| Page 114 | Kisaco Research
  • Biggest current opportunities for recoveries with strategies for identifying fraud attempts to drive more savings in your PI function 

Author:

Michael Devine

Director Special Investigations Unit
L.A Care

Michael Devine

Director Special Investigations Unit
L.A Care

Author:

Joshua Preuss

Special Agent at U.S. Department of Health & Human Services
Office of Inspector General

Joshua Preuss

Special Agent at U.S. Department of Health & Human Services
Office of Inspector General
  • Speed up reimbursement and streamline day-to-day operations through efficient data exchange to enable prior authorization, claim status monitoring and identification of care gaps. 

Author:

Darren Wethers

Chief Medical Officer
ATRIO Health Plans

Darren Wethers is a board-certified internal medicine physician and certified physician executive.
He graduated from Morehouse College, Northwestern University Medical School and completed internal medicine training at Emory University School of Medicine before establishing an internal medicine practice in the St. Louis, Missouri area, becoming a “Top Doctor” Honorée several years running. Dr. Wethers was the medical staff president at SSM St. Mary’s Health Center in 2006-07 and chaired the facility’s Credentials committee 2007-11.
In 2011, Dr. Wethers began a career in administrative medicine, servings as a medical director with Coventry Health Care and Aetna, vice president of clinical operations at Blue Cross Blue Shield of Arizona and is now at Atrio Health Plans, where he serves as chief medical officer.
Dr. Wethers is a member of the American Association for Physician Leadership, Fellow of the American College of Physicians, member of Alpha Phi Alpha and Sigma Pi Phi fraternities; he is a board member and immediate past chairman for Gamma Mu Educational Services (GMES) and is a board member of Northwestern University Medical School Alumni Association, for which he serves as president-elect and co-chair of the Inclusion and Allyship committee.

Darren Wethers

Chief Medical Officer
ATRIO Health Plans

Darren Wethers is a board-certified internal medicine physician and certified physician executive.
He graduated from Morehouse College, Northwestern University Medical School and completed internal medicine training at Emory University School of Medicine before establishing an internal medicine practice in the St. Louis, Missouri area, becoming a “Top Doctor” Honorée several years running. Dr. Wethers was the medical staff president at SSM St. Mary’s Health Center in 2006-07 and chaired the facility’s Credentials committee 2007-11.
In 2011, Dr. Wethers began a career in administrative medicine, servings as a medical director with Coventry Health Care and Aetna, vice president of clinical operations at Blue Cross Blue Shield of Arizona and is now at Atrio Health Plans, where he serves as chief medical officer.
Dr. Wethers is a member of the American Association for Physician Leadership, Fellow of the American College of Physicians, member of Alpha Phi Alpha and Sigma Pi Phi fraternities; he is a board member and immediate past chairman for Gamma Mu Educational Services (GMES) and is a board member of Northwestern University Medical School Alumni Association, for which he serves as president-elect and co-chair of the Inclusion and Allyship committee.

Author:

CJ Wolf

Professor and Asst. Program Director
Brigham Young University-Idaho

CJ Wolf

Professor and Asst. Program Director
Brigham Young University-Idaho

Author:

Jonique Dietzen

Payment Integrity Director
CareOregon

With over 18 years of experience in healthcare billing and finance, I am a certified professional coder dedicated to ensuring accurate claims and proper reimbursement for providers. Having worked extensively on the provider side in finance and revenue cycle, I bring wealth of knowledge to the table, particularly in processing and payment integrity.
Throughout my career, I have gained a comprehensive understanding of billing challenges from both perspectives. This unique insight drives my commitment to improving billing practices and advocating for provider education. I continue to leverage my expertise to enhance billing processes and support providers in navigating the complexities of healthcare finance.

Jonique Dietzen

Payment Integrity Director
CareOregon

With over 18 years of experience in healthcare billing and finance, I am a certified professional coder dedicated to ensuring accurate claims and proper reimbursement for providers. Having worked extensively on the provider side in finance and revenue cycle, I bring wealth of knowledge to the table, particularly in processing and payment integrity.
Throughout my career, I have gained a comprehensive understanding of billing challenges from both perspectives. This unique insight drives my commitment to improving billing practices and advocating for provider education. I continue to leverage my expertise to enhance billing processes and support providers in navigating the complexities of healthcare finance.