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  • 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
Track 2: Revenue Cycle Management & Revenue Integrity
  • A discussion focused on strengthening ties and reducing provider abrasion
  • Case studies of successful payer-provider initiatives and effective provider engagement strategies
  • Progressing mutually beneficial initiatives in a collaborative manner

Author:

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.

... read more

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.

Author:

Stina Redford

Director of Payment Innovation
Blue Cross of Idaho
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Stina Redford

Director of Payment Innovation
Blue Cross of Idaho
  • Explanation of factors contributing to underpayment, such as contractual discrepancies, coding errors, complex reimbursement rules, and more
  • Ensuring collaboration between revenue cycle teams, coding professionals, and payer relations departments to address underpayment issues
  • Adopting proactive monitoring, automated workflows and targeted follow-ups on identified discrepancies
Track 2: Revenue Cycle Management & Revenue Integrity
  • Coordinating the efforts of credentialing/enrollment, audits, investigations (SIUs), provider sanctions, and policy
  • Very few insurance payers have all those groups working together in a coordinated effort to reduce fraud, increase revenue, and render excellent customer service to enrolled health care providers.
Track 1: Payment Integrity

Author:

Dale Carr

Director
Missouri Medicaid Audit and Compliance (MMAC)

Dale Carr currently serves as Director of the Missouri Medicaid Audit & Compliance (MMAC) unit, which
has overall responsibility for Medicaid program integrity efforts. Dale has worked for the State of
Missouri since 2011. Director Carr was previously a Police Officer in Fallon, NV; an Investigator for the
U.S. Office of Special Counsel; and a Supervisory Special Agent with the Coast Guard Investigative
Service. Dale holds a Bachelor’s degree in Administration of Criminal Justice and is a graduate of the

158th Session of the FBI National Academy.

... read more

Dale Carr

Director
Missouri Medicaid Audit and Compliance (MMAC)

Dale Carr currently serves as Director of the Missouri Medicaid Audit & Compliance (MMAC) unit, which
has overall responsibility for Medicaid program integrity efforts. Dale has worked for the State of
Missouri since 2011. Director Carr was previously a Police Officer in Fallon, NV; an Investigator for the
U.S. Office of Special Counsel; and a Supervisory Special Agent with the Coast Guard Investigative
Service. Dale holds a Bachelor’s degree in Administration of Criminal Justice and is a graduate of the

158th Session of the FBI National Academy.

  • Empowering payers to proactively detect and prevent fraudulent activities
Track 1: Payment Integrity

Author:

Karen Weintraub

Executive Vice President
HEALTHCARE FRAUD SHIELD

With 25 years of data and 20 years of healthcare experience, Ms. Weintraub is currently responsible for the design and development of the company’s healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures. Prior to joining Healthcare Fraud Shield, managed SIUs on various healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity. Ms. Weintraub received a BA in Criminal Justice from the University of Delaware and an MA in Criminal Justice from Rutgers University. Ms. Weintraub is a Certified Professional Coder for Payers (CPC-P), a Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders, a Certified Dental Coder (CDC) from the American Dental Association, and the founder of the Hamilton, NJ AAPC chapter. She is also an Accredited Healthcare Fraud Investigator (AHFI) from the National Healthcare Anti-Fraud Association (NHCAA). Ms. Weintraub Taught CPT Coding, Fraud & Audits, and Medical Billing, Laws and Ethics and the local community college. 

... read more

Karen Weintraub

Executive Vice President
HEALTHCARE FRAUD SHIELD

With 25 years of data and 20 years of healthcare experience, Ms. Weintraub is currently responsible for the design and development of the company’s healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures. Prior to joining Healthcare Fraud Shield, managed SIUs on various healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity. Ms. Weintraub received a BA in Criminal Justice from the University of Delaware and an MA in Criminal Justice from Rutgers University. Ms. Weintraub is a Certified Professional Coder for Payers (CPC-P), a Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders, a Certified Dental Coder (CDC) from the American Dental Association, and the founder of the Hamilton, NJ AAPC chapter. She is also an Accredited Healthcare Fraud Investigator (AHFI) from the National Healthcare Anti-Fraud Association (NHCAA). Ms. Weintraub Taught CPT Coding, Fraud & Audits, and Medical Billing, Laws and Ethics and the local community college.