| Page 59 | Kisaco Research
  • Explore how blockchain technology can enhance security, transparency, and efficiency in payment integrity processes.

  • Understand how blockchain and smart contracts can protect against fraud, errors, and unauthorized access in healthcare payments.

  • This session will emphasize the importance of collaboration among stakeholders in developing and
    implementing consistent payment integrity metrics. Participants will explore strategies to improve data
    sharing, standardize measurement methodologies, and enhance fraud detection efforts.

Author:

Monique Pierce

Payment Solutions & Operations
Cohere Health

Monique is a Strategic Executive Healthcare Leader with proven ability to develop solutions and maximize the benefits of Payment Integrity programs.  She is known for having excellent domain knowledge and being driven, high performing, and having a deep dedication to recruiting and developing top talent.

 

Monique started her Payment Integrity career at Oxford HealthPlans in the COB and Subrogation Department after spending time in Payment Policy.  When United Healthcare acquired many health plans in the early 2000s like Oxford, Monique was tagged as part of the Optum team to integrate the processes and people into the COB systems that she had built at Oxford.  She led systems development, quality, reporting, operations, vendor management and was responsible for creating innovative proactive programs that more than doubled savings to $1.4B in three years.

 

Monique developed a successful program that reduced interest expense on late claims for UHC, assisted a communication company to develop COB tools and assisted in strategic system projects before joining SCIO Health Analytics in 2014 to develop new products - specifically prepayment programs.

In 2015 she became the product owner of SCIOMine, the company’s internal audit application and managed the roadmap.  Monique also owned

strategic direction for operational metrics and reporting including executive scorecards. Monique was promoted to VP of Business Opportunities and Client Engagement where she improved Audit Recovery TAT by 39% and reduced client implementations TAT by 11% and the Level of Effort by 18% while increasing the count of implementation projects by 126%.

 

In 2020 Monique joined Devoted Health, a startup company with the goal of building the first ever integrated Payment Integrity Program.  The company has one system, great data, and a great mission; to change health care by treating every member as if they are family.

 

In her spare time, Monique volunteers her time in the community on the Board of Directors of SCARE NH and works in her family business LARP Portal with her husband Rick.

Monique Pierce

Payment Solutions & Operations
Cohere Health

Monique is a Strategic Executive Healthcare Leader with proven ability to develop solutions and maximize the benefits of Payment Integrity programs.  She is known for having excellent domain knowledge and being driven, high performing, and having a deep dedication to recruiting and developing top talent.

 

Monique started her Payment Integrity career at Oxford HealthPlans in the COB and Subrogation Department after spending time in Payment Policy.  When United Healthcare acquired many health plans in the early 2000s like Oxford, Monique was tagged as part of the Optum team to integrate the processes and people into the COB systems that she had built at Oxford.  She led systems development, quality, reporting, operations, vendor management and was responsible for creating innovative proactive programs that more than doubled savings to $1.4B in three years.

 

Monique developed a successful program that reduced interest expense on late claims for UHC, assisted a communication company to develop COB tools and assisted in strategic system projects before joining SCIO Health Analytics in 2014 to develop new products - specifically prepayment programs.

In 2015 she became the product owner of SCIOMine, the company’s internal audit application and managed the roadmap.  Monique also owned

strategic direction for operational metrics and reporting including executive scorecards. Monique was promoted to VP of Business Opportunities and Client Engagement where she improved Audit Recovery TAT by 39% and reduced client implementations TAT by 11% and the Level of Effort by 18% while increasing the count of implementation projects by 126%.

 

In 2020 Monique joined Devoted Health, a startup company with the goal of building the first ever integrated Payment Integrity Program.  The company has one system, great data, and a great mission; to change health care by treating every member as if they are family.

 

In her spare time, Monique volunteers her time in the community on the Board of Directors of SCARE NH and works in her family business LARP Portal with her husband Rick.

  • An overview of the most significant fraud trends and payment integrity technologies and strategies going into 2025.

Author:

Kelly Bennett, JD, CFE, AHFI

Medicaid Program Integrity Chief
Agency for Health Care Administration

Kelly Bennett graduated from the University of Tampa and Florida State University College of Law.  She has been a member of the Florida Bar since 1997 and is a Certified Fraud Examiner and an Accredited Health Care Fraud Investigator.  She has worked at the Florida Agency for Health Care Administration since 2001 and has served in several roles, including as a Senior Attorney within the Medicaid Division of the Office of the General Counsel, the Assistant Bureau Chief for the Bureau of Medicaid Program Integrity, the Agency’s Medicaid
Fraud Liaison, and is currently the Chief of Medicaid Program Integrity, where she has served since July of 2014.  She is currently the President for the National Association for Medicaid Program Integrity and is an active participant in training and collaboration initiatives with the National Health Care Antifraud Association.

Kelly Bennett, JD, CFE, AHFI

Medicaid Program Integrity Chief
Agency for Health Care Administration

Kelly Bennett graduated from the University of Tampa and Florida State University College of Law.  She has been a member of the Florida Bar since 1997 and is a Certified Fraud Examiner and an Accredited Health Care Fraud Investigator.  She has worked at the Florida Agency for Health Care Administration since 2001 and has served in several roles, including as a Senior Attorney within the Medicaid Division of the Office of the General Counsel, the Assistant Bureau Chief for the Bureau of Medicaid Program Integrity, the Agency’s Medicaid
Fraud Liaison, and is currently the Chief of Medicaid Program Integrity, where she has served since July of 2014.  She is currently the President for the National Association for Medicaid Program Integrity and is an active participant in training and collaboration initiatives with the National Health Care Antifraud Association.

 

Benjamin Hoffman

Partner
Potter Clarkson

Benjamin Hoffman

Partner
Potter Clarkson

Benjamin Hoffman

Partner
Potter Clarkson
Enterprise Insights Report
2024 Indie Brand Spotlight Finalists
 

Edward Thomas

Director, Enterprise Revenue Cycle Training & Deployment
Trinity Health (HQ Michigan)

Edward Thomas

Director, Enterprise Revenue Cycle Training & Deployment
Trinity Health (HQ Michigan)

Edward Thomas

Director, Enterprise Revenue Cycle Training & Deployment
Trinity Health (HQ Michigan)

Intelligence Fabric Layer Introduced by Backbase to Make Integrating AI Into Banks Easy

Artificial intelligence (AI) can help accelerate banks’ productivity however it can be challenging to integrate. Looking to make this process more seamless, Backbase, the engagement banking platform, has introduced its Intelligence Fabric layer.