Accurate risk adjustment coding is a cornerstone of effective payment integrity, directly impacting reimbursement accuracy and audit risk. This session will explore how health plans can strengthen HCC coding through targeted audits, technology solutions, and coder education—ensuring proper risk score capture, reducing payment errors, and supporting defensible, compliant payment practices.
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.
Katch is the industry leader in payment coordination, offering end-to-end solutions from Proactive Injury Coverage Coordination (PICC) to subrogation.
Katch gives you more from every claim: more value, more savings, and more confidence in the process.
By combining human insight with data and technology, we deliver smarter outcomes—before and after claims are paid. We tailor our strategies to each client’s unique needs, building partnerships that create real impact.
Katch finds what others miss—earlier, faster, and easier.
Proactive By Design
Magical helps to securely transfer patient data between systems. Autofill forms and databases in your EHR system or on insurance portals without expensive integrations or APIs. Magical’s no-code solution allows teams to connect and move information between different systems and apps—instantly.
As the healthcare landscape evolves, the future of payment integrity depends on stronger, more transparent relationships between payers and providers. This session will explore how shifting from adversarial audits to aligned, data-driven collaboration can lead to more sustainable results. Using real case examples, we’ll discuss how leaders are redesigning their PI strategies to prioritize trust, accuracy, and efficiency.
Serving as Market President at Optum, Tisha has spent more than 25 years at the forefront of health plan innovation, helping clients build strategic, comprehensive programs to address their toughest challenges and achieve financial health and operational excellence at scale.
Optum is a leading information and technology-enabled health services business dedicated to helping health plans achieve payment accuracy and improve cost savings across the claim lifecycle.
