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Lori Jensen

Director of Value Analysis
University of Utah Health

Lori Jensen

Director of Value Analysis
University of Utah Health

Lori Jensen

Director of Value Analysis
University of Utah Health
 

Carl Reinhardt

Director of Special Investigations Unit – West
Anthem Blue Cross

Carl Reinhardt

Director of Special Investigations Unit – West
Anthem Blue Cross

Carl Reinhardt

Director of Special Investigations Unit – West
Anthem Blue Cross
  • Implementing a streamlined claims process to prevent missing information and incorrect coding, and tracking patterns claim denials to mitigate future issues
  • Highlighting causal factors such as front-end errors related to benefit information, coverage details, and missing or invalid claims data
  • Discussing the value of automated denial management systems as a means to reduce administrative burden
Track 2: Revenue Cycle Management & Revenue Integrity
  • Payment Integrity Begins at the Top
  • The SIU’s Greatest Need-Data
  • Recent Schemes & Trends
    • Internet Based Providers
    • Behavioral Health Providers
    • Telehealth Providers

Author:

Carl Reinhardt

Director of Special Investigations Unit – West
Anthem Blue Cross

Carl Reinhardt

Director of Special Investigations Unit – West
Anthem Blue Cross
  • Using an AI-first approach to enhance transparency and accuracy throughout the payment continuum

Author:

Mike Spellman

Senior Director, Consulting & Solution Design
Lyric

Mike Spellman

Senior Director, Consulting & Solution Design
Lyric
  • In healthcare to optimize skills used to improve the value of products, it is essential to remove clinical and financial silos. Collaborating and aligning revenue teams with value analysis teams provide a platform to tell the entire business story in healthcare, decrease cost, and increase revenue.   

  • Relationships in this arena generate opportunities to find billing and charging errors, and implement best practices into workflow, procedures, and buying trends. Collaboration benefits the teams by offering vital evidence that helps providers make judicious choices about the products they may want to bring into facilities.  A revenue cycle analyst can aid in the discovery of problems with processes or old ways of how and where procedures are performed. Using dashboards, reports, and charging and reimbursement data can be seamlessly be integrated into existing value analysis processes making it easy to collaborate on the best ways to achieve your revenue targets.  

Track 2: Revenue Cycle Management & Revenue Integrity

Author:

Lori Jensen

Director of Value Analysis
University of Utah Health

Lori Jensen

Director of Value Analysis
University of Utah Health
  • Developing a Payment Integrity Program from the ground up for a brand new Medicare Advantage Health Plan
  • Covering both the opportunities and the challenges of building and effectively managing PI programs that prevent, avoid, or recover billing errors, payment errors and other party liability errors
  • Listing of suggestions/ advice from our success, and lessons learned

Author:

Josh Miller

Director, Payment Integrity
Prominence

Josh Miller

Director, Payment Integrity
Prominence