Wynda Clayton, MS, RHIT
Deb Curry, MBA, RHIA, CCS-P, CRC
Shawn Larsen, RN
Tom Nasadoski, MBA
Wendy Schmerse, CPC
As the Director of Risk Adjustment, Programs & Audit at SCAN Health Plan, Antonette is responsible for the overall performance of Risk Adjustment in her organization. In this capacity, she oversees all risk adjustment audits including those that are mandated by the state and the federal government. She has 15 years of solid healthcare experience in the Medicare and commercial lines of business.
Dawn Carter is a Director of Product Strategy at Centauri Health Solutions, LLC. Her career in healthcare spans 26 years, which most recently includes extensive experience in developing revenue integrity and quality software solutions, with a focus on encounter management and risk adjustment solutions for Medicare Advantage, Medicaid and Commercial health plans. Prior to that, her experience spans all domains of health care including health plan and provider systems administration, and healthcare applications development. Her experience also includes multiple teaching engagements in medical administration, billing and coding. Dawn holds a Bachelor’s degree in Business Administration. She is a passionate and prolific industry speaker, author, blogger and subject matter expert in claims, EDI management, and risk adjustment.
Wynda Clayton, MS, RHIT
Wynda Clayton is a Risk Adjustment Manager at Providence Health Plans in Beaverton, OR. She received her Health Information Degree from College of Saint Mary’s, her BS in Health Care Management from Bellevue University and her MS from Clarkson College. Wynda has been in the health care field for over 25 years with experience on all phases from compliance to billing and reimbursement to coding to Quality Assurance to being a RADV Auditor to risk adjustment and providing physician education. Wynda is very enthusiastic and loves basketball, traveling and helping those unfortunate. To help is not always meaning to give, but it also means to teach others how to make a difference in their lives. Currently Wynda resides in Portland, OR with her husband Kevin. She can be contacted at [email protected]
Deb Curry, MBA, RHIA, CCS-P, CRC
Deb joined Paramount Healthcare in May 2013 and manages
the Medicare, Medicaid, and Commercial Marketplace Risk
Management Program. Additionally, she is a member of
Paramount’s STARS/HEDIS/Medicaid Performance
Improvement teams. 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), Certified Coding Specialist, physician based (CCS-P), and an AHIMA-approved ICD10-CM Trainer. 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). Deb is blessed with one awesome husband of almost 30 years, three amazing children (one son-in-law), two adorable grandsons, and three beautiful granddaughters who all fill her life with a lot of joy, a little mischief, and a whole bunch of love. In her spare time, Deb volunteers at her church as a Team Captain in the Youth Ministry, is Board Member of the University of Toledo Health Information Administration Advisory Board, Health and Human Services Alumni Affiliate at The University of Toledo, and Health Information Technology Advisory Committee at Owens Community College.
Diane Gabrielsen joined Network Health in 2018 as Vice President of Information System and Delivery. She brings over 25 years health insurance experience in a variety of product line, strategy and information systems (IS) roles including full system implementation, leading healthcare reform, exchange initiatives, Medicare Advantage product development and implementation in addition to many other key strategic initiatives. Gabrielsen’s broad industry experience in multiple business and IS leadership roles provides Diane a unique perspective on application of systems and solutions for strategic advantage.
Dr. Hayes is currently with Highmark, Inc. in Revenue Program Management as the Manger for Quality, HEDIS and Coding. She has over 28 years’ experience in the healthcare industry spanning roles as both a provider and reimbursement manager. She has extensive knowledge in the areas of clinical quality, healthcare leadership, compliance, risk revenue, HEDIS and documentation improvement. She continues to publish and speak nationally for professional organizations on topics related to improving care delivery and documentation accuracy to optimize appropriate reimbursement.
Bruce Kissinger is a Solution Architecture Director for Network Health in Menasha, WI. His focus is on the design and delivery of information solutions that are strategic for the business. Bruce Kissinger has over 30 years of experience in software architecture in a variety of business domains including: healthcare, environmental monitoring, manufacturing, and transportation.
Aldiana Krizanovic is the Senior Health Policy Consultant for Federal Government Relations at Florida Blue. In her prior role she served as a Health Policy Analyst for the Florida Blue Center for Health Policy. She holds a Master's in Public Health with a concentration in Health Policy from the University of North Florida. She specializes in Medicare regulation, with a focus on Medicare Advantage and Part D. In her role she monitors and analyzes Medicare regulatory changes and their impact to the business. Aldiana is passionate about advancing development of health policy that improves access to care for vulnerable populations, decreases cost of care, and improves individual's quality of life. She serves as an advisor to the Age-Friendly Public Health System Advisory Committee led by Trust for America's Health and the John A. Hartford Foundation.
Shawn Larsen, RN
Shawn has spent the last 20 years in Stars, Quality and Risk adjustment across Medicare, Medicaid and Commercial business lines. In this capacity Shawn has lead end to end operations, reporting, coding, audit and compliance activities. Currently Shawn is working with Allina Health | Aetna, a joint venture between Aetna Medicare and Allina Health System in Minneapolis, MN. Shawn is responsible for Stars, Quality and Risk Adjustment strategy and execution.
Tom Nasadoski, MBA
Tom Nasadoski is currently serving as the Director, Risk Adjustment and Recovery after being named Manager, Risk Adjustment in February, 2011. In this position, he oversees managing the Medicare Advantage, Commercial, and Medicaid risk adjustment initiatives and CMS reimbursement to the plan. Tom has built a Risk Adjustment unit at CDPHP consisting of over 20 internal staff with 7 specific job titles.
Nasadoski joined CDPHP in 2003 and has more than 20 years of managed care experience. His experience includes hospital contracting, vendor management, government program financial analysis, contract negotiation, application implementation, and revenue cycle management. Prior to joining CDPHP, Nasadoski served as a provider appeal coordinator for Empire Blue Cross Blue Shield.
He earned a Master in Business Administration degree from SUNY Empire State College as well as an advanced certificate in health care management in 2011. He also was a member of the Leadership Tech Valley program class of 2014 and became a Certified Risk Adjustment Coder (CRC) in 2018.
Dawn Peterson is the Director of Risk Adjustment operations for Martin’s Point Health Care. Dawn has sixteen years of service on the business side of medicine within integrated health systems across the Nation. Professional positions Dawn has served in are various and in the fields of communication, auditing, education, billing and coding and leadership for professional fee for service, risk adjustment, care and utilization management, population health and HEDIS chart retrieval and review.
Matt is responsible for the Client Success & Growth organizations and driving the strategic direction of Ciox's client relationships. Matt ensures the delivery of exceptional client satisfaction by driving the success of client business goals through strategic partnerships and value creation by planning, developing and managing client projects.
Wendy Schmerse, CPCRisk Adjustment Program Manager
Wendy Schmerse has over 30 years in healthcare as a coder, biller and educator. Wendy is the Risk Adjustment Program Manager at Americas Healthplan in Oxnard, California where she educates providers and their staff on medical billing and coding, documentation compliance and HCC coding. Wendy has developed a pre-visit chart auditing process to assist providers with HCC code reporting.
Craig VretasVice President, Healthcare Solutions
Craig is responsible for the development and acquisition of new business for Ameridial’s Healthcare Division. Craig has 30+ years of experience in the industry. Joining Ameridial in 1997, Craig is a true call center professional. He worked his way from call center manager, project manager and then to director of business development before taking on his current role. Craig offers detailed insight and realistic solutions to meet client program needs while surpassing expectations. With extensive experience in customer service and support, he brings professionalism and integrity to every project as he puts client needs first. Craig was previously Customer Care Manager for a long distance company and Outbound Telemarketing Supervisor for Time Warner Cable. Craig holds a Bachelor of Arts degree in Communications from The Ohio State University.
Daniel Weaver is an established leader with extensive experience developing and implementing intervention strategies to improve Medicare Stars performance. With demonstrated success with innovative intervention programs, Daniel's team has consistently delivered market-leading performance and forward-thinking engagement with providers and members.
Mr. Weisbrod currently serves as the Vice President – Risk Adjustment at Network Health in Menasha,
WI. Mr. Weisbrod brings over 20 years of health insurance, healthcare analytic and human service
experience to Network Health. Mr. Weisbrod specializes in government programs, health plan
operations, risk adjustment and data analytics. Prior to his work at Network Health, Mr. Weisbrod
served as Director of Government Programs for a regional Wisconsin health plan serving the state’s
Medicare, Medicaid and Marketplace participants. Mr. Weisbrod previously served as the Director of
Operations for the Wisconsin Health Insurance Risk-Sharing Plan (HIRSP), the state’s high-risk insurance
plan. HIRSP also administered the federal high-risk insurance plan in Wisconsin prior to the
implementation of the Affordable Care act.
Mr. Weisbrod has taught part-time at the college level for over 11 years and has extensive experience training health insurance and human service professionals. Josh lives in Neenah, WI with his wife and three school aged children.