Track 1: Payment Integrity
Dave Cardelle
Chief Strategy Officer
AMS
Dave Cardelle, R.Ph., is on the executive team at AMS and serves as the Chief Strategy Officer. He leads a dedicated team of professionals focused on transforming the payment integrity (PI) industry. With a BS in Pharmacy from the Massachusetts College of Pharmacy in Boston, MA, Dave brings a unique blend of healthcare expertise and domain knowledge to his role.
As the CSO, Dave leverages years of experience in the PI industry, including working for both Payer and Provider organizations to help AMS grow through innovative product, sales, marketing, and client relationship strategies.
Throughout his career, Dave has consistently demonstrated a keen understanding of healthcare-related matters, a skill that proves invaluable in the context of payment integrity. His passion for advancing the industry and commitment to maintaining the highest standards of integrity have earned him a reputation as a true industry expert.
AMS Intelligent Analytics
Website: 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.
Find out more: https://pricetransparency.com/
Leveraging data analytics and advanced investigative tools to uncover potential FWA
Demonstrating the value of predictive modelling in targeting suspicious providers and claims
Track 1: Payment Integrity
Coordinating the efforts of credentialing/enrollment, audits, investigations (SIUs), provider sanctions, and policy
Very few insurance payers have all those groups working together in a coordinated effort to reduce fraud, increase revenue, and render excellent customer service to enrolled health care providers.
Track 1: Payment Integrity
Josh Miller
Director, Payment Integrity
Prominence
Importance of accurate and complete clinical documentation
Addressing common coding challenges and complexities faced by providers,
Driving revenue integrity with a robust CDI program
Track 2: Revenue Cycle Management & Revenue Integrity
Tami Gomez
Director of Coding and CDI Programs
UC Davis Health
Tami Gomez
Director of Coding and CDI Programs
UC Davis Health
Details TBC
Track 1: Payment Integrity
Anthony Alvarado
Senior Investigator, Special Investigations Unit
Blue Shield of California
Anthony Alvarado
Senior Investigator, Special Investigations Unit
Blue Shield of California
Track 2: Revenue Cycle Management & Revenue Integrity