been recognized for his focus on these core tenants; Innovation, Collaboration, Customer Success). In 2012 Terry was awarded an OptumInsight Innovation award in recognition of his leadership on the Care Pattern Analysis solution. This innovation would enable clinicians and medical directors to conduct meaningful coaching discussions with providers that would reduce cost by decreasing and, in some cases, eliminating the variations in care.
In 2013, the Certified HEDIS solution, for which Terry provided Product Management leadership, was the recipient of the Gartner award for demonstrating best practices in dashboard design for HEDIS reporting. In addition, in 2013 Terry was the recipient of the 2013 Optum Innovation Leadership Shadow Award which recognizes individuals who consistently support Optum’s innovation culture in their daily work and inspire innovation in others through their leadership shadow. Sponsored three quality management solution patents as co-inventor.
In 2020 and 2021 Terry was directly responsible for designing, developing, and integrated two new solutions into the Apixio portfolio, accounting for over $3 million of revenue in just the first seven months of their release.
Terry earned his Bachelor of Arts degree from the University of Montana – Missoula and completed the Post-Baccalaureate Pre-Professional Health Science Program (Pre-Med) at Loyola University of Chicago.
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.
Aaron Winkel is a Senior Solutions Manager and Product Owner for Veradigm’s Risk Adjustment Analytics product suite. He has over 25 years of experience in the health care industry. Prior to his 7+ years at Veradigm (formerly Pulse8), he spent over 10 years at a health plan in Portland, OR in various leadership roles. As the Manager of the Analytics team, Aaron focused on Utilization metrics, Cost trends, opportunities for savings initiatives, Medicare bids, and oversaw all Risk Adjustment activities. He began his career as a Healthcare Analyst for a medical group that assumed financial risk for their patients by doing managed care. He received his Bachelor of Science in Statistics from Brigham Young University.
Beth works closely with our customers to ensure we deliver solutions that support their strategic objectives and drive better healthcare outcomes. She brings more than 20 years of experience in healthcare technology, consulting, project management, and sales. Beth got her start in healthcare IT at Epic and has held leadership roles at Evergreen Healthcare PArtners and healthfinch. An impassioned solution-oriented leader, Beth is committed to bringing our customers innovative solutions that reduce waste and enable greater access to care.