James McHale
Global Value-Based Partnership Manager
Mölnlycke
Track 1: Payment Integrity
Dave Cardelle
Chief Strategy Officer
AMS
Dave Cardelle, R.Ph., is on the executive team at AMS and serves as the Chief Strategy Officer. He leads a dedicated team of professionals focused on transforming the payment integrity (PI) industry. With a BS in Pharmacy from the Massachusetts College of Pharmacy in Boston, MA, Dave brings a unique blend of healthcare expertise and domain knowledge to his role.
As the CSO, Dave leverages years of experience in the PI industry, including working for both Payer and Provider organizations to help AMS grow through innovative product, sales, marketing, and client relationship strategies.
Throughout his career, Dave has consistently demonstrated a keen understanding of healthcare-related matters, a skill that proves invaluable in the context of payment integrity. His passion for advancing the industry and commitment to maintaining the highest standards of integrity have earned him a reputation as a true industry expert.
AMS Intelligent Analytics
Website: www.amspredict.com
Advanced Medical Strategies (AMS) is a leading enterprise healthcare affordability platform that unifies the industry's most comprehensive payment, pricing, clinical, financial, and operational intelligence into a single AI-powered platform. By integrating payment integrity, price transparency, decision intelligence, risk management, clinical standards of care, reimbursement policy intelligence, financial benchmarking, statistically valid analytics, proprietary implant and medical device cost intelligence, and advanced healthcare data, AMS helps healthcare organizations improve payment accuracy, reduce unnecessary spending, and strengthen financial performance.
AMS empowers organizations to prevent, identify, and recover overpayments across pre-payment and post-payment workflows while delivering transparent insights that address the root causes of payment errors, improve reimbursement strategies, strengthen policy governance, support more competitive provider contracting, enhance fiduciary oversight, and advance enterprise healthcare affordability. By transforming complex healthcare data into actionable intelligence, AMS enables clinical, financial, payment integrity, contracting, compliance, and executive leaders to make more informed decisions that improve operational performance, financial outcomes, and healthcare affordability across the healthcare ecosystem.
Leveraging data analytics and advanced investigative tools to uncover potential FWA
Demonstrating the value of predictive modelling in targeting suspicious providers and claims
Track 1: Payment Integrity
Coordinating the efforts of credentialing/enrollment, audits, investigations (SIUs), provider sanctions, and policy
Very few insurance payers have all those groups working together in a coordinated effort to reduce fraud, increase revenue, and render excellent customer service to enrolled health care providers.
Track 1: Payment Integrity
Josh Miller
Director, Payment Integrity
Prominence
Importance of accurate and complete clinical documentation
Addressing common coding challenges and complexities faced by providers,
Driving revenue integrity with a robust CDI program
Track 2: Revenue Cycle Management & Revenue Integrity
Tami Gomez
Director of Coding and CDI Programs
UC Davis Health
Tami Gomez
Director of Coding and CDI Programs
UC Davis Health
Details TBC
Track 1: Payment Integrity
Anthony Alvarado
Senior Investigator, Special Investigations Unit
Blue Shield of California
Anthony Alvarado
Senior Investigator, Special Investigations Unit
Blue Shield of California