2018 Speakers

Speakers Biographies


Dawn Peterson

Director of Utilization Management and Risk Adjustment Solutions
Health Alliance

Dawn Peterson, CPC is the director of risk adjustment revenue management for Health Alliance Medical Plans. Dawn's service in health care has been with the Carle Foundation Hospital, an integrated health system for thirteen years, spending the last six on the health plan side of the enterprise.

Dawn has served in various positons across the continuum with the enterprise and in addition to her duties in risk adjustment is currently the interim director of the provider relations team within the provider network management department. In her current roles Dawn directs teams responsible for provider and member education around chronic conditions and managed care operations, performance of clinical services that include face-to-face case management and in-home assessments, in addition to chart retrieval and review functionality for Medicare Advantage and Commercial Marketplace members.

Puneet Budhiraja ASA MAAA

Medicare / Chief Actuary
Capital District Physicians' Health Plan, Inc.

Puneet has been working in healthcare industry as an actuary for last 9 years. He has experience working for both the consulting and insurance side of the business. Puneet is currently working as Medicare / Chief Actuary for CDPHP (Capital District Physicians' Health Plan) as the lead actuary for Medicare and Medicaid business. Puneet has worked on wide variety of projects including pricing, reserving, product development, market surveys, and predictive modeling.

Puneet holds an Electrical Engineering degree and went to New Mexico State University to do his masters in Electrical engineering. In NMSU he became aware of Actuarial profession and decided to be an actuary

Tara A. Russo

VP of Medicare Risk Adjustment and HEDIS Quality Initiatives, VP of Navigate Directorate
Island Doctors

Tara Russo is the Vice President of Medicare Risk Adjustment, HEDIS Quality Initiatives, and Navigate Directorate for Island Doctors, a provider organization (MSO) headquartered in St. Augustine, Florida. Under her leadership, Island Doctors has become a leading example in the industry, operating 32 wholly owned and 46 affiliate offices. Tara is the Vice President of Coding, Quality, and Navigate for World Care Solutions. She is also the CEO of Transformative Healthcare Consulting, LLC. Tara is a national speaker and has presented on many occasions for the Resource Initiative and Society for Education (RISE) and Strategic Solutions Network.

Prior to her current role, Tara previously worked as a financial analyst for Humana, Florida Hospital and Visiting Nurse Service of New York. Earlier, she was the Finance Manager for the Department of Medicine at Memorial Sloan-Kettering Cancer Center in New York. She has a Master of Public Health from Columbia University School of Public Health, and holds credentials as a CPC, CPMA, CRC and CPC-I. She is a member of the American College of Health Care Executives (ACHE), Resource Initiative and Society for Education (RISE), National Alliance of Medical Auditing Specialists (NAMAS), American Health Information Management Association (AHIMA) and American Association of Professional Coders (AAPC).

Linda Lee

Vice President, Quality Improvement
MCS Healthcare Holdings LLC

Linda Lee possesses 27 years of experience in the Healthcare industry. She began working in Puerto Rico at MCS, Inc. in February 2011, as Vice President of Quality Improvement. As part of her responsibilities, Linda provides oversight and structure for continuous quality improvement. She also oversees all Quality Improvement activities including the Model of Care, the Special Needs Program, Accreditation, and HEDIS. Linda has implemented and promoted strategies that have resulted in significant improvement of her business unit and for MCS, Inc. in general. Linda holds a bachelor's degree in Mathematics and Applied Sciences from the University of California (UCLA) and has studied Econometrics at the Master's level at California State University Fullerton (CSUF).

Linda is part of professional associations such as the Fellow Life Management Institute (FLMI), the Health Insurance Association of America (HIAA) and the Insurance Institute of America (IIA), and she is a lifetime member of Worldwide Who's Who of Executives & Professionals. In her spare time, she enjoys travelling, gardening, and spending time with her family and dachshund.

Mital Panara

Vice President, Revenue Management
Freedom/Optimum Health

Currently working as Vice President of Freedom Health, Optimum Health, Beacon Health and AFCSC Health plan responsible for all the Revenue Management including develop plan benefits, Medicare Risk Adjustment, RAPS, Encounter, CSNP, Analytical, Revenue compliance monitoring and Successfully integration of other companies into Umbrella Organization. Joined Freedom Health since inception of the company and helps to achieve the 7 th fastest growing Private Company in USA as per INC 500.

Served as Executive Committee member of Chamber of Commerce and Professor at West bay Career University. Graduated Magna Cum Laude with MBA in Business/Finance, also served as President of Honor Society and President of Learning Society.

Proficient and well-known Public Speaker. Spoke at various conferences held by leading organizers in Healthcare Industry, including World Congress, Financial Research, RISE Group, World Research Group, Opal Group etc. on Medicare, Health Care Revenue Management and Compliance.

David Meyer

Vice President
SCAN Health Plan

Gaurish Chandrashekhar

Director of Revenue Management, Finance Department
Harvard Pilgrim Health Care

Gaurish Chandrashekhar is the Director of Revenue Management for the Finance department at Harvard Pilgrim Health Care. In this role, he is tasked with developing and leading a team to pursue risk adjustment revenue opportunities for Harvard Pilgrim's Medicare and Commercial lines of business by deploying effective prospective and retrospective initiatives. He joined Harvard Pilgrim in 2001 as a Sr.Analyst and grew through the ranks to the position of Manager, Pricing Applications. In his current role, he reports to the SVP & Chief Actuary.

Gaurish graduated from Southern New Hampshire University (previously New Hampshire College) in 1999 with a Masters in Computer Information Systems. Prior to immigrating to the United States, he completed his Bachelors in Engineering from University of Mumbai in 1994 and his MBA in Finance from ITM, Mumbai in 1998.

Outside of his day job, Gaurish is a professional percussionist and actively performs, records and teaches the fine art of Southern Indian drumming. His students have won awards at various national-level competitions. He has conducted lecture demonstrations at institutions such as Berklee College of Music and recorded for Boston Symphony Orchestra's web project. He was also one of six recipients of the Massachusetts Cultural Council's 2014-2015 Traditional Arts Apprentice grant program, as a Master artist. Gaurish resides in Newton, Massachusetts with his wife, Raina.

JORDAN MAUER

EVP Marketing and Member Engagement
Novu Health

Jordan is Executive Vice President of Marketing & Operations at Novu. In this role, he develops and leads the company's marketing and brand initiatives, as well as the end-to-end management of member-facing operations. With more than 15 years of senior marketing leadership experience, Jordan brings a passion for analytics, loyalty operations and engagement, as well as strategic energy to Novu.

Sujata Bajaj

Vice President of Product Development
Episource

Vice President of Product Development has over 10 years of experience leading the development and delivery of healthcare technology solutions. Her prior experiences have included developing MA, MSSP/ACO, Medicaid and exchange ACA related applications. She has deep experience in building risk adjustment analytics, CMS EDS submissions, gain/risk share reporting, HEDIS reporting and taking health plans to the coveted 4 plus STAR rating.

Jessica Smith

Vice President, Analytics & Compliance
Gorman Health Group

Jessica Smith is Vice President, Healthcare Analytics & Risk Adjustment Solutions at Gorman Health Group (GHG). In this role, she is responsible for the execution and oversight of risk adjustment consulting services for managed care, provider practice, and commercial market clients and leading and integrating cross-functional teams to ensure superior performance outcomes related to risk adjustment operations.

Jessica brings GHG clients more than 10 years of experience as one of the nation's leading experts on risk adjustment knowledge that bridges the gap between Medicare and commercial risk adjustment. She has experience developing strategies, initiatives, and end-to- end support for risk adjustment operations. Major emphasis is placed on warehouse development to support Affordable Care Act (ACA) deliverables and analyses.

Prior to joining the GHG team, Jessica led health plan efforts to implement commercial risk adjustment operations and technical support. In this role, Jessica was responsible for the overall strategy, design, and performance of the risk adjustment program. She led a cross-functional technical team of data analysts, solution architects, developers, testers, and business colleagues to implement all ACA data needs throughout the organization.

In addition to risk adjustment, Jessica also brings strong experience developing and operationalizing data governance, cost share reduction operations, regulatory compliance, and vendor management. For the past decade, she has been focused on public-private healthcare market interactions, all in the context of an ongoing analysis of key financial and public policy trends as they impact profitability in the industry. Jessica is passionate about the healthcare industry and delivering quality care to all members.

Jessica received her Bachelor of Science degree from the University of South Florida.

Michael Matthews

Partner
Foley & Lardner LLP

Michael P. Matthews is a partner with Foley & Lardner LLP and serves as chair of the Tampa Litigation Department and as chair of the firm's False Claims Act Litigation group. As a member of the firm's Government Enforcement, Compliance & White Collar Defense and Securities Enforcement & Litigation Practices, Mr. Matthews represents individual and corporate clients in a variety of government enforcement and securities litigation matters, including False Claims Act litigation, securities class actions, shareholder derivative actions, SEC enforcement matters, antitrust, and white collar criminal matters, as well as other complex litigation matters. In particular, he has litigated numerous federal and state qui tam whistleblower cases and has argued a variety of issues arising under the False Claims Act at both the trial and appellate level. A member of Foley's Health Care Industry Team and co- chair of the firm's Health Care Litigation group, he has represented individuals and entities in many aspects of the health care industry, including telehealth, managed care, medical device manufacturing, pharmaceutical manufacturing, health care provider systems, biotechnology, diagnostics, pharmacy and pharmacy benefit management, and medical equipment providers. To watch a video clip of a recent oral argument by Mr. Matthews at the Florida Supreme Court, see http://fla.st/1iXZrT2 (in which he successfully argued for the reversal of a client's conviction and life sentence based on the trial court's exclusion of another man's confession to the crime, see "News" at left sidebar).

Mr. Matthews also conducts internal investigations on behalf of corporations, audit committees, special litigation committees, and boards of directors. Engagements in securities and shareholder litigation matters include representations of a number of public companies, the former general counsel of a Fortune 50 company, the former CFO of a Fortune 500 company, and various officers and directors of other domestic and multinational companies. For example, recently Mr. Matthews orally argued motions to dismiss a putative Section 10(b) securities class action filed against a for-profit education company and its senior officers and a putative Section 14(a) securities class action against a financial services company and its directors. He also represents accountants and accounting firms in auditor liability and accountant malpractice cases, as well as Public Company Accounting Oversight Board (PCAOB) proceedings.

As a member of the firm's Business Litigation & Dispute Resolution and IP Litigation Practices, Mr. Matthews litigates and tries a variety of other complex commercial, intellectual property, and civil disputes. In particular, he has trial experience in a range of intellectual property matters, including trade secret misappropriation, copyright infringement, and equitable ownership of patents. Mr. Matthews and his colleagues at Foley also won a significant civil rights jury verdict that destruction of an affordable housing complex would have a discriminatory effect on minority and disabled residents of the complex.

Mr. Matthews is the creator and developer, along with Foley's software development team, of the firm's proprietary Case Appraiser software program, a quantitative case assessment tool for valuing litigation matters (as featured in, for example, a February 10, 2014 Tampa Bay Business Journal article, "Foley lawyer develops program for estimating litigation costs, values").

Kristina Trafton

Director, Risk Adjustment Risk & Revenue Management, Actuarial Services
Geisinger Health Plan

Kris has been leading the operational side of the Geisinger Health Plan Risk Adjustment program since 2007. In this role, she oversees four critical components to a successful risk adjustment program, including retrospective review/auditing; chart retrieval; compliance; and Risk Adjustment Education/Training. She's been the catalyst and visionary within her health plan to migrate from a primarily vendor-driven solution to a nearly all in-house solution. Her team has grown from 3 to 66 employees, including Master's-prepared leadership staff, Highly-skilled Coders, Boot-camp trained Educators and two Registered Nurses. Kris holds a Bachelor of Science degree in Business Administration/Accounting from Bloomsburg University.

Sue Kuypers

Managing Director, Product Management
Tessellate

As managing director of product management, Sue Kuypers oversees Tessellate's product portfolio. She brings a fresh perspective to product development, focusing on designing and deploying products that address customers' needs and achieve their goals. Lead by example Sue held various leadership roles throughout her more than 16 years with Blue Cross Blue Shield of Michigan. Most recently, as director of enterprise risk adjustment, she was accountable for strategy development, initiative execution and submissions for about 350,000 Commercial ACA members and 380,000 Medicare Advantage members. In addition, Sue was responsible for HEDIS submissions, Medicare Part D operations, finance, data management and other senior market segment functions. She also helped the company realize $260M in revenue annually from prospective and retrospective risk adjustment programs. Sue previously worked for ANR Pipeline Company and Dialogue Marketing. Education Sue holds a mater's degree in finance from Walsh College in Troy, Michigan, and a bachelor's degree in accounting from the University of Michigan-Flint.

Jennifer Zucchero

Manager, Risk Revenue
Gateway Health Plan

Jennifer Zucchero serves as the Manager, Risk Revenue for Gateway Health Plan in the DE market. Jennifer leads a team of Clinical Transformation Consultants focused on provider engagement for the Health Plan's Medicaid LOB, specifically in the area of Risk Adjustment. Jennifer has more than eighteen years of diverse experience in the healthcare industry. She began her career as a physical therapist and most recently served as the Director of Rehabilitation at Ware Presbyterian in PA. Jennifer also spent time in sales for Pfizer Pharmaceuticals where she earned numerous sales awards.
Jennifer earned her B.A. at The University of Delaware and her MPT from Rutgers University. She is currently working towards her MBA at West Chester University.

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