Shows
The Collective Voice of Health IT, A WEDI PodcastEpisode 209- Patient Privacy and the Increasing Complexity of Consent Management, Sponsored by EdifecsThis podcast episode is sponsored by Edifecs, a Cotiviti Business. For over 25 years, Edifecs has been a market leader in healthcare data interchange. Hundreds of health plans, providers, and government agencies rely on their interoperability solutions to unify, normalize, and exchange clinical and financial data. As the healthcare industry has evolved, Edifecs’ solutions have evolved with it. Their cloud-native, AI-powered solutions are designed to help healthcare organizations thrive in value-based care. Learn more about Edifecs at www.edifecs.com
Michael welcomes Brian Hanley, Vice President, Public Sector, with Edifecs. Brian discusses the current state of health care con...2025-07-0327 min
PantheonAIMarket Trends, AI Stocks, U.S. Trade Deficit & Crypto Update, Nvidia, Alphabet. AMD, PalantirCome check us out on our landing page, and also on Twitter/X. ⏳ Key Topics in This Episode:🚨 U.S. Trade Deficit Hits $1.1 Trillion – What It Means for Inflation & Tariffs📉 Services Sector Growth Slows – Will the Fed Cut Interest Rates Sooner?📉 Alphabet & AMD Struggle – AI Hype vs. Reality?📈 Mattel Plans Toy Price Hikes Due to Tariffs on China – How Will Consumers React?💰 KKR’s Cotiviti Nears $3 Billion Deal for Edifecs – Big Healthcare Play Incoming!📈 New York Times Increases Dividend by 38% After Subscriber Growth📉...2025-02-0510 min
RISE RadioEpisode 23: Staying ahead of interoperability to drive lasting impactJoin us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health.Katie Devlin, DHSc, MS, CPHIMS, vice president of interoperability at Cotiviti, returns to RISE Radio and is joined by Adam Gilbert, director of interoperability operations and partnerships at Cotiviti, for this 23-minute episode. They discuss the latest regulatory requirements, what to expect for 2025, challenges, and best practices to implement a...2024-11-0823 min
A Brave New PodcastUnpacking the Intelerad Rebrand, with Jordan BazinskyIntelerad recently completed a rebrand in May 2024. In this episode Josh and Jordan spend time unpacking the reasons Intelerad decided to pursue a rebrand, the process they followed to get there, as well as the outcomes in terms of brand essence and strategy, visual identity, and market impact. Here’s a little more about Jordan. As CEO of Intelerad, Jordan Bazinsky is committed to improving global human health through advanced imaging technologies. He is entrusted with ensuring that Intelerad’s vision aligns with their clients, and ultimately patients, in supporting their unique heal...2024-11-0636 min
Product RebelsRevolutionizing Healthcare with AgileVidya Dinamani and Heather Samarin sit down with Moliehi "Mo" Weitnauer, Chief Product Officer at MRO. Mo shares her dynamic journey from finance to healthcare technology, highlighting her experiences at McKinsey, Cotiviti, and Thrive. Now at MRO, she is revolutionizing healthcare records management with a customer-centric focus. Mo discusses her approach to balancing Agile principles with client needs and shares her insights on change management, the importance of understanding real users, and how her unique blend of strategy and product leadership continues to drive success in the healthcare industry. 2024-10-1731 min
Managed Care CastEffective Strategies to Enhance Medicare Advantage Star RatingsOn this episode of Managed Care Cast, we're talking with Marge Ciancetta, the product manager of Cotiviti's Star Intelligence solution, which helps health plans and providers improve their Medicare Advantage Star Ratings.
We discussed all things Star Ratings, including their importance, how they are calculated, and their impact on plans in 2024. Looking ahead, we also discussed strategies to improve ratings for 2025, especially for smaller plans.2024-08-1518 min
Off the Record with Brian MurphyKeeping credentials (and your career) current, with the Medical Coding GeekHaving worked in and around medical coding and CDI for almost 20 years, I can say for certain that few topics vex coders and CDI professionals more than the dreaded recertification process.
Credential maintenance. CEUs. CEU fees. Conference CEU codes. Certificates. On and on. It’s a cottage industry unto itself. It can be frustrating and confusing, and if you’re not on top of it, costly. In my ACDIS days we had folks lapse, despite our generous grace periods. They still do.
Few things get folks more fired up than this. So, I wanted to get...2024-01-2456 min
Inspiring Women with Laurie McGrawRachael Jones on the Calling of Leadership. And it starts with Grit and Grace || EP. 140
Laurie McGraw is speaking with Inspiring Woman Rachael Jones, Founder and CEO of Syntax Health at HLTH 2023.
This is the next episode of this Inspiring Women collaboration highlighting several of the extraordinary women leaders in the Redesign family. Syntax Health was launched out of the Redesign process and Rachael could not be more excited to talk about the company, how data and analytics support the industry’s move to Value Based Care. And then of course, what it really means to be part of the 1% club…. meaning, the few African American women who are also CEO...2023-11-3025 min
GTM Disrupted with Mike SmartThe New and Higher Bar for Product ExecutivesGTM Disrupted: The new and higher bar for product executives GTM Disrupted host Mike Smart sat with Mo Weitnauer, CPO of a fast-growing clinical data exchange company to discuss the new and rising bar for product organizations and specifically product executives. Mo shares from her diverse background as a strategy executive, health tech domain expert and former McKinsey consultant how as the function of product management becomes more entrenched in American corporations the expectation for successful business outcomes risen.Today the function of product management is much more about ensuring the organization is building the...2023-11-3039 min
Inclusion in ProgressIIP117 How to Deal with DEI Pushback & Still Affect Company CultureOn our last few episodes of the Inclusion in Progress podcast, we’ve been sharing examples of the types of diversity, equity and inclusion (DEI) work we’ve done with client partners. In today’s episode, we’re speaking with Jimmy Rose, former Vice President for Employee Experience at Cotiviti. Since connecting with Jimmy in 2020, we were fortunate to partner with him to establish DEI foundations for his company, teams and larger company culture. In our conversation, we discuss: How Jimmy first got into DEI work and how he’s see...2023-11-1720 minRISE RadioEpisode 17: Cotiviti’s Katie Devlin on navigating the health care interoperability landscapeKatie Devlin, DHSc, MS, CPHIMS, vice president, interoperability, Cotiviti, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health. In this 21-minute podcast, Devlin, author of the new white paper, Implementing a digital quality strategy, discusses interoperability, federal requirements, challenges, and how it supports improved risk adjustment and quality programs. About Katie DevlinKatie De...2023-09-0521 min
Tuning In to The C-SuiteBest Practices Plans Can Take in the Medicaid Redetermination Process to Prevent Members Losing CoverageBriana Contreras, an editor of Managed Healthcare Executive, spoke with Leah Dewey, vice president of clinical and consumer engagement operations at Cotiviti, in this month’s podcast episode. In our discussion, Leah talked about what she’s seeing as the process of Medicaid Redetermination is well underway and some of the issues affecting consumers, as many are at risk of losing coverage. Leah also shared best practices for health plans when reaching out to consumers and ways to keep members informed and engaged in the redetermination process. 2023-06-1018 min
Health Professional Radio - PodcastZelis - Study on Healthcare Billing Reveals Consumer FrustrationsMichael Axt, Chief Member Empowerment Officer at Zelis, a company modernizing the healthcare financial experience, discusses recent research outlining consumer frustration with the healthcare billing process, the lack of processes for correcting errors, and the implications for payers, providers, and consumers.
#Zelis
Michael Axt is Chief Member Empowerment Officer of Zelis, providing strategic leadership and oversight of products across the organization. Michael has deep experience in managing product development functions, corporate strategy, and corporate development. Most recently, he served as SVP of Strategy and Corporate Development at Diversified, where he led all aspects of mergers...2023-03-2110 min
The Credit Edge by Bloomberg IntelligencePrivate Credit Booming With M&A DealsThe largest buyout financing ever arranged by private credit firms may be in the works -- Apollo Global Management and HPS Investment Partners are among lenders that have offered to help provide a record $5.5 billion loan supporting the buyout of health-care technology company Cotiviti. In this episode of the Credit Edge Podcast, Bloomberg News reporter Jill Shah is joined by private credit reporter David Brooke to talk about the $1.4 trillion private credit market and the increasing role in M&A financing. Bloomberg Intelligence’s Stephen Flynn also provides an update on some of the names in the telecommunications and me...2023-03-0122 min
Speaking to InfluenceHonoring Reverend Dr. Martin Luther King, Jr., and His Timeless Communication Expertise Part TwoThis is Part Two the first two part podcast by Dr. Laura Sicola and Vocal Impact Productions, Laura is joined by Nikelle King and Rachael Jones to discuss the incredible communication skills of Rev. Dr. Martin Luther King, Jr. If you missed Part 1 you can find that in Episode 139 of Speaking to Influence. Here are a few things that you will learn in this episode: How Dr. King used repetitive phrases in his speeches to leave his audiences remembering key points of his speeches. Sharing Dr. King’s speeches and writings to understand how tho...2023-01-1830 min
Speaking to InfluenceHonoring Reverend Dr. Martin Luther King, Jr., and His Timeless Communication Expertise Part OneThis week in the first two part podcast by Dr. Laura Sicola and Vocal Impact Productions, Laura is joined by Nikelle King and Rachael Jones to discuss the incredible communication skills of Rev. Dr. Martin Luther King, Jr. Here are a few things that you will learn in this episode: How Dr. King used repetitive phrases in his speeches to leave his audiences remembering key points of his speeches. Sharing Dr. King’s speeches and writings to understand how those skills inspired an entire generation. Understanding the power of Dr. King’s storytelling and the empathy that h...2023-01-1731 min
Keeping IT BriefA Non-Traditional Look at LeadershipToday we speak with Brooke Pierce, Vice President, CMS Division Manager, with Leidos on how Servant Leadership can draw the most out of your team in a positive way. This non-traditional style of leadership entails a set of behaviors and practices that places the primary emphasis on the well-being of the entire team. Brooke Pierce, Vice President, CMS Division Manager, with LeidosBrooke Pierce (Patterson) is the VP and Division Manager for the CMS Division within Leidos’ Health Group, a $250m annual, 587-person division. This division supports the Nation’s large...2022-12-2209 min
Speaking to InfluenceRachael Jones - CEO, Syntax, a Redesign Health Company: Stakeholder Messaging and Radical AccountabilityThis week Rachael Jones shares how her organization is turning stakeholders into teammates and making value-based care work for everyone involved. Listen in as Laura and Rachael discuss issues that cause friction around patient care, how Rachael navigated being an outsider and bringing a team together after a merger, the clarifying questions that matter most. Here are a few things you’ll learn during this conversation: Why Rachael uses the mantra “Clarify role. Clarify goal.” The Importance of the Three C’s – Communication, Consensus Building, and Collaboration Why Radical Accountability is valuable in emerging leaders How...2022-11-2931 min
Monitor MondaysWinds of Change in the South: No Jubilee with CotivitiAlong the gulf shores of Mobile Bay in Alabama, at the crack of dawn you might hear shouts of jubilation from early risers there to witness flounder, soft-shell blue crabs, and gulf shrimp beach themselves due to the upward movement of oxygen-deprived bottom waters. The aftermath is a bounty of seafood on the sandy beaches, and hence the local dish known as “jubilee.”Yet when it comes to local healthcare providers dealing with the Recovery Auditor (RA) Cotiviti, there is no jubilance – as you will hear Jennifer Bartlett explain during the next live edition of Monitor Mondays. Bartle...2022-11-1431 min
Listening In (With Permission): Conversations About Today's Pressing Health Care TopicsEpisode 111: Rachael Jones on Health Equity StrategySuzanne calls Rachael Jones, Senior Vice President, Performance Analytics & Quality at Cotiviti, to discuss health equity and what employers and other health care purchasers can do to advance it.
"You really have to have a comprehensive strategy that looks at clinical data, financial data, member stratification, gaps in care..."
"Beyond having that strategy, payers should also think about this problem, or this issue of health equity, as not only theirs to solve. It's about a community and village of partnerships in the health care ecosystem..."2022-07-2920 min
Lance Jay Plus + ("THE" Lance Jay Radio Network & The Rubicon HealthCast on SiriusXM 141)"ALL CAPS" 4.15.22(Part II) Of Lance's #healthcast series interview with RaeAnn Grossman Cotiviti's EVP of Risk Adjustment....2022-04-1414 minTuning In to The C-SuiteEmad Rizk of Cotiviti Addresses How Expanding Access to Data Around SDoH Improves Care, Risk AssessmentBriana Contreras, editor of Managed Healthcare Executive spoke with Emad Rizk, M.D., chairman, president, and CEO of Cotiviti in this week's episode of Tuning In to the C-Suite. In the discussion, they talked about the issues of risk in healthcare and how they have led to inequalities in care. They also addressed how adopting risk assessment tools that expand access to data around social determinants of health can help reduce bias and improve care. 2022-04-0611 minLance Jay Plus + ("THE" Lance Jay Radio Network & The Rubicon HealthCast on SiriusXM 141)"Global Cap" 4.7.22(Part I) RaeAnn Grossman EVP of Risk Adjustment of Cotiviti joins the show to discuss her career in managed care and shares wisdom on leadership and the healthcare industry...2022-04-0500 min
Slice of Healthcare#217 - Dr. Emad Rizk, President & CEO at CotivitiOur guest: Dr. Emad Rizk, President & CEO at Cotiviti In this episode, we discussed:His backgroundThe “why-how-what” of CotivitiWhy is it now more important than ever for payers to focus on payment accuracy?The differences between prospective and retrospective accuracyWhat are the pros and cons to both?How can payers improve payment accuracy amid current COVID-19 financial woes?What’s next for Cotiviti?This episode was recorded in November 2021. Our sponsors for this episode are BlocHealth, Curation Health, ChenMed & MediTelecare.BlocHealth is building the ecosystem of services and solution...2022-04-0516 min
The Product Management Leaders PodcastOperational Readiness, Collaboration Between Teams & Creating Value (with David Wolf, AVP of Payor Solutions @ MedeAnalytics, Cotiviti)The sixteenth episode of The Product Management Leaders Podcast is now live!Our aim with this podcast is to connect you with some of the top PM leaders and share their real-world strategies and tactics for building world-class products.In today's episode, Grant Duncan speaks with David Wolf, AVP of Payor Solutions at MedeAnalytics and former VP of Product Management at Cotiviti and other companies. He’s spent much of his career in the healthcare space, so this episode is a nice take on how to apply product management strategies for a specific industry that ev...2022-03-2536 min
HIT Like a Girl Pod: Empowering Women in Health ITRachael Jones Embraces Change and Gravitates Toward ComplexityAs the SVP for Performance and Analytics for Cotiviti, Rachael Jones leads advanced analytics teams that focus on medical costs, provider economics, network management, and value-based care. Her work looks at a continuum of data to see how poverty, food scarcity, having a place to live and access to healthcare plays into the risk and cost of care itself. In this episode, she talks about aligning incentives around value in healthcare and what it takes to create sustaining change that will stand the test of time.2021-10-1326 min
ProactiveIT Cyber Security DailyEpisode 378 - Let’s End the Week on a Positive NoteGood Morning and Welcome to the ProactiveIT Cyber Security Daily number 378. It is Friday June 11th 2021. I am your host Scott Gombar and Let’s End the Week on a Positive Note
Beef Supplier JBS Paid Hackers $11 Million Ransom After Cyberattack
Foodservice supplier Edward Don hit by a ransomware attack
CD Projekt: Data stolen in ransomware attack now circulating online
Hackers breach gaming giant Electronic Arts, steal game source code
Microsoft Teams bug is prompting users to select a certificate
Hackers can exploit bugs in Samsung pre-installed apps to spy on users
Slilpp, the largest stolen logins market, seized by la...2021-06-1119 min
Managed Care CastLeveraging Health Data and AI to Predict COVID-19 HotspotsEarly on in the pandemic, having the ability to predict where outbreaks were going to take place was something to be desired. Cotiviti developed a COVID-19 tracker map using big data models and artificial intelligence (AI) technologies, which can accurately predict where in the United States new COVID-19 outbreaks would occur and show the relative risk of infection for people with underlying health conditions.
On this episode of Managed Care Cast, we speak with Nicole Neumarker, the executive vice president of development and innovation at Cotiviti. Nicole shared Cotiviti’s results with their tracker map at the 2021 AcademyHealth National Health Po...2021-03-3015 min
Boju Bajai#49 (अ)समावेशी समृद्धि | Ep 2 | Interrupting Spacesसमृद्ध नेपाल कसको लागि? चिल्ला सडक र महँगा एयरपोर्टहरूले भरिएको समृद्ध नेपालको परिकल्पनामा व्हिलचियर प्रयोगकर्ता लगायत विभिन्न किसिमको अपाङ्गता भएका व्यक्तिहरुले पनि प्रयोग गर्न मिल्ने भौतिक संरचनाहरू पनि पर्छन् की पर्दैनन् ? समृद्ध नेपालको सडक, फुटपाथ, गगनचुम्बी भवन र त्यहाँ थुप्रिएका अवसरसम्मको पहुँच अपाङ्गता भएका व्यक्तिहरूका लागि पनि उत्तिकै सहज हुनुपर्छ। तर अवस्था त्यस्तो भइसकेको छैन। र यहि (अ)समावेशी समृद्धिले तेर्साएका चुनौतीहरु बारे यसपालिको हाम्रो गफगाफ ।
In this episode, reporter Nikita Tripathi talked to Shreeti Shrestha. Twenty-five-year-old Shreeti works as a software engineer and she was featured in The Kathmandu Post piece ‘The women who are changing the face of tech in Nepal’ by Prajesh SJB Rana for her work at Cotiviti Nepal and Dallo Tech. She is also a wheelchair user. We wanted to find out from Shreeti how she is navigating the physical side of the city but also her personal and professional experience working in the tech industry in Nepal.
This episode is part of a five-part series, Interrupting Spaces, produced by Boju Bajai in collaboration with the United Nations in Nepal.
Over the next five weeks, we will bring you stories of women who are interrupting and disrupting the spaces and structures around them through their work, their voices, and their presence. You do not want to miss this special series. For new episode updates, please subscribe to Boju Bajai podcast on SoundCloud, Spotify, Apple Podcasts, Podcast Addict, CastBox, or wherever you get your podcast.
Related readings:
‘The women who are changing the face of tech in Nepal’ - https://tkpo.st/2LdKgef
Twitter by Shubha Kayastha on how inclusive the streets are - https://twitter.com/Shubha_a/status/1360237874344435713
‘Report on Accessibility Audit on Kathmandu Nepal’ (PDF file) by National Federation of the Disabled - Nepal - https://nfdn.or...2021-03-1427 min
Nepali Podcast givingBackNatural Language Processing | Rajendra Banjade, Ph.D. | Nepali Podcast - givingBack | Ep 26Guest: Rajendra Banjade, Ph.D
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Rajendra Banjade has been working in a managerial role in data science at Audible (Amazon company) for more than three years and is based in New Jersey. His focus is on Natural Language Processing (NLP), Machine Learning (ML), and data science in general, and his work at Audible includes supporting business decisions and improving customer experience by analyzing a vast amount of contents, such as texts from books and customer activities and building predictive models.
Rajendra received his MS & Ph.D. in computer science from the University of Memphis, Tennessee. During his graduate study, he...2021-01-121h 00
Healthcare IT Today InterviewsHealthcare Interoperability - How Is Your Organization Doing Against the Industry?To really dive into the issue of healthcare interoperability, I sat down with 4 experts to really understand where healthcare interoperability is working today:
* Matthew Michela, President & CEO, Life Image
* Drew Ivan, Chief Product & Strategy Officer, Lyniate
* Dr. Chris Hobson, Chief Medical Officer, Orion Health
* Emad Rizk, M.D.; Chairman, President & CEO; Cotiviti
Along with discussing some of COVID-19 and interoperability with this panel, I also ask them about what the baseline interoperability looks like for a healthcare organization and then what interoperability looks like today for a more advanced healt...2020-12-3046 min
HFMA’s Voices in Healthcare FinanceHow the pandemic paved the way for fraud, waste and abuse in telehealthEmad Rizk of Cotiviti discusses the fraud, waste and abuse risks of telehealth, and Sondra Cari from sponsor Huron talks about the opportunities of revenue cycle learning.
2020-11-1819 min
Equity Breakdown: The New IndustrialistMultiplan (MPLN) BreakdownHi Everyone,Massive disruptions in the healthcare industry are evolving post-pandemic crisis. With rising costs, and a complex relationship between patients, physicians, and insurance companies, technology solutions will shake up the industry. The U.S. will grow to $6.2 trillion in healthcare spending by 2028. The demand to transform the current inefficiencies in the value chain and offer low costs are high. Today, we will break down Multiplan (MPLN), a company that has been around since the 1980s that merged Churchill Capital Corp II SPAC to tackle the healthcare problems at a staggering valuation of $11.1 billion. Business Summary: 2020-10-0816 min
Healthcare Weekly: At the Forefront of Healthcare InnovationCan We Predict Future Healthcare Risks?Learn more about Cotiviti’s services here.
2020-09-0628 min
The #HCBiz Show!The State of Payer Data with Jordan BazinskyPayers already face a formidable challenge when it comes to internal data management. After years of consolidation in the industry, many payers have a collection of legacy systems cobbled together to run their operations. This makes data management difficult for things like claims, provider directories, and member demographics. And those are just “the basics”. Now, as quality measurement evolves and payers experiment in value-based payment, there’s an acute need for the integration of real-time clinical data to support operations and care management. Finally, there are the CMS and ONC final rules that create new requirements for payers to sh...2020-08-141h 00
Educate YourselfCotiviti: Nicole NeumarkerNicole Neumarker is currently working as Vice President of R&D for Cotiviti, a leading solutions and analytics company that leverages unparalleled clinical and financial datasets to deliver deep insight into the performance of the healthcare system. At Cotiviti she is responsible for delivering value through the software engineering and innovation teams globally. Nicole is the former VP Technology of Helix Education, and originally began her technical career at Cisco Systems’ headquarters in Silicon Valley. Currently at Cotiviti, Nicole’s initiative portfolio under management, includes all development for new product introduction as well as innovation across the existing install base. She...2020-03-1231 min
From the Trenches: A Healthcare Analytics PodcastEpisode 18 - The insider's guide to clinical appropriatenessWhen a health plan is deciding whether to pay a claim, there’s no shortage of information to consider and reviews that must be performed, including medical coding and documentation. And perhaps the most challenging question to answer is this: is the information on the claim clinically appropriate?
On episode 18 of “From the Trenches” podcast, we speak with Marla Wilson, Cotiviti vice president of clinical and coding operations, and Ken Sabulsky, vice president of audit operations. Listen as they dive into how Cotiviti reviews member claim history and medical charts to ensure clinical appropriateness.2019-09-2300 minFrom the Trenches: A Healthcare Analytics PodcastEpisode 17 - How to step up claim overpayment recovery resultsPayment accuracy programs are critical to delivering value to health plan members. Some plans excel at recovery management while others struggle—and the difference in financial results is significant. But regardless of size, any health plan can improve its recovery results by pulling a few key levers. Cotiviti's Chris Mastro, vice president of operations, once again joins Jeremy Bamford, senior product director for payment accuracy, to look at what drives success in recovering claim overpayments.2019-06-1800 minFrom the Trenches: A Healthcare Analytics PodcastEpisode 16 - The keys to successful claim overpayment recoveryFor health plans, managing payment recovery is very challenging and hard to accomplish without negatively impacting their net promoter scores. And this proves especially difficult when using collection agencies that are not experts in claims payment and the plan’s individual overpayment concepts. On the latest episode of our “From the Trenches” podcast, Cotiviti’s Chris Mastro, vice president of operations, joins Jeremy Bamford, senior product director for payment accuracy, to examine the keys to successful claim overpayment recovery.2019-06-0700 minFrom the Trenches: A Healthcare Analytics PodcastEpisode 15 - How to sharpen your inpatient auditing program with better chart selectionAlthough the cost of inpatient hospital stays continues to rise, health plans are finding that their inpatient claim auditing programs are returning less value. They’re also facing challenges such as provider abrasion resulting from requesting too many medical charts to validate those claims, which makes it more difficult to successfully retrieve medical records. We talk with Cotiviti product director Jena Reilly about how health plans be more selective and focus on pursuing medical records that will actually return value back to the plan.2019-05-2000 minFrom the Trenches: A Healthcare Analytics PodcastEpisode 14 - Excellus BlueCross BlueShield's data lake journeyAs they look to tame their data and turn it into actionable insights, many payers are significantly ramping up their data analytics strategy by building a data lake, housing both structured and unstructured data. Serving 1.5 million members, Excellus BlueCross BlueShield of New York is making significant progress on its own data lake journey. We speak with Tom Morley, manager of analytics and data strategy for Excellus.2019-04-1100 minFrom the Trenches: A Healthcare Analytics PodcastEpisode 13 - A path to success in the changing data management landscapeThe longstanding barriers to data sharing between healthcare organizations have been breaking down over the past decade, removing a major obstacle to partnerships between payers and providers. But major challenges remain, as data management only continues to grow in complexity and healthcare organizations try to make sense of a flood of information. Cotiviti chief analytics officer David Costello joins the podcast to discuss the best framework for better data management in healthcare.2019-03-1100 minFrom the Trenches: A Healthcare Analytics PodcastEpisode 12 - Fighting healthcare fraud and abuse with NHCAAHealthcare organizations must constantly improve their technologies and processes to stay one step ahead of healthcare fraud. So, what does the leading national organization focused on the fight against healthcare fraud see on the horizon in this ongoing battle? On the latest episode of our “From the Trenches” podcast, we sit down with Louis Saccoccio, CEO of the National Healthcare Anti-Fraud Association (NHCAA) at the organization’s 2018 Annual Training Conference.2018-11-0600 minFrom the Trenches: A Healthcare Analytics PodcastEpisode 11 - How clinical validation is good for payers, providers, and patientsWhen a health plan denies a claim, the provider wants to know why it was denied. Sometimes, the answer is that a modifier appears to have been used inappropriately, which Cotiviti detects using a process we call clinical validation. And as it turns out, clinical validation doesn’t just lead to better outcomes for the payer, but also the members and providers that it serves. On the latest episode of Cotiviti's “From the Trenches” podcast, we talk with John Neumann, registered nurse and clinical consultant for Cotiviti’s Payment Accuracy solutions.2018-09-2700 minFrom the Trenches: A Healthcare Analytics PodcastEpisode 10 - How risk adjustment coding validation gives health plans more certaintyCompliance is becoming an increasingly difficult challenge for Medicare Advantage plans, especially when it comes to their risk adjustment programs. When CMS selects plans for a risk adjustment data validation (RADV) audit, they need to have a high degree of certainty that their diagnoses submitted for reimbursement are valid. So, what’s the solution? We look at the benefits of coding claim validation with Lesley Brown, Cotiviti vice president of Risk Adjustment.2018-07-1800 minFrom the Trenches: A Healthcare Analytics PodcastEpisode 09 - Navigating to better Star Ratings performanceYou’ve submitted your final data to NCQA and CMS, marking the end of the HEDIS® 2018 marathon. Now it’s on to the next challenge: Star Ratings performance. In the latest episode of Cotiviti's “From the Trenches” podcast, we wrap up this year’s HEDIS season, discuss the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System, and introduce Star Navigator, a new solution to enable Medicare Advantage plans to optimize their Star Ratings.2018-06-1900 minFrom the Trenches: A Healthcare Analytics PodcastEpisode 08 - The final sprint to the HEDIS 2018 finishThe countdown is on for the June 15 deadline to submit your HEDIS 2018® data, and there’s no shortage of details to keep track of to ensure your submission is accurate, locked on time, and approved by your auditor. We hear from Cotiviti product manager Jamison Gillitzer and senior data analyst Charan Govind, who offer important reminders to help health plans dot their i’s and cross their t’s in these final weeks of the HEDIS 2018 season.2018-05-2100 minFrom the Trenches: A Healthcare Analytics PodcastEpisode 07 - Validating clinical claims without medical record reviewAutomated claim editing systems are a crucial component of accurate and efficient claims payment. But there will always be claims that are too complex to be auto-adjudicated and need a human touch. So, what exactly do you need to clinically validate a claim? We talk with Kris Jensen, registered nurse and clinical consultant for Cotiviti's Payment Accuracy solutions.2018-05-0800 minFrom the Trenches: A Healthcare Analytics PodcastEpisode 06 - Are you ready for medical record review validation?The HEDIS® 2018 deadline for submitting your medical record review validation (MRRV) data is earlier this year than in years past. Are you prepared? On this episode, our monthly dive into HEDIS season continues as we get tips for MRRV success from Carrie Taylor and Holly Conk, managers of HEDIS abstraction for Cotiviti.2018-04-2400 minFrom the Trenches: A Healthcare Analytics PodcastEpisode 05 - Are you catching all types of duplicate claims?Is your claim editing system catching all types of duplicate claims, or are many of them passing through and getting paid? And if so, what can you do about it? We talk with John Neumann, registered nurse and clinical consultant for Cotiviti's Payment Accuracy solutions, who breaks down common misconceptions about duplicate claims and describes how health plans can combat them.2018-04-1000 minFrom the Trenches: A Healthcare Analytics PodcastEpisode 04 - Sifting the 2019 Medicare Advantage final rate noticeThe Centers for Medicare & Medicaid Services (CMS) has released its final 2019 Medicare Advantage and Part D Rate Announcement and Call Letter. What are the key takeaways for Medicare Advantage plans and their risk adjustment programs? We dive in with vice president Lesley Brown, who drives the product strategy for Cotiviti's Risk Adjustment solutions.2018-04-0600 minFrom the Trenches: A Healthcare Analytics PodcastEpisode 03 - HEDIS measure changes on the horizonThe National Committee for Quality Assurance (NCQA) is proposing several new measures and measure changes for next year’s HEDIS® season. We examine how this would impact health plans with Jenna Fitcher, product director for Cotiviti's Quality and Performance Solutions, as well as product manager Jamison Gillitzer.2018-03-2800 min
intrepidNOW HealthcareTime to Get Bullish on Interoperability via Consumer Directed Data ExchangeTime to Get Bullish on Interoperability via Consumer Directed Data Exchange
GUEST
Ryan Howells, Principal at Leavitt Partners
DISCUSSION
Ryan joined us to discuss how Consumer Directed Data Exchange is the breakthrough that we have been waiting for to enable interoperability. Specifically, we discuss the following with Ryan:
(3:00) Will you remind the audience what the CARIN Alliance is and what you are focused on?
(6:11) What is the TEFCA and why does it matter?
(8:36) What is the difference between user proofing and authentication and why are they both important?
(10:45) I’ve...2018-03-0515 minFrom the Trenches: A Healthcare Analytics PodcastEpisode 02 - The changing quality landscapeAs payers increasingly use quality data to drive performance improvement initiatives across their organizations, Cotiviti conducted a survey in late 2017 to determine how organizational shifts are affecting their strategy and planning. We look over the results with David Bartley, vice president of Quality and Performance.2018-02-1400 minFrom the Trenches: A Healthcare Analytics PodcastEpisode 01 - Prepping Your HEDIS dataOn the premiere episode of our podcast, we look at how health plans should get their data ready for their HEDIS® production run with Jenna Fitcher, product director for Cotiviti's Quality and Performance solutions, and Geetha Bhatraj, director of data program management.2018-01-3000 minintrepidNOW HealthcareThe Carin Alliance and InteroperabilityThe Carin Alliance and Interoperability
GUEST
Ryan Howells, Principal at Leavitt Partners
DISCUSSION
Ryan joined us to discuss The Carin Alliance and Interoperability. Specifically, we discuss the following with Ryan:
(2:46) One of the areas that Leavitt Partners has been focused on is how to advance consumer-mediated or consumer-directed exchange. Can you briefly explain what those terms mean?
(4:50) As you know Ryan many individuals and organizations have tried and failed in the past to make progress on this topic, why do you think you can make more progress now, espec...2017-01-2514 min
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