Speakers
Adele L. Towers, MD MPH FACP CRC
Professor of Medicine, Division of Geriatric Medicine
Director, Risk Adjustment
Aldiana Krizanovic, MPH, CPH
Senior Health Policy Consultant, Federal Government Relations
Amanda Brown
Vice President - Revenue Integrity
Amy Jack, RHIA, CRC, CCA
Director of Risk Adjustment
Ava Johnson
Associate Director, Ambulatory CDQI
Brett J. Goff
Director of Risk Adjustment
Brittney Peyton CPC, CRC
Risk Adjustment Program Manager
Christopher G. Bresette
Director of Medicare Part C Audits
Crystal Hartmann
Risk Adjustment Program Manager
Dao Vang, RHIA, CCS-P, CRC,
Senior Program Manager - Provider Enablement for Risk Adjustment,
Dawn Marie Cusimano, CRC
System Manager, Ambulatory Risk Adjustment and Clinical Documentation Integrity
Dean Ratzlaff
Director – Actuary/Revenue Management
Dr. Julio Perez, AHCCA
Director, Medicare Risk Adjustment
Emily Crooks, APRN, FNP-C
Family Nurse Practitioner, Director, Population Health,
Jennifer Hawkes CPC, CRC
Risk Adjustment, Manager, Member Engagement
Jessica Vaughn, DNP, RN, NEA-BC, CCDS, CCDS-O, CRC
Director of Operations, Condition Management and Documentation, Enterprise Population Health
John M. Barkley
Vice President, Risk Adjustment & Data Integrity
Kaitlyn Greve
Product/Program Development Consultant
Keslie Crichton
Chief Sales Office
Kevin Rodriguez, CDIS
Supervisor Risk Adjustment & Quality
Lisa Wigfield
RN CCM CRC CRC-I CDEO
Michael Bagel
Associate Vice President of Public Policy
Ray Evans
Vice President – Healthcare Sales
Rebecca Welling
Vice President Risk Adjustment
Ryan C. Dodson, CRC
Risk Adjustment Consultant
Sarah J. Hartley, MHA, RHIA, CDEO, CRC
System Director, Ambulatory Risk Adjustment and Clinical Documentation Integrity
Scott Weiner
Director, Government Programs
Subbu Ramalingam
Senior Consultant
Susan L. Waterman
Director of Risk Adjustment
Syed M. Rizvi, MHA,
Director, Risk Adjustment Operations
Speaker Details
Adele L. Towers, MD MPH FACP CRC
Professor of Medicine, Division of Geriatric Medicine
University of Pittsburgh School of Medicine
Director, Risk Adjustment
UPMC Enterprises
Dr. Towers is the Director of Risk Adjustment for UPMC Enterprises and is also a geriatrician on the faculty at the University of Pittsburgh. At UPMC Enterprises, she is directly involved in the development of healthcare related technology, with emphasis on use of Natural Language Processing (NLP) for Risk Adjustment coding and use of Clinical Analytics to optimize clinical performance. Dr. Towers has presented the experience at UPMC with use of NLP and Clinical Analytics at multiple regional and national conferences.
Aldiana Krizanovic, MPH, CPH
Senior Health Policy Consultant, Federal Government Relations
Florida Blue
Amanda Brown
Vice President - Revenue Integrity
CoventBridge Group
Amanda Brown is the Vice President of Revenue Integrity at CoventBridge Group where she provides expertise to her clients spanning Medicare Advantage, Medicare Part D, Medicaid, Marketplace, Commercial and FEHB products. She is a subject matter expert in the design and implementation of effective compliance, program integrity, risk, audit, vendor oversight, and ethics programs. Amanda has a keen ability to break down silos and bring organizational collaboration to facilitate compliance with policies, laws, regulations, and risk management.
Amy Jack RHIA, CRC, CCA
Director of Risk Adjustment
Select Health
Amy Jack is the Director of Risk Adjustment at Select Health. She has honed her expertise in
Risk Adjustment documentation and coding for more than a decade by earning a Health
Information Management Bachelor's degree from Weber State University, along with her
credentials of Registered Health Information Administrator, Certified Coding Associate and
Certified Risk Adjustment Coder.
For the past nine years, Amy has grown a dedicated team of Risk Adjustment coding specialists
and has led them to be the standard-bearers of ethical and compliant Risk Adjustment coding.
She thrives in her role as a mentor and team leader. She takes delight in sharing knowledge
about coding and documentation best practices with Providers and their staff, and her expertise
has led her to be a sought-after presenter at industry events.
Ava Johnson
Associate Director, Ambulatory CDQI
Mount Sinai Hospital, NYC
Ava Johnson is the Director of the Outpatient Clinical Documentation Quality Improvement department at Mount Sinai Hospital in NYC. Ava has a background as a seasoned coding instructor, multispecialty coder, CDI specialist, physician educator, and public speaker with a focus on executive leadership and career development.
Brett J. Goff
Director of Risk Adjustment
Peach State Health Plan/Centene
Brett Goff serves as Director of Risk Adjustment Programs and Strategy for Peach State HealthPlan, part of Centene Corporation health plans. which proudly offers Medicare Advantage, Medicaid and ACA health insurance coverage to 1.4 million members across Georgia state. Brett oversees the strategic vision, implementation, and execution of Risk Adjustment clinical gap closure programs. While working for Centene Corporation Brett has served in many Risk Adjustment roles for both health plan and corporate teams. Including RA operations for new and transitioning markets, RA liaison to Southeast markets, and RA project manager of Kansas health plan. Brett’s healthcare experiences have helped him focus on supporting solutions that meet payer and provider needs. In his free time, Brett enjoys Mountain Biking, Skiing, and spending time with his family.
Brittney Peyton CPC, CRC
Risk Adjustment Program Manager
Blue Cross of Idaho
I’m the risk adjustment program manager at Blue Cross of Idaho. I am responsible for overseeing our vendors performance and risk adjustment programs for Medicare Advantage and Affordable Care Act lines of business. I am a key contributor in the strategy planning, vendor vetting, contracting, implementation and monitoring of our vendors and risk adjustment programs. I bring over 15 years of experience in the health insurance industry and am a certified professional coder and certified risk adjustment coder through AAPC.
Christopher G. Bresette
Director of Medicare Part C Audits
United States Department of Health and Human Services (HHS), Office of Inspector General, Office of Audit Services
Christopher G. Bresette is the Director of Medicare Part C Audits with the United States Department of Health and Human Services (HHS), Office of Inspector General, Office of Audit Services. Mr. Bresette is responsible for the implementation and coordination of all audits of the Medicare Advantage program. Based on more than 30 years of experience, he provides expert advice to other auditors about the design and execution of those audits. In addition, Mr. Bresette has a wealth of knowledge regarding other HHS programs, including traditional Medicare and Medicaid, and has conducted several audits designed to detect and prevent fraud, waste, and abuse. Mr. Bresette also provides training to new and experienced auditors about the Medicare Advantage program. Mr. Bresette graduated with honors from Rockhurst University with a BSBA in Accounting and is a certified public accountant, licensed in Missouri. Mr. Bresette has received numerous exceptional achievement awards and was previously bestowed with one of the agency’s highest honors when he received the Inspector General’s Bronze Award for the outstanding auditor of the year.
Crystal Hartmann
Risk Adjustment Program Manager
Blue Cross of Idaho
Crystal Hartmann has been at Blue Cross of Idaho for two years, previously in the Provider Relations role directly supporting Eastern and Northern Idaho clinics and hospitals, and currently working as the Risk Adjustment Program Manager. She has over 15 years’ experience in the healthcare industry, previously serving in roles as a Clinic Administrator and Director of Operations for a multitude of specialties including Family Practice, Pediatrics, Urgent Care, and Prosthetics/Orthotics. Crystal is passionate about identifying opportunities for change management and implementing lean efficiencies; she holds several lean certifications including her Lean Six Sigma Black Belt and Certified Process Improvement Specialist certification, as well as her Certified Medical Practice Examiner certification (CMPE). With a robust knowledge of clinic operations, from practice building to physician onboarding, Crystal is focused on serving as a bridge between payer and provider for optimal success outcomes.
Dao Vang, RHIA, CCS-P, CRC
Senior Program Manager - Provider Enablement for Risk Adjustment,
Blue Cross Blue Shield of Minnesota
Dao Vang is currently a Senior Program Manager specializing in provider enablement for risk
adjustment at Blue Cross Blue Shield of Minnesota. With a robust background in revenue cycle
management and coding, she enjoys bridging the gap between payer and care systems through
innovative implementation of clinical data exchange. Dao has created educational content for
healthcare professionals, collaborated with stakeholders on clinical documentation integrity, and
maintained up-to-date knowledge on risk adjustment regulations.
Dao's career began with a solid foundation in coding and compliance. Her commitment to
education and compliance has been evident throughout her roles, where she consistently
delivered training sessions and supported teams in navigating complex coding regulations. With
a passion for healthcare excellence and a dedication to continuous improvement, Dao is a key
player in advancing risk adjustment strategies and ensuring compliance across healthcare
systems.
Dawn Marie Cusimano, CRC
System Manager, Ambulatory Risk Adjustment and Clinical Documentation Integrity
Endeavor Health Physician Partners/NorthShore
Dawn Marie Cusimano, CRC is the Manager of ambulatory clinical documentation integrity (CDI) and risk adjustment for Endeavor Health. Dawn has over 16 years of ambulatory medical coding and billing experience and has spent the last 6.5 years focused on risk adjustment and building ambulatory clinical documentation programs at 3 separate healthcare organizations in the Chicagoland area. Dawn joined Endeavor Health in April 2022 and was tasked with partnering with her Director to develop and deploy an ambulatory CDI department throughout their system to cover ~500,000 risk adjusted lives. This development included building compliant processes, EPIC tools, Key Performance Indicators (KPIs), dashboards/scorecards, and educational material for coders, nurses, providers, and executive leadership. Since that time, Dawn and her team have implemented an advanced and progressive ambulatory CDI program which currently supports 2,600 providers in primary care throughout 9 hospitals and numerous outpatient locations with projected growth into 2025 to cover ~1 million risk adjusted lives.
Dean Ratzlaff
Director – Actuary/Revenue Management
Sentara Health Plans
Dean brings the perspective of an Actuary to risk adjustment. Prior to working in Risk Adjustment he did claim processing, Medicare Advantage bids, set various accounting items, and ACA rate filing. He has over a decade of Risk Adjustment experience that spans Medicare, Medicaid and ACA. He has worked in risk adjustment at both for- profit and non-profit insurers. After years of doing chart reviews off the side of his desk, he convinced his company to create a risk adjustment department that has since grown to over 16 people. His experience building a risk adjustment department spans hiring, RFPs, communicatin g to executives, forecasting, HEDIS collaboration, writing regulatory opinions, and much more. One of his current efforts involves capitalizing on interoperabili ty. Nationwide standards such as FHIR APIs and USCDI have recently become codified in regulations, accelerating the country to EMR 2.0 – where EMRs communicate with each other and with other systems. This opens up new possibilities for risk adjustment at a Health Plan. Dean’s presentations pair in-depth understanding with practical tips, spanning both theory and application.
Dr. Julio Perez, AHCCA
Director, Medicare Risk Adjustment
Ultimate Health Plans, Inc.
Julio Perez, MD, is UHP’s Medicare Risk Adjustment Director with over six years dedicated to clinical roles. Before his current position, Julio was a Senior Risk Adjustment Analyst with Aegis Medical Group, engaging in the review and analysis of both acute and chronic disease conditions following CMS guidelines. He played a vital role in educating providers about risk adjustment and was instrumental in employee training programs. A graduate from Santo Domingo Institute of Technology Medical School, Julio also proudly holds an advanced HCC auditor certification. With a deep commitment to improving healthcare through meticulous risk adjustment practices, Julio brings a wealth of knowledge and experience to the conference. We are delighted to have him share his insights with us.
Emily Crooks, APRN, FNP-C
Family Nurse Practitioner, Director, Population Health
Affinity Health Group
Emily Crooks is the Director of Population Health for Affinity Health Group (AHG) in Monroe, LA. She has 22 years of nurse practitioner experience with the past 11 years focused on preventive care, risk stratification, quality performance, and provider education. Emily currently leads operations, strategy, and process improvement for AHG’s Population Health Department. AHG Population Health partners with Blue Cross Blue Shield of Louisiana to provide in-home health assessments for MA and ACA lines of business. These comprehensive in-home assessments focus on disease prevention and early detection, risk identification, patient education, and access to care which contributes to improved patient outcomes. Emily also serves as a Population Health Advisor and Clinical Documentation Supervising Lead for eleHealth, a physician-led management services organization. She oversees clinical documentation and coding reviews for eleHealth’s Network and Medicare ACO practices. As a subject matter expert in clear, accurate clinical documentation and coding best practices, she delivers effective, provider centered education and tools that promote improved performance in quality and gain sharing programs.
Jennifer Hawkes CPC, CRC
Risk Adjustment, Manager, Member Engagement
Blue Cross of Idaho
Jennifer is a Manager of Member Engagement at Blue Cross of Idaho, she was a key player in
vendor contracting, planning, developing, monitoring, and improving Medicare and ACA risk
adjustment programs since 2017. She is responsible for the success of several risk adjustment
prospective and retrospective programs including MA and ACA Retrospective programs and
Telehealth and In-home Health Assessments. She brings over 27 years of experience in the
health insurance, auditing and healthcare industries and holds certifications in professional and
risk adjustment coding.
She now has a tremendous opportunity to improve member health outcomes and create
understanding. Her current focus is on strategic planning around member education and
adoption of healthcare activities and collaboration with other stakeholders to combine efforts,
eliminate duplication, and map the member’s journey to maximize outcomes.
She is also passionate about bringing understanding, education, and awareness to managing
type 1 diabetes and living an active love and laughter filled life.
She is from the beautiful state of Idaho, a mother of two beautiful young adult children. She
enjoys backpacking, hiking, camping, biking, and spending as much time as possible outdoors
in the breathtaking Idaho mountains with her husband and adventurous friends.
Jessica Vaughn, DNP, RN, NEA-BC, CCDS, CCDS-O, CRC
Director of Operations, Condition Management and Documentation, Enterprise Population Health
Advocate Health
A nurse of 27 years, Jessica has 14 years of CDI experience with over 10 years dedicated to risk adjustment operations.
Jessica spearheaded some of the nation’s first ambulatory CDI programs focused on value-based care initiatives. In 2022, she joined
Advocate Health, the nation’s 3 rd largest non-profit health system, where she leads a large multidisciplinary team focused on
Population Health initiatives including ambulatory documentation, care gap closure, comprehensive care and revenue cycle
management. She is a leader in the industry, having spoken at multiple conferences, authored articles, received ACDIS’s Professional
Achievement Award, helped write the original study guide and initial CCDS-O certification exam, and most recently reviewed the
ACDIS 2024 Outpatient Pocket Guide. Jessica has held clinical certifications in pediatrics, oncology, chemo and biotherapy, and
AHIMA’s approved ICD-10 CM/PCS trainer. She completed her Doctorate in Nursing Executive Leadership at Duke University in
Durham, NC and advocates for empowering interprofessional healthcare teams to improve patient care.
John M. Barkley
Vice President, Risk Adjustment & Data Integrity
EmmblemHealth/ConnectiCare/AdvantageCare Physicians
John Barkley is the Vice President of Risk Adjustment and Data Integrity for Emblem Health. Emblem Health is one of the nation’s largest nonprofit health insurers, with 3.2 million members and an 80 year legacy serving New York’s communities. John is responsible for all risk adjustment operations, submissions and data integrity activities for Emblem and ConnectiCare. He has been with Emblem for 13 years and prior to those 21 years with Aetna in various financial roles, including leading risk adjustment operations. John started his career as a CPA working for Deloitte. John has been an attendee and presenter at many industry conferences over the years. When not executing risk adjustment operations John enjoys boating, kayaking and fishing on Cape Cod Massachusetts where he lives.
Kaitlyn Greve
Product/Program Development Consultant
Advocate Health
Kaitlyn Greve is the Product Program Development Consultant at Advocate Health, the 3 rd largest non-profit health system. Prior to joining Advocate Health Kaitlyn spent over 6 years in healthcare consulting, focused on Revenue Cycle operations. She joined Advocate Health in 2020 and is responsible for the business operations of Condition Management & Documentation post-encounter programs including retrospective reviews and data reconciliation. To ensure integration of program strategy and data management, she partners closely with functional leaders internally and manages vendor and payor partnership.
Keslie Crichton
Chief Sales Officer
Benelynk
Keslie brings a long history of strong execution and delivery for integrated
solutions across risk adjustment, quality performance and eligibility and
enrollment solutions in both Medicare and Medicaid.
At BeneLynk, Keslie is responsible for driving enterprise growth and innovative
partnerships to improve outreach strategies and health outcomes for our client’s
members. Keslie works closely with BeneLynk’s product team to offer
differentiated services and capabilities to maintain its market leader position.
Keslie has worked in managed care for over 25 years with a focus on SDoH
solutions that improve members lives but also provide a return on investment for
our clients. Keslie's passion lies in working on strategies that put members at the
center while ensuring we deliver accurate risk-adjusted revenue, quality
performance, and member retention.
Prior to joining BeneLynk, Keslie served as Vice President, Sales, and Account
Management at Change Healthcare (formerly Altegra Health/Social Service
Coordinators). Keslie holds a B.S. in Business Administration from Regis
University and worked toward her MBA and Masters in Healthcare Administration
at Sacred Heart University in Fairfield, CT.
Kevin Rodriguez, CDIS
Supervisor Risk Adjustment & Quality
Wellvana Premier Care
I am an international medical graduate from Nicaragua with a passion for healthcare and a focus on Value Based Medicine. I'm particularly intrigued by the Medicare Advantage industry and its influence it's had on the healthcare landscape. My primary focus is to bring about positive change to this industry while maintaining ethical standards.
Lisa Wigfield
RN CCM CRC CRC-I CDEO
Blue Cross Blue Shield of Michigan
Lisa has been a Registered Nurse for over 30 years. She earned her Diploma in Nursing at St Clair College in Ontario Canada. She then went on to pursue her Bachelor of Science Degree also in Nursing, from the University of Windsor. Lisa has spent the majority of her career in the Health Plan arena. She has had experience in quality-of-care outcomes, Care management models of care including SDoH community outreach. She was offered the opportunity to collaborate with the Medicare Risk Adjustment team. She obtained several Coding certifications focused on Risk Adjustment. Along with the Medicare Risk Adjustment team she was the clinical subject matter expert and lead creating an outpatient risk adjustment program. The focus of the program included Clinical Coding and documentation education with a focus on Provider Engagement and Collaboration.
Michael Bagel
Associate Vice President of Public Policy
Alliance of Community Health Plans (ACHP)
Michael is a public policy expert with nearly two decades of working with federal policymakers and lawmakers to advance regulatory and legislative activities. He previously served as a senior policy advisor at the Department of Health and Human Services Office of the Secretary, attorney with the Office of Management and Budget, and as a law clerk at the US Department of Labor and Health Policy Associate with the Senate Finance Committee.
Ray Evans
Vice President – Healthcare Sales
CoventBridge Group
Ray Evans is the Vice President of Healthcare Sales at CoventBridge Group where he is responsible for providing FWA solutions that deliver cost savings and drive efficiencies for our customers in the healthcare markets. In Ray’s more than 30-year career, he has had extensive experience working within, and servicing healthcare organizations. This experience gives him the knowledge and insight to provide the most customized and successful FWA solutions in the industry.
Rebecca Welling
Vice President Risk Adjustment
Intermountain Health
Rebecca Welling is the VP of Risk Adjustment for Intermountain Health and SelectHealth. Her teams oversees all risk adjustment programs pertinent to Medicare, Medicaid and ACA lines of business. Rebecca is also a certified coder. Rebecca has been managing overseeing Risk Adjustment Programs for 18 years and previously worked with Providence St Joseph, AYIN, Premera Blue Cross, and other payer partners. Rebecca’s primary focuses is to ensure Select Health and Intermountain Health runs an ethical, compliant and comprehensive risk adjustment program.
Ryan C. Dodson, CRC
Risk Adjustment Consultant
Choice Medical Group
His background is in management and operational processes for 15 years and begun working in the Risk Adjustment arena 15+ years ago. Ryan has proven himself by helping Medical Groups and Health Plans to accurately improve their documentation with a solid track record of provider engagement. Ryan uses a unique blend of comedy, and deep risk adjustment knowledge to get buy-ins from providers to improve their documentation. His track record of results of improving documentation and thus improving revenue streams and patient care brings value to any group he works with. Having worked on the provider, payer, and now the vendor side Ryan is able to bring a unique perspective to the conversation and develop out of the box ideas to help any size group. In 2020 Ryan co-founded New Vision Healthcare Solutions to fill a niche in the market on providing provider education with data stemming from analytics, and provider chart data. Ryan is a Certified Risk Adjustment Coder (CRC) credential through the AAPC.
Sarah J. Hartley, MHA, RHIA, CDEO, CRC
System Director, Ambulatory Risk Adjustment and Clinical Documentation Integrity
Endeavor Health Physician Partners/NorthShore
Sarah’s Bio- Sarah Hartley, MHA, RHIA, CDEO, CRC – Has been in healthcare for 23 years, with various experience in HIM, Coding, Inpatient CDI and Ambulatory Risk Adjustment/OP CDI. With an education in Health Information Management and Health Administration she’s been successful in her career and been given multiple opportunities to revamp, rebuild and create new departments. She actively teaches at several colleges with varying courses including, health information, reimbursement, management, statistics, medical terminology and ethical/legal aspects of healthcare. One of the most exciting points of my career has been rebuilding an inpatient CDI team (bringing them from an outsourced function to fully in-house and was able to more than double our return) and successfully creating multiple ambulatory CDI programs at three large healthcare organizations. In my role as HIM Director and Director of CDI (both Inpatient and Ambulatory), I have had to build successful relationships with providers at all levels, obtain their buy-in and support and collaborate to make improvements. Currently I serve as System Director of Ambulatory Risk Adjustment and Clinical Documentation Integrity (aCDI) at Endeavor Health Physician Partners, based out of Chicago. Endeavor Health Physician Partners is a Clinically Integrated Network of ~400 lives, more than 2,600 providers and 9 hospitals, my role is to ensure the success of our ambulatory risk adjustment program through complete and accurate documentation, coding and risk adjustment practices.
Scott Weiner
Director, Government Programs
Sentara Health Plans
Scott is the Director of Government Programs at Sentara Health Plans. Prior to joining Sentara, Scott was the founder of Quadralytics, a data analytic, software, and finance consulting company. Previously, he was the Senior Vice President, Analytics and Strategy, EMSI HEALTH where he was focused on expanding the company’s HEDIS, Medicare Stars, Medicaid Risk Adjustment and data analytics offerings to better meet the needs of health plans and other clients. He has extensive executive-level and health-plan consulting experience, having held managed care, risk adjustment and data analytics positions for more than 20 years. He has a Master of Business Administration (MBA) from Seattle University and a bachelor’s degree in accounting from Central Washington University. He holds the Certified Risk Adjustment Coder (CRC) and Certified Professional Coder (CPC) designation from AAPC and CMA and CFM from the Institute of Management Accountants.
Subbu Ramalingam
Senior Consultant
ATTAC Consulting Group
Senior Consultant ATTAC Consulting Group | Philadelphia, PA | December 2024 - Present Strategy & execution consulting to drive the highest performance in healthcare quality, 5-star rating, risk adjustment, and cost results for healthcare organizations. The only U.S. organization with deep expertise in end-end Risk Adjustment & STARs/Quality performance for healthcare organizations. Leader in driving Value Based-Care results for payers and provider
Susan L. Waterman
Director of Risk Adjustment
Baylor Scott & White Health
Susan Waterman is the Director of Risk Adjustment for Baylor Scott and White Health Plan. Baylor Scott and White is an integrated healthcare system with over 50 hospitals, research centers, and 800 + patient care sites across Texas. Susan’s primary focus is ensuring accurate risk scores by leading a team of auditors and focusing on provider engagement and education, working with other departments to achieve health plan goals, and a commitment to designing and implementing affordable, high quality health care coverage so customers, patients and team members are empowered to live well.
Syed M. Rizvi, MHA
Director, Risk Adjustment Operations
Southwestern Health Resources
Syed Rizvi, MHA, CPC – Syed is a dedicated healthcare leader focused on the ever-evolving value based care landscape for over 10 years. He has worked with large provider groups and payors to help increase quality and mitigate costs, giving him a unique and comprehensive approach to managing care. By utilizing data to tell a clear story and provide insights for innovation, Syed has built strategies to tackle some of the most complex healthcare topics including risk adjustment, hospital contracting, HEDIS Quality improvement, and provider/vendor relations. Syed is currently serving as Director of Risk Adjustment submissions at Southwestern Health Resources, and has also lead teams around strategy, quality, and provider network.