This session will bring together payers and providers to discuss the challenges and opportunities presented by healthcare mandates and electronic medical record systems. Participants will explore strategies for effective collaboration to improve patient care and reduce administrative burdens.
This presentation will delve into the latest trends and tactics employed by fraudsters, providing actionable insights to safeguard your organization. Attendees will gain a comprehensive understanding of the evolving threat landscape, learn to identify red flags, and implement effective prevention strategies.
- Understand how enhanced data exchange can streamline workflows, reduce administrative burdens, and improve overall efficiency.
Explore the critical role of interoperability and data sharing in improving fraud detection, claim accuracy, and cost management.
This session will explore the critical role of both technology and human expertise in achieving optimal COB operations. Participants will learn how to effectively combine advanced analytics and automation with human judgment to improve efficiency, accuracy, and overall COB performance.
Helen Liu, Pharm.D.
Health Plan Leader
Independent
Helen Liu, PharmD, brings 29 years of diverse pharmacy experience, blending clinical expertise, operational efficiency, technological innovation, and management across various healthcare settings.
Over the past four years, Helen has successfully led pharmacy operations at ATRIO Health Plans (Medicare), achieving significant milestones in PA/ST, FWA, MTM programs, resulting in over $4.5M in savings. She’s conducted formulary analyses to support actuary Medicare annual bid submissions, including IRA and M3P programs, collaborated with partners and the Pharmacy Benefit Manager (PBM) to identify cost-saving opportunities through formulary alternatives, biosimilars, and rebate strategies, and partnered in the RFP PBM selection process and resolved complex pharmacy-related issues through cross-departmental collaboration.
Before ATRIO, Helen spent seven years at Kaiser Permanente, where she served as Regional Assistant Director to implement hospitals Drug Use Management Program. Her efforts led to over $20 million in savings through inventory management, drug cost-saving initiatives, and the standardization of clinical content/practice guidelines.
Explore how blockchain technology can enhance security, transparency, and efficiency in payment integrity processes.
Understand how blockchain and smart contracts can protect against fraud, errors, and unauthorized access in healthcare payments.
US considers Google break-up in landmark antitrust case
Submitted by Priya Khosla on October 9, 2024 - 6:49am
Justice department could seek ‘structural remedies’ such as forced product sales after judge’s ruling of illegal monopoly in search
This session will emphasize the importance of collaboration among stakeholders in developing and
implementing consistent payment integrity metrics. Participants will explore strategies to improve data
sharing, standardize measurement methodologies, and enhance fraud detection efforts.
Monique Pierce
Payment Solutions & Operations
Cohere Health
Monique started her Payment Integrity career in COB at Oxford HealthPlans. After the merger with UnitedHealthcare, she led multiple teams and was responsible for creating innovative programs. Monique joined SCIO Health Analytics in 2014 and was responsible for system and process improvements before being promoted to VP of client engagement and business optimization In 2020, Monique joined start-up Devoted Health and created a full suite of programs from the ground up. Based on a passion for metrics and measuring performance, she centralized and standardized all programs reducing implementation time and maximizing savings. Today, Monique is driving opportunities to improve claim payment by designing and developing new prior auth and claim reconciliation products at Cohere Health.