Rise

Cathy Anderson Director, Division of Risk Adjustment Operations

Centers for Medicare & Medicaid Services (CMS)

Catherine Anderson is the Director of the Division of Risk Adjustment Operations within the Payment Policy and Financial Management Group within the Center for Consumer Information & Insurance Oversight (CCIIO) at CMS.  CCIIO is responsible for the policy, implementation, and operations for the Patient Protection and Affordable Care Act (ACA), including the premium stabilization programs designed to provide consumers with affordable health insurance coverage, to reduce incentives for health insurance issuers to avoid enrolling sicker people, and to stabilize premiums in the individual and small group health insurance markets inside and outside the Marketplaces. The risk adjustment program is the only permanent premium stabilization program under the ACA. Ms. Anderson has ten years of experience in ACA risk adjustment and risk adjustment data validation.

Mark Bigelow VP, Risk Adjustment

Cambia Health Solutions

Karen Bowers Director Risk Management

American Health Plans

As the Director of Risk Management at American Health Plans, Karen Bowers leverages over 20 years of experience in medical records coding, data analytics, and risk management. She leads initiatives focused on Medicare Part C risk adjustment, clinical documentation improvement, and regulatory compliance, with a particular emphasis on optimizing risk posture, developing effective compliance policies, and conducting thorough audits. Karen's strategic efforts have significantly enhanced quality of care, improved HCC coding accuracy, strengthened provider engagement, and supported the management of RADV audits and data submissions.

Beyond her leadership role, Karen is also a committed educator. She has designed training programs to enhance coding accuracy and compliance, while mentoring healthcare professionals at all levels.

Karen holds a Bachelor’s degree in Health Information Management and is certified as a Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), and Certified Professional Coder (CPC). Her skills in project management and process implementation further enhance her ability to lead and innovate within complex healthcare environments.

Kaitlyn Brack Coding Auditor-Educator

Baptist Health Deaconess Madisonville

Kaitlyn Brack is a physician medical coding auditor and educator at Baptist Health Deaconess - Madisonville, and an E/M auditor at Norwood. Her coding areas of expertise include Medicare wellness, evaluation and management, family practice, internal medicine, and pediatrics, with experience in endocrinology, rheumatology, palliative care, NH/AL/SNF, rural health, inpatient/outpatient, and oncology. Kaitlyn has a Bachelor of Science in health informatics and information management from the University of Southern Indiana. She also has her yellow belt certification for Lean Six Sigma. Kaitlyn writes HBM articles, presents topics at chapter events and conferences, AAPC Auditing Committee Chair, and is a member of the CEMC and CPEDC exam committees.

Jeannine Bumford Director of Risk Adjustment

Christus Health

As Director of Risk Adjustment Operations, Jeannine Bumford has successfully planned, designed, and overseen the business and strategic objectives in creating and optimizing a Risk Adjustment Program. Her team has effectively managed all risk adjustment programs pertinent to Medicare, Medicare Advantage, and ACA lines of business. Jeannine's extensive experience in risk adjustment, spanning over twelve years, has significantly improved provider engagement, finance, HCC coding, RADV audits, and data submissions. She holds certifications for Professional Coder (CPC) and Risk Coder (CRC).

John Criswell Founder, CEO, and Chairman

Porter

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. 

Alan Crop Vice President, Sales

Innovihealth

Roxanna Cross Solutions Architect

Reveleer

Roxanna Cross, Solution Architect at Reveleer, is an accomplished leader with substantial health care IT experience delivering  solutions that help health payers and ACOs improve population health, enhance care quality, and manage costs.  At Reveleer, Roxanna functions as a senior consultant and subject matter expert providing consultative input to customers, sales, product management, and operations in the areas of risk adjustment and quality management.  Prior to Reveleer, Roxanna held leadership positions at Innovaccer, Blue Health Intelligence, WellPoint, and ViPS, a General Dynamics company, where she developed her diverse skills in healthcare analytics, risk adjustment, HEDIS reporting, AI/predictive models, population risk stratification and value-base care measurement.  Roxanna is a graduate of the Advanced Technology School at Villa Julie College and the Data Processing Institute in Baltimore, Maryland.

Deborah Curry Risk Adjustment Programs Director

Paramount Insurance Company

Deb joined Paramount Healthcare in May 2013 and oversees the Risk Adjustment, Coordination of Benefits, and Subrogation departments.
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) and Certified Coding Specialist, physician based (CCS-P). 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).
Additionally, Deb is a 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.

Shannon Decker Risk Adjustment Expert, Founder & CEO

VBC One

Dr. Shannon Decker is Founder & CEO 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 25 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 25 years of experience in healthcare--17 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 in the social and behavioral sciences 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 social and behavioral theories may be brought to bear in value based care and population health management as a whole.

Ryan Dodson Risk Adjustment Consultant

Choice Medical Group

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.

Kelly Drury Senior Advisor, Payment Policy and Financial Management Group

Centers for Medicare & Medicaid Services (CMS)

Kelly Drury is the Senior Advisor for the Payment Policy and Financial Management Group within the Center for Consumer Information & Insurance Oversight (CCIIO) at CMS, overseeing dynamic marketplace data and shaping payment policies for the individual and small group markets. Ms. Drury has more than ten years of experience in CCIIO including previously directing risk adjustment and risk adjustment data validation program payments. She has also worked in Medicare payment policy, financial services, and state government policymaking. She is a graduate of the University of Maryland and Johns Hopkins University’s Carey Business School.

Rose T. Dunn Chief Operating Officer

First Class Solutions, Inc.

Ms. Dunn is Chief Operating Officer of St. Louis-based First Class Solutions, Inc.  Rose’s career started at Barnes Hospital, the flagship of BJC Healthcare, where she ultimately was Vice President and responsible for 1,600 employees.

After Barnes, she worked for MetLife as national AVP, where she gained a solid understanding of managed care.  Rose also served as the CFO of an Illinois dual-hospital system and participated in their bond issue. 

Rose is an AHIMA Distinguished Member, Legacy, and Outstanding Service award recipient and has served as the elected President and employed interim CEO of the 80,000-member professional association.  She has served on numerous AHIMA committees, councils, and the Foundation.

She is active in ACHE, AICPA, HFMA, HIMSS, ARMA International, and AHIMA. Rose has authored more than a dozen texts including ACHE/HAP’s Dunn & Haimann’s Healthcare Management, published 200+ articles, and made numerous healthcare related presentations.  She authored and supports the Fundamentals of HCCs course for Libman Education.

In her spare time, she bakes cheesecakes and tends to feral cats.

Tiffany Ferguson Healthcare Industry Specialist Adjunct Professor

Northern Arizona University

Tiffany Ferguson is CEO of Phoenix Medical Management, Inc. Tiffany serves as an adjunct professor at Northern Arizona University, Department of Social Work, and on the American College of Physician Advisors (ACPA) Observation Committee. Tiffany is co-author of The Hospital Guide to Contemporary Case Management through HcPro. She is a contributor for RACmonitor and Case Management Monthly; she also serves as Vice Chair on the editorial board for CMSAToday. She is the weekly correspondent on SDoH for the news podcast Talk Ten Tuesday. After practicing as a hospital social worker, she went on to serve as Director of Case Management and quickly assumed responsibilities in system level leadership roles in Health & Care Management, which includes CM, UR, CDI, HIM, and coding. She has held C-level responsibility for a large employed medical group which included value-based arrangements and outpatient care management. Tiffany is a graduate of Northern Arizona University and received her MSW at UCLA. She is a licensed social worker, ACM, and CMAC certified.

Colleen Gianatasio Director Clinical Documentation Integrity and Coding Compliance

Capital District Physician’s Health Plan (CDPHP)

Colleen Gianatasio CPC, CPC-P, CPMA, CPC-I, CRC has 18 years of experience in the health insurance field. She has experience in customer service, claims, quality and coding. As Risk Adjustment Quality and Education Program Manager for Capital District Physician’s Health Plan (CDPHP) Colleen’s primary responsibilities are provider engagement and clinical documentation improvement for accurate coding. 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-Elect of the AAPC National Advisory Board.

Rafael J. Gonzalez Director of Clinical Coding & Clinical Documentation Integrity

Leon Medical Centers

RaeAnn Grossman CEO

HLTHWorks

RaeAnn Grossman joins us today as a health care innovator, strategic thought leader and premier healthcare operator. RaeAnn has over 25 years of experience in healthcare working at health plans, provider organizations, and tech-enabled solutions companies. RaeAnn is a subject matter expert in Medicare Advantage, Duals, SNPs, MSSP, Medicaid, and other governmental programs.

While at BCBSAZ and Centene, she led the provider strategy, network management, VBC contracting, provider engagement, redesigned payment integrity, and built national care pathways for complex conditions. , plus the hospitalist program that still exists today.

While working with Gorman Health Group, RaeAnn built over 22 Medicare Advantage plans and 17 ACOs, plus tech-enabled solutions, and drove turnarounds with an incredible team of network, operations, risk adjustment, and quality consultants. She has reimagined risk adjustment, moving it from retrospective to prospective and concurrent strategies. She has integrated risk, quality, and care throughout her career to drive the greatest impact with the most efficiency. She built Signify and Datavant. At Cotiviti, she turned around a $550M risk adjustment, quality, network, clinical, and consumer organization business unit.

RaeAnn is a transformative leader in innovation and is a completely purpose-driven healthcare executive. Now at HLTHWorks as CEO, RaeAnn continues to drive organizational transformation, build global workforce to compliment the challenge jobs of care delivery and responding to government regulatory changes. In short, every day RaeAnn focuses on simplifying healthcare, driving greater value, and bettering the health status of all populations

Leigh Anne Harmon Manager of Clinical Documentation Integrity

DaVita Integrated Kidney Care

Leigh Anne, APRN, NP-C, AGCNS-BC, NEA-BC, CCDS-O, CPC, CRC, CDEO, CPMA, CPCO, is an experienced Certified Clinical Documentation Specialist with over 20 years in the healthcare industry. Her expertise lies in documentation integrity and risk adjustment, with a strong focus on auditing, coding accuracy, and clinical documentation improvement.  She is dedicated to educating and training healthcare professionals to enhance clinical documentation and optimize reimbursement. Her knowledge covers coding guidelines, diagnosis capture, and regulatory compliance, with a commitment to upholding legal and ethical standards to prevent fraud, waste, and abuse.  Her passion for advancing healthcare quality is evident in her work developing documentation guidelines, conducting provider audits, and leading risk adjustment programs. As a leader in these initiatives, Leigh Anne takes pride in collaborating with other professionals to drive excellence in healthcare documentation.

Jennifer Hawkes Manager, Member Engagement

Blue Cross of Idaho

Jennifer is a Manger of Member Engagement at Blue Cross of Idaho, for the previous 8 years she was a key player in vendor contracting, planning, developing, monitoring, and improving Medicare and ACA risk adjustment programs. She is responsible for the success of several risk adjustment prospective and retrospective programs. 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’s been focused on Risk Adjustment since 2017 and 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.

Caroline Hebron Senior Manager, Quality & Risk Adjustment

Cedars-Sinai

Jeannie Hennum Vice President of Health Plan Performance

Verisma

Jeannie Hennum has 25+ years of experience focused on payers and providers in medical record retrieval, release of information (ROI), risk adjustment, quality measures, and claims adjudication. She currently runs Verisma’s Health Plan Performance as VP, supporting value-based care initiatives.

Previously Hennum was the CEO at ChartFast, developing relationships with health systems and plans, and automating the request and delivery of medical information between those parties.

In addition, Hennum worked for several health information (HI) companies, responsible for provider sales at Optum/Episource; payer sales at Optum/naviHealth; payer, provider sales, and operations as senior VP at CIOX Health (formerly HealthPort, now Datavant); payer sales as regional director at Change Healthcare (formerly Outcomes Health Information Solutions, now Optum); payer sales and operations as VP at Health Solutions Plus; and president and CEO at Linnaeus.

Hennum is a former board member for the State University of New York Children’s Center at Cortland. She continues to provide consultative services to the healthcare industry including speaking engagements and publications for audits and best practices for HI.

Carrie Horn Director Outpatient CDI

Baylor Scott and White Healthcare

Ava Johnson Associate Director, Ambulatory CDQI

Mount Sinai Hospital, NYC

Ava Johnson is the Associate Director of the Outpatient Clinical Documentation Quality Improvement department at Mount Sinai Hospital in NYC. Ava is a seasoned coding instructor, physician educator, multispecialty coder, CDI specialist and public speaker with a focus on executive leadership and career development.

Dr. Ekaette Joseph-Isang Principal Consultant

Ritebridge

Dr. Ekaette Joseph-Isang is a subject matter expert in population health and value-based care with over 20 years combined experience in payor-provider strategy.

Her expertise cuts across population health, risk adjustment, healthcare quality, and healthcare innovation. Her specialty is in serving as a bridge between payers and providers and supporting  organizations in getting their providers the tools,  resources, and education that they need to stay competitive and efficient in the value based care space.

She is certified across multiple professional organizations in the risk adjustment, CDI, coding, and healthcare quality and is highly sought after for healthcare strategy and operations consulting.

Jenn Kerfoot Chief Strategy & Growth Officer

DUOS

Jenn is a visionary healthcare leader with deep expertise in Medicare Advantage and Value-Based Care. She leverages her extensive background in healthcare policy, regulation, and business development to drive strategic growth and innovation at DUOS, developing tailored solutions that meet the evolving needs of Medicare Advantage plans. A seasoned podcast host, Jenn regularly explores critical issues like the looming threat of Medicare insolvency, the challenges of financing care for an aging population, the impact of rising healthcare costs, and disparities in care access. With previous leadership roles at FarmboxRx, Excelera Health, and NationsBenefits, Jenn has a proven track record of navigating complex healthcare regulations and aligning strategies with market demands. Beyond her executive role, she is a recognized thought leader and advocate for progressive healthcare practices, advising venture capital and private equity firms on investments in transformative healthcare solutions. Jenn’s pragmatic optimism and relentless problem-solving approach are key to her success in fostering collaboration and pushing the boundaries of what’s possible in healthcare.

Marilee Klock Senior Director, Diagnosis Accuracy Program

GuideHealth

Marilee started her career as an observation and surgical overnight coder with the Revenue Management department at Geisinger in 2008. In 2011, she decided to make a move to the insurance side of things and took on the role of Risk Adjustment Coder. While at Geisinger, Marilee held positions such as HCC analyst, Lead- Risk Adjustment Educator, Manager of Clinical Transformation and Director of Coding Operations. During COVID, she decided to leave Geisinger and transition to a more national level role. Over the past few years she has spent time building national level CDI programs, working in large HCC coding contract work, and VBC operations at a health plan. In her most recent role, she is the Senior Director of the Diagnosis Accuracy program at Guidehealth.

Marilee is a Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC) through the American Academy of Professional Coders (AAPC). Through her career, non-coding opportunities have presented themselves as well. Marilee is a Certified Business Analyst, carries a SQL Programming Skills Certification, and has a Green Belt in Lean/Six Sigma. Marilee attained a Bachelor’s degree in Management in 2015 and a Master’s in Business Administration in early 2017. In 2019, she decided to go back to school for an additional Bachelor's degree in Human Resources Management. 

In her free time, Marilee enjoys camping and boating on the Susquehanna river with her family and friends. Marilee grew up in rural Pennsylvania and plans to never leave the area! Her entire family of over 500 people (mostly) all live within a 25-30 mile radius. She has a total of 4 children, and they are always keeping her busy and on her toes.

Danielle Kopetman Associate Solutions Consultant

Episource

In her role on the Solutions team at Episource, Danielle collaborates closely with payers and provider groups to identify opportunities, deliver actionable insights, and support programs that focus on risk adjustment and enhancing patient care. Danielle earned her Bachelors degree from Tulane University.

Mark Koransky Senior Consulting Actuary

Wakely Consulting Group

Mark Koransky has over ten years of experience as a health actuary working for both insurance and consulting firms. He is well-versed in all aspects of MA bid preparation and financial projections for new and existing MA plans. He has prepared MA and prescription drug bids throughout his entire actuarial career, acting as strategic leader and certifying actuary. He is knowledgeable in many core areas including forecasting, pricing, and reserving. Mr. Koransky supports Medicare and Medicaid health plans, risk-taking healthcare providers, pharmaceutical companies, and investment banks on a variety of actuarial and financial matters.

Mr. Koransky has supported and led numerous analyses to identify key drivers of historical results and actionable opportunities for improvement. He is the trusted advisor on MA for multiple plans, including bid certification, analytics, and forecast development.

Mr. Koransky earned a bachelor’s degree in actuarial mathematics from the University of Michigan. He is a fellow of the Society of Actuaries and a member of the American Academy of Actuaries.

Andrew Lockhart CEO

Fathom

Andrew Lockhart is CEO of Fathom, the leader in autonomous coding. Fathom applies cutting-edge deep learning to produce complete risk-adjustment coding results with zero human intervention. Fathom partners with leading health plans, managed care organizations, and health systems.

Andrew is a recognized industry expert, having published dozens of articles in leading industry publications such as Healthcare Business Today and HIT Consultant, while earning awards such as Slice of Healthcare's Top Digital Health Leader in 2023. He has presented to healthcare executives at Becker's, Google, Healthcare Finance Institute, and Health Innovation Roundtable, among other engagements. Andrew earned his MBA from Stanford University and his BA from the University of Toronto.

Donna Malone Director Risk Capture, Population Health Management

Mass General Brigham

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP, RISE Fellow: Director Risk Adjustment with Mass General Brigham in MA, Adjunct Professor with MassBay Community College, Chair of the RISE Risk Adjustment Academy HCC Coding Faculty Advisory Group as well as content developer RISE designations and workshops, and 2022-2025 AAPC National Advisory Board. Donna has over 28 years’ experience (Payer, Provider System and Vendor) in healthcare with primary focus on Value-Based Care.

Donna has also served as President of the Watertown AAPC Chapter (2017-2022) and Education officer (2016)

Donna speaks nationally for RISE, AAPC and AHIMA

She also received the 2021 MaHIMA Champion Award

J. Gabriel McGlamery Director of Commercial Market Strategic Integration

Florida Blue

Jenni Monfils

Risk Adjustment Industry Expert

Jenni Monfils, CPC, CDEO, CRC has over 20 years of healthcare experience in revenue cycle, coding, and documentation improvement. She is an accomplished risk adjustment professional with extensive experience in both the Medicare and HHS HCC model plus Medicaid. Jenni specializes in developing provider risk adjustment education and HCC quality oversight programs to ensure compliance. She has project managed HHS-RADV audits, Medicare Advantage Contract Level RADV audits and Part C Improper Payment Measure (National RADV) audits. Jenni demonstrates effective leadership and innovative problem-solving skills to plan and execute the necessary oversight in the everchanging risk adjustment space.

Yenney Orosa Director, ACO Risk Coding, Billing & Revenue Cycle Management

American Choice Healthcare

Yenney Orosa is a highly experienced healthcare professional with over 12 years of expertise in Clinical Documentation Improvement (CDI) for outpatient settings, risk coding, billing. She has been serving as the Director of ACO Risk Coding, Billing & Revenue Cycle Management at American Choice Healthcare since March 2018. In this role, she oversees the ACO Reach contracts across various states, leading initiatives to enhance clinical documentation practices, streamline coding processes, improve practice revenue performance, and ensure accurate risk adjustment capture for the Medicare population. Additionally, she leads the Commercial ACO line of business, focusing on quality performance.

Yenney's comprehensive experience spans all phases of coding, compliance, revenue cycle, auditing, monitoring, and provider education. She is an active member of the American Academy of Professional Coders (AAPC) and holds the following certifications:

1. Certified professional Coder (CPC)
2. Certified Risk Adjustment Coder (CRC)
3. Certified Documentation Expert Outpatient (CDEO)
4. Certified Professional Compliance Officer CPCO)
5. Certified professional Auditor (CMPA)

She is also a member of the AHA Coding Clinic and RISE and holds a certificate of Advanced HCC Auditor (AHCCA).

Outside of her professional achievements, Yenney is blessed with an amazing husband who she’s been with for 21 years as well as her 2 beautiful children.

Jennifer Podulka Senior Vice President of Federal Policy

America's Physician Groups (APG)

Jennifer Podulka serves as the Senior Vice President of Federal Policy for America’s Physician Groups (APG), a national association of about 360 medical groups and independent practice associations that deliver patient-centered, high-quality care to nearly 90 million patients. Jennifer leads APG’s relationships with the Centers for Medicare & Medicaid Services, the Innovation Center (CMMI), other federal agencies, and the White House.

Prior to joining APG, Jennifer advised Congress on payment and policy options as a staff member for MedPAC and the Government Accountability Office. She has published numerous studies and presented to national audiences on topics including physician payment policy, CMMI models, Medicare Advantage, value-based care, prescription drugs, Programs of All-Inclusive Care for the Elderly (PACE), special needs plans, encounter data, COVID-19, and the federal budget and broader health care system.  She previously held positions with the National Quality Forum, Truven Health Analytics, and Acumen, LLC. Jennifer has most recently been a principal with Health Management Associates (HMA) where she analyzed CMS programs and demonstrations and recommended policy changes on behalf of HMA’s clients.

Jennifer earned her B.A. in government and M.P.Aff. in Public Affairs from the University of Texas, Austin.

Jacqualine N. Reid Team Leader/Social Science Analyst

HHS/OIG/Office of Evaluation and Inspections

Leanne Scott Health Insurance Specialist

Centers for Medicare & Medicaid Services (CMS)

Leanne Scott is a Health Insurance Specialist in the Division of Policy and Analysis within the Payment Policy and Financial Management Group within the Center for Consumer Information & Insurance Oversight (CCIIO) at CMS. Leanne has worked for CMS since 2020, starting in the Center for Program Integrity (CPI) before working for CCIIO.  Currently, among other areas, Leanne is a leading subject matter expert on HHS-operated risk adjustment data validation policy and the administrative fees under the No Surprises Act. She holds a B.S. in Economics from the University of Maryland with minors in Statistics and Spanish and a Masters in Business Research from the Stanford Graduate School of Business.

Kaitlin Sebourn Senior Manager of Clinical Programs

DaVita Integrated Kidney Care

Kaitlin, MHA, RHIA, CDIP, CRC has nearly a decade of experience in healthcare, with a focus in coding and documentation. With a focus in auditing, process improvement, and strategic planning, Kaitlin is a recognized leader in driving clinical excellence and ensuring compliance with industry standards.

In her role, Kaitlin oversees the coding team and has accountability for the development and implementation of risk adjustment strategies, enhancing clinical documentation practices, and leading rigorous auditing processes. She enjoys collaborating with other leaders in clinical documentation integrity, provider education, and compliance to leverage her expertise.

Kaitlin is pursuing a Doctor of Education (EdD) in Organizational Leadership at Franklin University and spends her time mentoring young professionals and new graduates.

Laura Sheriff Risk Adjustment Industry Expert

Laura Sheriff, RN, MSN, is currently working as a consultant with physician groups and health plans to capitalize on risk adjustment performance and operations.  Laura is an MSN with >12 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 designed and coordinated activities including provider education, training, auditing, data mining, and data analysis to direct program success and achieve all risk goals.  Laura is also a certified professional coder and a certified risk coder. 

Jason N. Silberberg Partner

Frier Levitt

Jason Silberberg is a partner in Frier Levitt’s Healthcare Litigation section and co-chairs the firm’s value-based care litigation group.

Jason has experience handling a wide range of healthcare and life sciences litigation and regulatory matters affecting clients in various sectors, but currently focuses his practice on helping clients in the value-based care space with strategic litigation and pre-litigation-based solutions to commercial disputes. Jason counsels accountable care organizations (ACOs), patient-centered medical homes, clinically integrated networks (CINs), and healthcare data analytics vendors in resolving conflicts with payers, including Medicare Advantage Organizations and Managed Medicaid plans. Jason also regularly represents clients in False Claims Act matters and provider-agency disputes under state and federal Administrative Procedure Acts.

Prior to joining Frier Levitt as an associate in 2014, Jason worked for several years as a Deputy Attorney General in the New Jersey Attorney General’s Office, Banking & Insurance Section, where he civilly prosecuted healthcare providers, insurance producers, and insurance carriers for violations of the state Fraud and Producer Acts. He also has authored several amicus curiae briefs on novel questions of law concerning the interpretation of healthcare and insurance related statutes.

Chris Trygstad Vice President, Product

Biomedix

Chris Trygstad is a Vice President with Biomedix, a market leader in font-line diagnostic solutions. Chris oversees all aspects of Product at Biomedix, including functional and technical product design, security, interfacing, promotion, and support. Chris has over 20 years of experience in technology-based products and over 10 years concentrating on designing and delivering innovative medical technology products and services that improve and save lives. Chris is an expert in both commercial and public Fee-For-Service reimbursement models as well as commercial and public Value-Based-Care coverage models.

Dr. Sunita Varghees System Vice President of CDI

Baylor Scott and White Healthcare

Dr. Sunita Varghees serves as System VP of Clinical Documentation Integrity for Baylor Scott and White Healthcare in Texas. Dr. Varghees began her career in Hospital Medicine at Scott & White Memorial Hospital in Temple, Texas, and later went on to become Division Director of that group. She moved into the Quality/Physician Documentation space in 2014 for the legacy Scott and White clinics and hospitals, allowing her to understand the intersection and interdependence of quality and provider documentation.

Dr. Varghees received her bachelor and medical degrees from Texas A&M University and completed an internal medicine residency at Scott & White in Temple Texas. She also holds a PhD in Bacterial Pathogenesis from Texas A&M HSC.

Helen L. Veet Director of Quality Manager ACP and KF – PA Medicaid

AmeriHealth Caritas Pennsylvania; Keystone First

Helen Veet DNP, RN is the Director of Quality Management for AmeriHealth Caritas Pennsylvania and Keystone First Medicaid Plans. Helen specializes in the Medicaid quality programs, assist with HEDIS project collection, and has a passion for healthcare quality. She has a background in cardiac and orthopedic clinical nursing as well as Healthcare Systems Leadership. In her role at AmeriHealth Caritas Pennsylvania and Keystone First, she overees the Community Health Navigator team, Community Outreach Team, and the Quality of Care Nurse team. She enjoys country line dancing and traveling the world with her family.

Max Voldman Partner

Whistleblower Partners

Max Voldman is a partner at Whistleblower Partners. Max’s practice is focused on representing whistleblowers under the federal False Claims Act and numerous state law equivalents, and the whistleblower programs of the Internal Revenue Service, Securities and Exchange Commission, Commodity Futures Trading Commission, and Department of Transportation.

He is part of the legal team pursuing a qui tam case against UnitedHealth Group alleging the nation’s largest Medicare Advantage Organization submitted false claims for payment to the Medicare Program by improperly inflating its members’ risk scores. Max also has experience analyzing complex data sets, developing damages models, and assisting with statistical analyses. He has also published numerous articles on issues of healthcare law, whistleblower programs, and environmental issues.

Max received his J.D. from Georgetown University Law Center. During law school, Max served as a research assistant on taxation to Professor John Brooks and as the Symposium Editor for the Journal of Law and Public Policy. Prior to law school, Max completed his undergraduate studies at the University of Illinois, where he was a member of the Mathematics Honors Society and graduated with a degree in Actuarial Science and a Minor in Business.

Max worked in State Farm’s actuarial science department and coached the debate team for a high school in Illinois, including one team that won the State Championship. He is fluent in Russian. 

In his spare time, Max enjoys hiking, tennis, and is, unfortunately, a devoted fan of the Chicago Bears. 

Nick Volpe Sales Director - Risk Adjustment

Wolters Kluwer, Health Language

Nick is a Sales Director at Wolters Kluwer, Health Language, responsible for the sales, account management, and customer success of the Coder Workbench solution. Nick has been in Value Based Care for over four years, first serving as the Finance Manager for VillageMD's VBC National Operations and, most recently, as a Growth Strategy Director at Vim, supporting prospective and concurrent risk adjustment within EMR solutions. He started his career in Corporate Finance at GE Healthcare, and also spent time in Management Consulting at EY.    

Outside of work, Nick enjoys spending time trying new bars and restaurants in downtown Chicago, where he lives with his girlfriend Nicole. He also loves sports (Go Patriots) and is proud to have recently finished his first (and last) Chicago Marathon! 

Susan Waterman Director of Risk Adjustment

Baylor Scott and White Healthcare

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.

Megan Zakrewsky Vice President, Clinical Data Exchange

Veradigm

Megan is currently the Vice President of Product for Clinical Data Exchange Payer Solutions at Veradigm. In this role, she is responsible for a portfolio of solutions facilitating data exchange between providers and payers, primarily supporting payer risk adjustment and quality initiatives.

Prior to Veradigm, she spent time working on provider-provider and provider-patient health information exchange solutions. A Drexel University undergraduate alumnus - she has master’s certificate in Healthcare Quality and Safety from Thomas Jefferson University and an MBA from West Chester University. She lives in South Jersey with her four boys and husband.