Panels and Presentations Addressing Key Challenges of Payment Integrity
Payment Integrity
Payer-provider abrasion remains one of the biggest barriers to efficient payment, timely care, and operational success. Too often, denials, delayed payments, and prior authorization disputes stem from misaligned expectations, incomplete data, and unclear communication—not true disagreement. This session will offer a candid, solutions-focused discussion on what payers really need from providers, what providers can do upfront to reduce friction, and how both sides can work together to minimize rework, prevent avoidable denials, and create shared wins.
Learning Objectives:
- Gain clear insights into how providers can proactively align documentation, coding, and authorization workflows to meet payer requirements and reduce denials and appeals.
- Learn practical approaches to improve data sharing, reduce ambiguity in clinical and billing documentation, and foster payer-provider partnerships that lead to faster resolutions and fewer administrative burdens.
- Explore strategies to move beyond transactional interactions and build trust-based partnerships between payers and providers—focusing on shared goals like timely care, accurate payment, and operational efficiency.
Medical Cost Containment
Moderator
Sarah Armstrong
CEO
Trend Health Partners
Sarah is, above all else, a passionate leader of people. With a career spanning over two decades, her journey began as a financial analyst at a small community hospital in Kentucky, where she developed a profound appreciation for the pivotal role of people in healthcare, both in the clinic and in the back office. This early experience ignited her passion for enhancing Revenue Cycle performance and fostering leadership talents that resonate with the values of collaboration and efficiency.
Her leadership at TREND is deeply influenced by her comprehensive background, championing a culture of inclusivity and collaboration. By valuing each team member's contribution, Sarah drives innovations that not only challenge the conventional adversarial healthcare models but also promote a cooperative and efficient environment that benefits all stakeholders.
She leads with a commitment to transparency, cooperation over competition, and a deep-seated belief in empowering her team. Under her leadership, TREND is pioneering a new era of healthcare solutions that prioritize accuracy, fairness, and collaborative problem-solving, all aimed at improving outcomes for patients and providers alike.
Sarah's leadership is characterized by her ability to bridge traditional divides within the industry, advocating for a paradigm shift from adversarial dynamics to cooperative partnerships. Her strategic vision is supported by her unwavering dedication to TREND's ideals, both internally and externally, driving TREND Health Partners to challenge the status quo and lead American healthcare into a more efficient and equitable future.
Panelists
Jonique Dietzen
Payment Integrity Director
CareOregon
With over 18 years of experience in healthcare billing and finance, I am a certified professional coder dedicated to ensuring accurate claims and proper reimbursement for providers. Having worked extensively on the provider side in finance and revenue cycle, I bring wealth of knowledge to the table, particularly in processing and payment integrity.
Throughout my career, I have gained a comprehensive understanding of billing challenges from both perspectives. This unique insight drives my commitment to improving billing practices and advocating for provider education. I continue to leverage my expertise to enhance billing processes and support providers in navigating the complexities of healthcare finance.
Mandi Heiple
Director of Payment Integrity
Medica
Mandi Heiple is the Director of Payment Integrity at Medica, where she leads a high-performing team dedicated to ensuring accurate, compliant, and efficient claims payment across commercial and government lines of business. She oversees end-to-end payment integrity strategy – from prospective editing and coding validation to retrospective audits. Her teams drive measurable savings while protecting provider relationships and improving member experiences.
With over 20 years in healthcare operations and payment integrity, Mandi has focused on designing and implementing solutions that close process gaps, reduce improper payments, and strengthen compliance frameworks.
Dr. Ahmad Kilani MD, MBA, MLS, MSIT, CHCQM-PHYADV, FABQAURP, FACP, FACHE
Medical Director
Cleveland Clinic
Dr. Kilani is currently serving as Associate Medical Director for Cleveland Clinic Revenue Cycle Management and Medical Director of Throughput for Cleveland Clinic West Submarket. Nationally, he serves as Vice President of Operations for the American College of Physician Advisors. Dr. Kilani is board certified in Internal Medicine. Additionally, he has a Master of Business in Healthcare from Baldwin Wallace University, a Master of Legal Studies from Cleveland-Marshall College of Law, and a Master of Science in Information Technology from the University of Cincinnati. He is a Fellow of the American College of Physicians, a Fellow of the American College of Healthcare Executives, and board-certified in Healthcare Quality Management through the American Board of Quality Assurance and Utilization Review Physicians.”
Heather Wilson
Vice President and Chief Revenue Cycle Officer
The Christ Hospital Health Network
Trend Health Partners
Website: https://www.trendhealthpartners.com/
TREND Health Partners is on a mission to revolutionize healthcare financial management. By combining innovative technology, transparent collaboration, and a relentless commitment to operational excellence, TREND helps payers and providers eliminate waste, recover overpayments, and prevent future errors. TREND creates shared visibility, streamlines workflows, and delivers AI-powered insights that drive measurable results. The outcome: stronger alignment, lower administrative costs, and a smarter, more accurate payment system
Medical Cost Containment
Engage in focused, small-group discussions where payers and providers connect over specific topics, share perspectives, and explore solutions from both sides—offering a balanced, holistic view of key challenges and opportunities.
- Price Transparency 4 Years In: Navigating Compliance, Challenges, and Opportunities for Providers and PayersJoin us for a dynamic roundtable at the Healthcare Payment and Revenue Integrity Congress, where providers and payers will explore the impact of price transparency. Led by Dave Cardelle (SIIA Price Transparency Committee), the session will examine key challenges and strategies around the CMS Final Rule on Hospital Price Transparency and TiC MRFs, four years on. Discussion topics include compliance, penalties, costs, rate setting, contract negotiations, and using transparency data for analysis. Don’t miss this chance to share insights and shape the future of price transparency.Dave Cardelle, Chief Strategy Officer, AMS
- Payment Integrity 101Join us for Payment Integrity 101 at the Healthcare Payment and Revenue Integrity Congress, a foundational session designed for those new to or expanding their role in payment integrity. This session will break down the key components of payment integrity, from pre-pay to post-pay strategies, common fraud, waste, and abuse (FWA) schemes, to how plans and providers can align on reducing improper payments. Whether you're building a team, refining your approach, or just starting out, this session offers a practical roadmap and terminology primer to help you navigate the space with confidence.Simi Binning, Responsible AI Lead, HCSC
Charlie Jensen, Head of Payment Integrity Strategy, Blue Cross Blue Shield, Illinois Provider Contracts Uncovered: From Fine Print to Financial Power
Contracts are more than legal fine print. They decide whether your organization thrives or just survives. In this session, we’ll pull back the curtain on contract language, expose common traps that drain revenue, and share negotiation tactics that actually move the needle. Expect real talk, practical tips, and a fresh look at how providers can flip contracts into cost-containing, revenue-protecting assets.
Quick-Hit Takeaways
Spot the traps: Know the clauses that cost you most.
Negotiate smarter: Tactics payers don’t want you to know.
Stay compliant: Align terms with today’s rules.
Think strategic: Make every contract work for your bottom line.Maya Turner, Executive Managing Director, Turner Expert Consulting Services, LLC
- The Next Era of Payment Integrity: Smarter, Faster, More Scalable
Join Tina Azar from Machinify for an intimate discussion on the evolving landscape of payment integrity. We’ll explore real-world challenges in balancing speed, accuracy, and provider relations, and share perspectives on how technology and strategy are shaping the future. This roundtable offers a chance to exchange experiences, uncover new approaches, and walk away with practical ideas to apply within your own organization.
Tina Azar, VP COS and Sales Enablement, Machinify
Medical Cost Containment
Maya Turner
Owner/Executive Managing Director
Turner Expert Consulting
Dave Cardelle
Chief Strategy Officer
AMS
Charlie Jensen
Head of Payment Integrity Strategy
Blue Cross Blue Shield, Illinois
Simi Binning
Responsible AI Lead
HCSC
Simi Binning is an accomplished healthcare professional with over a decade of experience in developing and executing successful strategies that drive business growth. Currently serving as a Responsible AI lead at HCSC, her focus is on AI governance and innovative problem solving.
Tina Azar
VP COS and Sales Enablement
Machinify
Machinify
Website: https://www.machinify.com/
Machinify is redefining payment integrity with AI-powered solutions designed to be frictionless, intelligent, and future-ready. Trusted by over 60 health plans, Machinify simplifies the complexity of healthcare claims with a platform that coordinates, validates, and pays claims with precision. Backed by cutting-edge technology and healthcare expertise, Machinify delivers cost savings, operational clarity, and strategic insight—empowering payers to take full control of their payment operations.
Machinify Solutions
Machinify offers a unified platform for payment integrity, combining pre-pay and post-pay solutions to detect, prevent, and resolve improper payments across the claim lifecycle.
- Pre-Pay Adjudication & Accuracy: Automatically identify potential errors or duplications before claims are paid, reducing downstream recovery efforts.
- Post-Pay Analytics & Recovery: Leverage advanced AI to uncover patterns, prioritize audits, and streamline recovery with high accuracy and minimal friction.
- Audit & SIU Support: Equip Special Investigation Units and audit teams with AI-enhanced tools to detect fraud, waste, and abuse faster and more effectively.
- Configurable, Modular Platform: Tailored to integrate into existing workflows with flexibility and speed, enabling rapid value without disruption.
Machinify’s intelligent platform unifies fragmented payment integrity processes, empowering payers to reduce costs, increase efficiency, and improve payment accuracy at scale.
AMS Intelligent Analytics
Website: http://www.amspredict.com/
Advanced Medical Strategies (AMS) is the premier provider of payment integrity, risk management, and business intelligence solutions to identify and address excessive claims, prevent and recoup overpayments, and effectively manage the risks associated with high-cost claimants and group health underwriting.
Denial management isn’t just about fighting back—it’s about understanding why denials happen and fixing the root causes upstream. This session will focus on how hospitals and health systems can use audit findings and denial data to identify coding gaps, documentation weaknesses, and process breakdowns that lead to preventable denials. Learn how to close these gaps through stronger internal collaboration across revenue cycle, coding, and clinical teams, while also using data-driven insights to foster more productive payer relationships.
Learning Objectives:
- Learn how to analyze denial patterns and audit results to uncover documentation, coding, and process issues—enabling proactive prevention rather than reactive rework.
- Discover best practices for improving internal workflows, fostering collaboration between clinical and revenue cycle teams, and ensuring that claims reflect accurate, defensible coding and clear clinical intent.
Revenue Cycle Management
Betye Ochoa
Director, Revenue Cycle Redesign
NorthShore University HealthSystem
Kimberly D Conner
Subject Matter Expert
Independent
Payment Integrity
As health plans continue to evolve their strategies around medical cost containment, the distinction between payment integrity and fraud, waste, and abuse is becoming increasingly nuanced. This session explores the “gray zone” where wasteful or abusive billing practices don’t clearly qualify as fraud, but still pose significant financial and ethical risks.
- How payment integrity and SIU teams can effectively collaborate
- Where the hand-off should occur between routine overpayment detection and deeper investigation
- Real-world examples where waste tipped into abuse, and how it was handled
- How health plans can build workflows that enable earlier intervention before issues escalate
- The operational and cultural gaps between PI and SIU and how to bridge them
Payment Integrity
Matt Perryman
Chief Analytics & Insight Officer
Alivia Analytics
Matt leads Alivia’s advanced analytics, data science, and platform development for fraud, waste, and abuse (FWA) detection—validated through payment integrity edits, audits, and data mining. With expertise in healthcare analytics and risk modeling, he oversees AI-powered solutions that help Medicaid, Medicare, and commercial payers prevent improper payments and uncover emerging fraud schemes.
Before assuming this role, Matt built a strong reputation at Alivia as a customer-facing data scientist, helping technical and non-technical users alike apply analytics to drive measurable results. He is a regular speaker at healthcare FWA conferences, including NHCAA and NAMPI, where he presents pre- and post-payment analytic strategies alongside health plan leaders. He was valedictorian of his graduating class from Boston College with degrees in biochemistry and philosophy.
Scott Hirschbrunner
Director of Payment Integrity
Nebraska Blue
Scott brings a wealth of experience, with a 26-year background in PI leadership at CMS, Optum, and Blue Cross & Blue Shield of Kansas City. He currently is the Director of Payment Integrity at Blue Cross Blue Shield of Nebraska. His functional areas of responsibility include SIU, Recovery, Bill-Audit, Claim Editing, COB, W/C, Subrogation, DRG Audit, Data Mining and Credit Balance Recovery. Scott’s goals are strengthening management of PI vendor performance and contracts, seeking opportunities for generating revenue and setting of targets using national benchmark data. He holds a Bachelor of Science in Accounting with a minor in Management and Communications and is well-versed in both commercial and government lines of business. Scott is married for 16 years with two boys and two girls. He enjoys being outdoors, doing yard work, taking walks, coaching girls’ softball, giving blood, and volunteering.
Alivia Analytics
Website: https://www.aliviaanalytics.com/
Your most expansive Payment Integrity and FWA partner for medical, pharmacy, vision, and dental claims. This features our powerful, configurable Alivia 360™ Platform that provides pre- and post-payment flexibility and considerable cost savings across the healthcare claims management process. It seamlessly transitions between FWA detection and Payment Integrity solutions including clinical and non-clinical audit scenarios, first- and second-pass claims editing, and COB/TPL. Alivia 360™ not only ensures comprehensive financial oversight but full adaptability to operational needs. Alivia integrates AI as an assistant, not a replacement, prioritizing ethical use, human oversight, and compliance with industry standards. Our solutions are offered as SaaS or tech-enabled services that build strong cases against inappropriate billing practices, identify new recoveries missed by legacy vendors, deliver actionable analytics, and offer automated corrections. Alivia enables healthcare payers to streamline vendor management, improving control and strategic decision-making. Schedule a discovery meeting and demo.
As value-based care continues to reshape payment models, many health systems struggle to balance financial performance with care quality goals. This session will offer practical strategies to use denial data, coding insights, and care coordination metrics to strengthen value-based outcomes—without sacrificing revenue. This discussion will highlight how to engage teams, optimize processes, and identify sustainable financial opportunities within value-based contracts.
Learning Objectives:
- Learn how to use denial patterns and audit insights to improve documentation, coding accuracy, and contract performance.
- Gain strategies to foster physician buy-in and leadership collaboration, finding “win-win” solutions that support both revenue integrity and value-based care success.
Revenue Cycle Management
Deepak Nalli
Vice President Revenue Cycle Operations
Spire Orthopedic Partners
As fraud schemes become increasingly complex, healthcare organizations must stay ahead of evolving threats that impact both clinical and financial integrity. This session will explore the latest fraud trends across the healthcare landscape - from billing manipulation and phantom providers to evolving schemes in hospice, home health, telehealth, and behavioral health. Join industry leaders as they share real-world examples, warning signs to watch for, and proactive strategies for detecting, preventing, and responding to fraud across care settings.
Payment Integrity
Peter Monson
Sr. Manager, Special Investigations Unit
UCare HP
Peter Monson is the Sr. Manager of the Special Investigations Unit at UCare, where he leads a team dedicated to preventing, detecting, and correcting fraud, waste, and abuse in health care claims. With more than a decade of investigative and leadership experience across health plans and state government, he has overseen some of the most significant Medicaid fraud cases in Minnesota’s history and has redesigned investigative practices to maximize efficiency and impact.
In addition to his role at UCare, Peter previously served as President of the Midwest Insurance Fraud Prevention Association, fostering collaboration between private insurers and government agencies to strengthen fraud prevention efforts. He holds a Bachelor of Science in Criminal Justice and minor in Psychology from North Dakota State University.
Mandi Heiple
Director of Payment Integrity
Medica
Mandi Heiple is the Director of Payment Integrity at Medica, where she leads a high-performing team dedicated to ensuring accurate, compliant, and efficient claims payment across commercial and government lines of business. She oversees end-to-end payment integrity strategy – from prospective editing and coding validation to retrospective audits. Her teams drive measurable savings while protecting provider relationships and improving member experiences.
With over 20 years in healthcare operations and payment integrity, Mandi has focused on designing and implementing solutions that close process gaps, reduce improper payments, and strengthen compliance frameworks.
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.
Healthcare Fraud Shield
Website: https://www.hcfraudshield.com/
Healthcare Fraud Shield specializes in fraud, waste, abuse, & error detection and payment integrity for healthcare payers nationally by efficiently stopping claims prior to payment, utilizing post-payment advanced analytics, artificial intelligence, and shared client data insights. We save health plans millions annually incremental to existing pre-payment processes using our unique and proven approach. HCFSPlatformTM offers the combination of targeted rules, artificial intelligence, and shared analytics across multiple payers resulting in higher ROI (up to 20:1 or more) compared to other vendors.
The HCFSPlatformTM was developed by industry leading healthcare subject matter experts and is a component of over 60+ clients including 7 of the 10 largest commercial insurers in the US. Our client satisfaction rating is exceptional with a net promoter score of 94 and client retention rate over 95%. HCFSPlatformTM is a fully integrated platform consisting of PreShield (prepayment analytics & claim review logic), PostShield (post-payment analytics), AIShield (AI-driven analytic insights), RxShield (pharmacy and pharmaceutical specific analytics), Shared Analytics, CaseShield (SIU/PI case management), QueryShield (ad hoc query and reporting tool), HCFSServices (data mining, investigative, and record reviews), and AuditPlusTM (Medical Record Review & SVRS).