Rise

Gaby Alcalá Founder and CEO

MAPA HealthCare

Gabrielena (Gaby) Alcala is a consultant with over 20 years of experience in the healthcare industry. She has worked with various organizations, from start-ups to large corporations. Her current focus is on helping organizations transition to value-based care. Gaby is passionate about assisting organizations in executing projects in an agile manner, improving processes, and making healthcare more patient-centered.

Gaby has worked with multiple organizations, including Iora Health, Community Care Cooperative (C3), CityBlock, Partners HealthCare (currently Mass General Brigham), BearingPoint (formerly KPMG Consulting), and The World Bank. Her work has included Medicare Advantage risk adjustment strategic planning and implementation, new business and program development, and operational system redesign.

With a great ability to swiftly adapt, she excels in managing complex projects, collaborating with stakeholders, inspiring teams, and consistently delivering positive outcomes in challenging environments.

She has an MA in Economics from the University of Michigan and a BA in Economics from Universidad Católica Andrés Bello in Venezuela. Gaby is fluent in English and Spanish, with intermediate proficiency in French.

Rachel Biblow Associate Editor of Strategy, Innovation, and Outcomes

Journal of Patient Experience

As a Healthcare Executive she relentlessly pursues better health, experience, and business outcomes. She facilitates transformational results by partnering with organizations to implement an outcomes-based experience model to achieve differentiated value.

As an expert advisor she partners with executive leaders and organizations to create clarity around strategic imperatives and intentional process design to achieve transformational outcomes. She most recently led as the Chief Experience Officer of JenCare, where she leveraged her experiences as a Partner & Senior Vice President at Press Ganey to create meaningful results across safety, quality, workforce engagement and patient experience.

Prior to Press Ganey, Rachel served at the Children’s Hospital of Philadelphia, leading the strategy and implementation of an enterprise-wide initiative to improve patient and family experience.

Rachel is widely recognized for her work advancing patient and family partnerships with health systems to drive value and quality outcomes. She is a founding leader of the National Pediatric Experience Collaborative formed in 2016. She is an international speaker on Experience, Culture, Patient & Family-Centered Care, Leadership Development, Organizational Dynamics and Change.

Paul Burke Chief Product Officer

Reveleer

Cory Busse VP, Strategy & Sales Enablement

Icario

Anna Carley RHIT, Senior Director - CRM, Payer Solutions

GeBBS Healthcare Solutions

With nearly a decade of dedicated experience in risk adjustment and quality improvement, Anna Carley, RHIT, stands as a seasoned professional in the healthcare industry. Currently serving as the Senior Director of Client Relations at GeBBS Healthcare Solutions, a leading risk adjustment service and technology partner, Anna plays a pivotal role as the primary liaison between clients and GeBBS.

Anna's expertise extends across various facets of risk adjustment, showcasing her comprehensive understanding of both payer and provider perspectives. During her tenure at UnitedHealthcare, she contributed significantly to the development of risk adjustment strategies. On the provider side, Anna made impactful contributions at Stanford Health Care, where she played a key role in establishing robust risk adjustment, quality, and pharmacy programs.

Residing in Austin, Texas, with her husband and three daughters—Penelope, Valerie, and Felicity—Anna Carley, RHIT, is not only a dedicated professional but also a loving family person. Beyond her commitments at GeBBS Healthcare Solutions, she values quality time with her family and two dogs, Sampson and Dodger.

Jason Christ Member of the Firm

Epstein Becker Green   

Kailey Collier Director of Quality Performance

Kern Health Systems

Kailey is the Director of Quality Performance for Kern Health Systems (KHS). She was born and raised in Bakersfield, California with a passion for the local community. She has been employed with KHS for more than eight years with responsibilities varying across MCAS/HEDIS, Grievances, Potential Quality Issues, and Site Reviews. Her prior clinical experience includes critical care nursing in the Emergency Department (ED), Case Management, Utilization Management, and more than ten years of Quality experience in the managed care setting for multiple lines of business. This is where she realized her passion for serving the local community of Kern County. As the Director of Quality for a managed Medi-Cal health plan, she supports the overall quality of care to members primarily who are poverty stricken, homeless, or gravely disabled. Kailey’s personal and professional mission is to support access to high quality and equitable care to the community she was born and raised in the Central Valley of California. Kailey holds a Bachelor’s of Science Degree in Nursing and is currently pursuing a Master’s Degree in Healthcare Administration. She enjoys reading, baking, and spending time with her husband and two daughters.

Debbie Conboy SVP, Risk Adjustment

Signify Health

Debbie is the SVP of risk adjustment and quality at Signify Health, bringing 35 years of healthcare experience to her role. With a focused expertise in Risk adjustment and Stars/quality, Debbie is widely recognized as an industry expert in these areas.  Debbie has deep knowledge of multiple risk adjustment algorithms, data submission requirements, RADV/HRADV, as well as the regulatory environment that Medicare Advantage, Medicaid, and ACA operate within and around.  At Signify, Debbie helps guide our clinical roadmap with a focus on accurate and appropriate documentation to support diagnostic capture, and has executive responsibility over our Coding and CDI teams.

Laura Cooley PhD, Editor-in-Chief

Journal of Patient Experience

As Editor-in-Chief of the Journal of Patient Experience, she advocates for improved health and experience outcomes through evidence-based research and practice. As a mission-driven professional, she aims to drive value through strategic thought leadership, program development, and academic scholarship to improve patient experience outcomes. She provides consultative support and speaks at high-profile conferences as a recognized subject matter expert.

She most recently led The Academy of Communication in Healthcare, where she consistently partnered with C-Suite leaders to support the development and implementation of their Patient Experience strategies. She developed and managed a robust portfolio of healthcare enterprise affiliates.

Laura is Co-Editor for “Communication Rx: Transforming Healthcare through Communication and Relationships”, a popular book in the McGraw-Hill Professional Series.In her role as Editor-in-Chief at The Journal of Patient Experience (an open-access peer-reviewed academic publication) she leads a team dedicated to creating influential content focused on patient experience research and education.

John Criswell Founder, CEO, 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. 

Deb Curry MBA, RHIA, CCS-P, CRC, Risk Adjustment Programs Director

Medical Mutual

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

Shannon Decker 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.

Tina Dueringer CEO, Principal Advisor

Dueringer Advisors, Inc 

Tina Dueringer, BSN, RN, CCM, PCC, is the CEO and Principal Advisor at Dueringer Advisors Inc., a distinguished consulting firm dedicated to supporting health plans, vendors, and leaders in the health insurance and provider sectors. With a robust background spanning Medicare Advantage, Medicaid, Duals, ACA, and commercial markets, Tina brings extensive expertise in care management, utilization management, clinical quality, Model of Care development, Stars ratings, HEDIS measures, and accreditation standards such as NCQA and URAC.

Tina's career is marked by strategic insights into health plan operations, including strategic planning, joint ventures, partnerships, delegated relationships, and the advancement of value-based care models. She is deeply committed to advancing Health Equity, Population Health, and integrated care initiatives across the industry.

Previously, Tina served as Vice President of Clinical Quality and Stars at Rebellis Group, specializing in Medicare Advantage and government consulting. Her leadership journey includes pivotal roles at Cityblock, Blue Cross Blue Shield of Arizona, and the Wisconsin Department of Health Services, Medicaid Policy Division.

Tina earned her Bachelor of Science in Nursing and holds a post-graduate certification in Population Care Coordination from Duke University. She is also a Board-Certified Case Manager (CCM), underscoring her dedication to enhancing healthcare delivery and outcomes through comprehensive care coordination strategies.

Donna Furlong RN Clinical Services Senior Director

Banner Medical Group

Robert Garnett Vice President, Government Analytics and Health Benefits Cost of Care

Elevance Health

Colleen Gianatasio Director, Clinical Documentation Integrity and Coding Compliance  

CDPHP

Colleen Gianatasio CPC, CPCO, CRC, CDEO, CPC-P, CPMA, CPPM, CCS, CCDS-O, and AAPC Approved Instructor has over 20 years of experience in the health insurance field. She has experience in customer service, claims, quality, and coding. As Director, Clinical Documentation Integrity and Coding Compliance, Colleen’s primary responsibilities are provider engagement and clinical documentation improvement for accurate coding and reimbursement. 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 of the AAPC National Advisory Board.

Liz Haynes Risk Adjustment & Stars Government Programs

Blue Cross and Blue Shield of Kansas City

Liz Haynes is the DVP of Risk Adjustment & Stars- Government Programs at Blue Cross and Blue Shield of Kansas City (Blue KC). In this role, Liz leads provider engagement and the operations, oversight, strategic direction of Risk Adjustment and Star functions for Blue KC’s Medicare Advantage and Affordable Care Act health plans. These government-sponsored lines of business contribute significantly to Blue KC’s mission to provide affordable access to healthcare.  Liz has an extensive background in healthcare with experience ranging from bedside nursing to provider engagement on behalf of national payers. Prior to joining Blue KC in 2018, Liz served for seven years in Risk & Quality at Optum Insight and eleven years with BJC HealthCare. Liz is a respected expert in Government Programs Provider Engagement, Stars and Risk Adjustment.  She manages comprehensive solutions for overall contract performance and is actively involved in several healthcare initiatives bridging health care and health insurance.  She has experience with taking several Medicare Advantage contracts to 4 Star. Liz was named as the 2023 recipient of RISE’s prestigious quality award for advancing the lives of America's seniors through clinical leadership and policy vision. Liz earned both a Bachelor & Master of Nursing from Chamberlain University with an emphasis in Informatics.

Jennifer Holman Director of Risk Adjustment Programs

Centene

Mary Inman Partner

Whistleblower Partners LLP

Mary Inman is a partner and co-founder of Whistleblower Partners LLP, a law firm dedicated to representing whistleblowers under the various U.S. whistleblower reward programs.  Mary and her colleagues have pioneered a series of successful whistleblower cases against prominent health insurers, hospitals, provider groups, and vendors under the False Claims Act alleging manipulation of the risk scores of Medicare Advantage patients.  Mary is a recognized expert and frequent author, commentator, and speaker on frauds in the healthcare industry, particularly those exposed by whistleblowers. 

Dr. Mansoor Khan CEO

Persivia

Dr. Mansoor Khan is a 20-year veteran of the software and healthcare industries. He is a serial entrepreneur who has been developing advanced technologies and cutting-edge software since the mid-90s. Over the years he has led teams that have developed technology and applications for Disease Surveillance, Artificial Intelligence, Quality Management, Analytics, Care Management, and Cost and Utilization Management. These efforts have won numerous awards over the years including Best Decision Support System for ACOs (Blackbook) and Top 100 AI companies. Previously Dr. Khan founded and had successful exits from KeyCommerce (1997 – 2004), DiagnosisOne (2005 – 2012), and was CEO of Alere Analytics (2012 – 2015).

Dr. Fauzia Khan CMO

Persivia

Chris Lance Chief Product Officer

Edifecs

Dr. Edward Likovich CEO

Nymbl

Edward Likovich, CEO of health-tech company Nymbl Science, is on a personal mission to empower older adults to live more freely through digital balance training. Hailing from Hermitage, PA, Ed earned three degrees from Harvard, including a PhD in applied physics. His career spans roles in J.P. Morgan's algorithmic trading group and his tenure as the CEO of GoodLux Technology, where he pioneered bright light therapy products for depression. Ed's expansive journey, from academia to cutting-edge digital health solutions, reflects his passion for making a meaningful impact in the world.

Helen Liu Pharm.D.

Health Plan Leader/Senior Consultant

Helen Liu, PharmD is a clinical pharmacist and healthcare leader with nearly three decades of experience driving clinical excellence, optimizing medication use, and improving patient outcomes across diverse healthcare settings. Drawing on her extensive background, Helen brings a unique blend of clinical expertise and strategic insight to her consulting practice, where she partners with organizations to enhance clinical operations, medication safety, and cost-effectiveness.

In her prior leadership roles, Helen spearheaded transformative pharmacy initiatives. At ATRIO Health Plans, she implemented a Pharmacy & Therapeutic Committee and developed a Part B Prior Authorization/Step Therapy Program, yielding $1.5 million in savings within the first year. She also led formulary analyses for Medicare submissions and crafted strategies to enhance Star quality measures. Her commitment to clinical integrity resulted in policies that ensured compliance with CMS regulations on critical medications, such as insulin B vs. D, hospice, and transplant drugs. During her seven-year tenure at Kaiser Permanente, Helen served as Regional Assistant Director and Drug Use Management leader, where she focused on optimizing medication use across the region. She played a pivotal role in delivering over $20 million in savings through inventory management and drug cost-saving initiatives, while also standardizing clinical practices to ensure consistent, evidence-based care. Her efforts in improving sterile compounding workflows and infusion clinic operations further solidified her reputation as a leader in clinical process improvement.

Now, as a consultant, Helen applies her vast clinical knowledge and operational experience to help healthcare organizations refine their pharmacy services, improve clinical outcomes, and achieve operational efficiencies. She remains dedicated to advancing clinical pharmacy practice and continues to advocate for the integration of cutting-edge clinical evidence to drive optimal patient care and achieve organizational goals.

Jimmy Liu VP, Analytics and MRR Solutions

Advantmed

Jimmy Liu is Vice President of Analytics and MRR Solutions at Advantmed. He has been helping health plans with their risk adjustment strategy across all lines of business for more than 15 years. Jimmy is a risk adjustment thought leader, conference speaker, and author of numerous white papers and articles. Jimmy started in consulting doing 10 years of application design and development for the financial services industry. He then spent the next 6 years at Independence Blue Cross in Philadelphia working on HIPAA EDI and eBusiness initiatives. He has designed and developed more than 20 large scale applications in his career, several of which became risk adjustment products. Jimmy has also spent more than 10 years doing risk analytics and developing suspecting algorithms that are used to create prospective and retrospective chase lists. Jimmy is a graduate of the University of Pennsylvania and lives in the greater Philadelphia area.

Andrew Lockhart CEO

Fathom Health

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 CPC, CRC, AAPC Approved Instructor, AHCCA, RAP    Director Risk Capture – Population Health 

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

Dr. Robery Mirsky Former CMO

Aetna Medicare

Bob Mirsky, MD, MMM, FAAFP, is a seasoned physician executive with extensive health plan experience across Medicare, Medicaid, and commercial lines of business. Dr. Mirsky most recently served as Chief Medical Officer and Vice President of Medical Operations at Aetna Medicare (a CVSH Company). He has held leadership roles as CMO for North Shore-LIJ (Northwell) CareConnect Insurance Company, CMO for the Mid-Atlantic Region of Coventry Health Care, CMO Gateway Health Plan in Pittsburgh, Senior MD FloridaBlue, and CMO Tenet Health System Florida. Dr. Mirsky practiced family medicine for ten years in New York and Florida and completed his residency and chief residency at St. Joseph’s Medical Center in New York.

Brian Murtha Director of Risk Adjustment Digital Strategy

Centene

Brian is Director, Digital Strategy for Centene’s Risk Adjustment organization. His vision has helped to reshape Centene’s approach to clinical data exchange and establish a framework to execute at scale and with purpose. Today, his team leads all bidirectional EMR integration and clinical data management efforts, and contributes over 5m electronic charts to Centene’s medical record retrieval initiatives. Prior to working on interoperability, he engineered WellCare’s prospective program infrastructure.

He is a co-lead of the DaVinci Risk Adjustment IG, member of Apixio’s executive advisory council, and frequent collaborator with the industry’s largest EMRs to improve and expand their payer solutions.

When he’s not working, you may find him on the Gulf of Mexico chasing fish and catching a sunburn.

Barb Nelson Director of Clinical Services Optimization

Medica Health Plans

Alexandra Povlishock MHA, Vice President

Optum

Teresa Ross

Whistleblower

Lori Rund Blue KC

VP Government Programs

Lori Rund is the Vice President of Government Programs at Blue Cross and Blue Shield of Kansas City (Blue KC). Lori is responsible for the oversight and ongoing strategic direction for Blue KC’s Government Programs line of business, including Medicare, ACA, and Medicaid. She has been with Blue KC since November 2019. Prior to joining Blue KC, Lori worked nine years for the Henry Ford Health System health plan, HAP, as the Vice President for Product Management and Market Intelligence.  She has had an extensive career with 30+ years of experience within the healthcare industry. She is a member of the RISE Medicare Member Acquisition & Experience Advisory Board and member of the Girls on the Run Board of Greater Kansas City. Lori earned a Bachelor of Business Administration from Loyola University, New Orleans, Louisiana.

Heidi Schwarzwald Home & Community Services

Signify Health

Dr. Heidi Schwarzwald is the strategic advisor to Signify Health’s Network, Clinical and Product Teams on items related to clinician network, IHE governance, and new Product development. She was honored to receive the CEO Award in 2021.

Dr. Schwarzwald is a board-certified pediatrician and a fellow in the American Academy of Pediatrics. Dr. Schwarzwald has held several roles with Aetna, including VP CMO of Provider Network and Deputy CMO for Aetna Better Health, leading the population health team. Prior to joining Aetna in October 2019, Dr. Schwarzwald served as the Chief Medical Officer for Texas Children’s Health Plan and Associate Vice Chair for Community Pediatrics for Baylor College of Medicine.

She received her undergraduate degree from Harvard University, her medical degree from the University of Cincinnati College of Medicine and completed a pediatric residency at Baylor College of Medicine in Houston Texas. She completed her Master’s in Public Health at the University of Texas School of Public Health in Houston Texas.

Dr. Schwarzwald lives in Houston Texas with her husband and two children.

Namita Seth Mohta M.D., Executive Editor

NEJM Catalyst Innovations in Care Delivery

Namita Seth Mohta is a physician executive with expertise in health care delivery transformation. As the Executive Editor for NEJM Catalyst Innovations in Care Delivery, she is part of the founding leadership team and has responsibility for content strategy and quality. Most recently, Dr. Mohta served as the Director of the Serious Illness Care Program (SICP) at Ariadne Labs, a health system innovation center at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. Dr. Mohta has been part of the founding Population Health and ACO leadership teams as Medical Director, Mass General Brigham and the New England Quality Care Alliance, both in Boston. Dr Mohta has worked with multiple start-ups, including PatientPing (now Bamboo Health), a digital health company, as their Physician Lead. She worked as a management consultant with the Boston Consulting Group prior to medical training. 

Dr. Mohta practices internal medicine as a Hospitalist at Brigham and Women’s Hospital. She is Associate Faculty at Ariadne Labs and Assistant Professor in the Department of Medicine at Harvard Medical School. She completed her Internal Medicine and Primary Care residency training at Brigham and Women’s Hospital. Dr. Mohta is a graduate of Yale College and Yale School of Medicine.

Laura Sheriff

Healthcare Expert

Laura Sheriff is a highly experienced and skilled professional in the healthcare industry, with a wealth of knowledge and expertise in risk adjustment, quality improvement, and population health analytics. With her background in Medicare, Medicaid, and Marketplace Managed Care, as well as her leadership abilities and certifications as a professional coder and risk coder, Laura brings a unique set of skills to her consulting work with physician groups and health plans.

Amir St. Clair Vice President, Enterprise Risk Management

Advocate Health

Max Voldman Partner

Whistleblower Partners LLP

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. 

Susan Waterman Trainer, Director, Risk Adjustment   

Baylor Scott & White

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.

Charlotte Yeh Former CMO

AARP

Dr. Yeh is a passionate advocate for healthcare transformation and healthy aging. Her career has spanned the industry: providers, payers, tech companies, nonprofits, and the government. Roles have included Chief Medical Officer, AARP Services Inc.; Regional Administrator, Centers for Medicare and Medicaid Services; and emergency department chief. Dr. Yeh received an MD from Northwestern University Medical School. She has extensive board experience and has garnered many honors for her work.

Michael Zeli Executive Director of Clinical Documentation Integrity PHSO

AdventHealth

Mike Zeli has over 20 years of Healthcare experience w/ 10+ years in risk adjustment with an emphasis on Medicare Advantage. After starting a career as an Acturarial Analyst, he was able to adapt his technical and analytical experience to the world of Risk Adjustment. His experiences range from managing RAF coding production, estimating risk adjusted financial accruals, managing vendor relationships, coordinating RAPs and EDS processes, In home assessments, and other prospective CDI programs.

He is currently the Executive Director of Risk Adjustment and Quality for AdventHealth. This role leverages prior health plan experience to educate primary care providers on the importance of risk adjustment and coding to the highest level of specificity.