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Payer-provider abrasion remains one of the biggest barriers to efficient payment, timely care, and operational success. Too often, denials, delayed payments, and prior authorization disputes stem from misaligned expectations, incomplete data, and unclear communication—not true disagreement. This session will offer a candid, solutions-focused discussion on what payers really need from providers, what providers can do upfront to reduce friction, and how both sides can work together to minimize rework, prevent avoidable denials, and create shared wins.


Learning Objectives:

  • Gain clear insights into how providers can proactively align documentation, coding, and authorization workflows to meet payer requirements and reduce denials and appeals.
  • Learn practical approaches to improve data sharing, reduce ambiguity in clinical and billing documentation, and foster payer-provider partnerships that lead to faster resolutions and fewer administrative burdens.
  • Explore strategies to move beyond transactional interactions and build trust-based partnerships between payers and providers—focusing on shared goals like timely care, accurate payment, and operational efficiency.
Medical Cost Containment
Moderator

Author:

Sarah Armstrong

CEO
Trend Health Partners

Sarah is, above all else, a passionate leader of people. With a career spanning over two decades, her journey began as a financial analyst at a small community hospital in Kentucky, where she developed a profound appreciation for the pivotal role of people in healthcare, both in the clinic and in the back office. This early experience ignited her passion for enhancing Revenue Cycle performance and fostering leadership talents that resonate with the values of collaboration and efficiency.

Her leadership at TREND is deeply influenced by her comprehensive background, championing a culture of inclusivity and collaboration. By valuing each team member's contribution, Sarah drives innovations that not only challenge the conventional adversarial healthcare models but also promote a cooperative and efficient environment that benefits all stakeholders.

She leads with a commitment to transparency, cooperation over competition, and a deep-seated belief in empowering her team. Under her leadership, TREND is pioneering a new era of healthcare solutions that prioritize accuracy, fairness, and collaborative problem-solving, all aimed at improving outcomes for patients and providers alike.

Sarah's leadership is characterized by her ability to bridge traditional divides within the industry, advocating for a paradigm shift from adversarial dynamics to cooperative partnerships. Her strategic vision is supported by her unwavering dedication to TREND's  ideals, both internally and externally, driving TREND Health Partners to challenge the status quo and lead American healthcare into a more efficient and equitable future.

 

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Sarah Armstrong

CEO
Trend Health Partners

Sarah is, above all else, a passionate leader of people. With a career spanning over two decades, her journey began as a financial analyst at a small community hospital in Kentucky, where she developed a profound appreciation for the pivotal role of people in healthcare, both in the clinic and in the back office. This early experience ignited her passion for enhancing Revenue Cycle performance and fostering leadership talents that resonate with the values of collaboration and efficiency.

Her leadership at TREND is deeply influenced by her comprehensive background, championing a culture of inclusivity and collaboration. By valuing each team member's contribution, Sarah drives innovations that not only challenge the conventional adversarial healthcare models but also promote a cooperative and efficient environment that benefits all stakeholders.

She leads with a commitment to transparency, cooperation over competition, and a deep-seated belief in empowering her team. Under her leadership, TREND is pioneering a new era of healthcare solutions that prioritize accuracy, fairness, and collaborative problem-solving, all aimed at improving outcomes for patients and providers alike.

Sarah's leadership is characterized by her ability to bridge traditional divides within the industry, advocating for a paradigm shift from adversarial dynamics to cooperative partnerships. Her strategic vision is supported by her unwavering dedication to TREND's  ideals, both internally and externally, driving TREND Health Partners to challenge the status quo and lead American healthcare into a more efficient and equitable future.

 

Panelists

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.

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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.

Author:

Mandi Heiple

Director of Payment Integrity
Medica

Mandi Heiple is the Director of Payment Integrity at Medica, where she leads a high-performing team dedicated to ensuring accurate, compliant, and efficient claims payment across commercial and government lines of business. She oversees end-to-end payment integrity strategy – from prospective editing and coding validation to retrospective audits. Her teams drive measurable savings while protecting provider relationships and improving member experiences.

With over 20 years in healthcare operations and payment integrity, Mandi has focused on designing and implementing solutions that close process gaps, reduce improper payments, and strengthen compliance frameworks.

... read more

Mandi Heiple

Director of Payment Integrity
Medica

Mandi Heiple is the Director of Payment Integrity at Medica, where she leads a high-performing team dedicated to ensuring accurate, compliant, and efficient claims payment across commercial and government lines of business. She oversees end-to-end payment integrity strategy – from prospective editing and coding validation to retrospective audits. Her teams drive measurable savings while protecting provider relationships and improving member experiences.

With over 20 years in healthcare operations and payment integrity, Mandi has focused on designing and implementing solutions that close process gaps, reduce improper payments, and strengthen compliance frameworks.

Author:

Dr. Ahmad Kilani MD, MBA, MLS, MSIT, CHCQM-PHYADV, FABQAURP, FACP, FACHE

Medical Director
Cleveland Clinic

Dr. Kilani is currently serving as Associate Medical Director for Cleveland Clinic Revenue Cycle Management and Medical Director of Throughput for Cleveland Clinic West Submarket. Nationally, he serves as Vice President of Operations for the American College of Physician Advisors. Dr. Kilani is board certified in Internal Medicine. Additionally, he has a Master of Business in Healthcare from Baldwin Wallace University, a Master of Legal Studies from Cleveland-Marshall College of Law, and a Master of Science in Information Technology from the University of Cincinnati. He is a Fellow of the American College of Physicians, a Fellow of the American College of Healthcare Executives, and board-certified in Healthcare Quality Management through the American Board of Quality Assurance and Utilization Review Physicians.”

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Dr. Ahmad Kilani MD, MBA, MLS, MSIT, CHCQM-PHYADV, FABQAURP, FACP, FACHE

Medical Director
Cleveland Clinic

Dr. Kilani is currently serving as Associate Medical Director for Cleveland Clinic Revenue Cycle Management and Medical Director of Throughput for Cleveland Clinic West Submarket. Nationally, he serves as Vice President of Operations for the American College of Physician Advisors. Dr. Kilani is board certified in Internal Medicine. Additionally, he has a Master of Business in Healthcare from Baldwin Wallace University, a Master of Legal Studies from Cleveland-Marshall College of Law, and a Master of Science in Information Technology from the University of Cincinnati. He is a Fellow of the American College of Physicians, a Fellow of the American College of Healthcare Executives, and board-certified in Healthcare Quality Management through the American Board of Quality Assurance and Utilization Review Physicians.”

Author:

Heather Wilson

Vice President and Chief Revenue Cycle Officer
The Christ Hospital Health Network
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Heather Wilson

Vice President and Chief Revenue Cycle Officer
The Christ Hospital Health Network
Engage in focused, small-group discussions where payers and providers connect over specific topics, share perspectives, and explore solutions from both sides—offering a balanced, holistic view of key challenges and opportunities.
  • Price Transparency 4 Years In: Navigating Compliance, Challenges, and Opportunities for Providers and Payers
    Join us for a dynamic roundtable at the Healthcare Payment and Revenue Integrity Congress, where providers and payers will explore the impact of price transparency. Led by Dave Cardelle (SIIA Price Transparency Committee), the session will examine key challenges and strategies around the CMS Final Rule on Hospital Price Transparency and TiC MRFs, four years on. Discussion topics include compliance, penalties, costs, rate setting, contract negotiations, and using transparency data for analysis. Don’t miss this chance to share insights and shape the future of price transparency.
    Dave Cardelle, Chief Strategy Officer, AMS
  • Payment Integrity 101
    Join us for Payment Integrity 101 at the Healthcare Payment and Revenue Integrity Congress, a foundational session designed for those new to or expanding their role in payment integrity. This session will break down the key components of payment integrity, from pre-pay to post-pay strategies, common fraud, waste, and abuse (FWA) schemes, to how plans and providers can align on reducing improper payments. Whether you're building a team, refining your approach, or just starting out, this session offers a practical roadmap and terminology primer to help you navigate the space with confidence.
    Simi Binning, Responsible AI Lead, HCSC
Medical Cost Containment

Author:

Maya Turner

Owner/Executive Managing Director
Turner Expert Consulting
... read more

Maya Turner

Owner/Executive Managing Director
Turner Expert Consulting

Author:

Dave Cardelle

Chief Strategy Officer
AMS
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Dave Cardelle

Chief Strategy Officer
AMS

Author:

Charlie Jensen

Head of Payment Integrity Strategy
Blue Cross Blue Shield, Illinois
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Charlie Jensen

Head of Payment Integrity Strategy
Blue Cross Blue Shield, Illinois

Denial management isn’t just about fighting back—it’s about understanding why denials happen and fixing the root causes upstream. This session will focus on how hospitals and health systems can use audit findings and denial data to identify coding gaps, documentation weaknesses, and process breakdowns that lead to preventable denials. Learn how to close these gaps through stronger internal collaboration across revenue cycle, coding, and clinical teams, while also using data-driven insights to foster more productive payer relationships.


Learning Objectives:

  • Learn how to analyze denial patterns and audit results to uncover documentation, coding, and process issues—enabling proactive prevention rather than reactive rework.
  • Discover best practices for improving internal workflows, fostering collaboration between clinical and revenue cycle teams, and ensuring that claims reflect accurate, defensible coding and clear clinical intent.
Revenue Cycle Management

Author:

Betye Ochoa

Director, Revenue Cycle Redesign
NorthShore University HealthSystem
... read more

Betye Ochoa

Director, Revenue Cycle Redesign
NorthShore University HealthSystem

Author:

Kimberly D Conner

Subject Matter Expert
Independent
... read more

Kimberly D Conner

Subject Matter Expert
Independent
Payment Integrity

Author:

Matt Perryman

Chief Analytics & Insight Officer
Alivia Analytics
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Matt Perryman

Chief Analytics & Insight Officer
Alivia Analytics

As value-based care continues to reshape payment models, many health systems struggle to balance financial performance with care quality goals. This session will offer practical strategies to use denial data, coding insights, and care coordination metrics to strengthen value-based outcomes—without sacrificing revenue. This discussion will highlight how to engage teams, optimize processes, and identify sustainable financial opportunities within value-based contracts.


Learning Objectives:

  • Learn how to use denial patterns and audit insights to improve documentation, coding accuracy, and contract performance.
  • Gain strategies to foster physician buy-in and leadership collaboration, finding “win-win” solutions that support both revenue integrity and value-based care success.
Revenue Cycle Management

Author:

Corella Lumpkins

Manager of Coding, Compliance and Provider Education
Loudoun Medical Group P.C.

Corella Lumpkins is the Manager of Coding, Compliance & Provider Education at Loudoun Medical Group (LMG) - one of the largest and most diverse physician-owned, multi-specialty Accountable Care Organizations in Northern Virginia/DC suburbs. As a subject matter expert, Corella has over 35 years of experience working in every area of the healthcare revenue cycle. Corella holds a bachelor’s degree and eleven certifications with an extensive background in auditing, billing, coding, implementing corporate compliance programs, CDI, education, denial and practice management. Prior to joining LMG, Corella has held leadership roles at Lifebridge, Medstar, Johns Hopkins and the University of Maryland health systems.

Corella is an author, adjunct faculty member and national speaker currently serving on both the AAPC National Advisory Board and Association of Clinical Documentation Integrity Specialists (ACDIS) Leadership Council. Corella works closely with providers in navigating patient-centric value-based care. 

... read more

Corella Lumpkins

Manager of Coding, Compliance and Provider Education
Loudoun Medical Group P.C.

Corella Lumpkins is the Manager of Coding, Compliance & Provider Education at Loudoun Medical Group (LMG) - one of the largest and most diverse physician-owned, multi-specialty Accountable Care Organizations in Northern Virginia/DC suburbs. As a subject matter expert, Corella has over 35 years of experience working in every area of the healthcare revenue cycle. Corella holds a bachelor’s degree and eleven certifications with an extensive background in auditing, billing, coding, implementing corporate compliance programs, CDI, education, denial and practice management. Prior to joining LMG, Corella has held leadership roles at Lifebridge, Medstar, Johns Hopkins and the University of Maryland health systems.

Corella is an author, adjunct faculty member and national speaker currently serving on both the AAPC National Advisory Board and Association of Clinical Documentation Integrity Specialists (ACDIS) Leadership Council. Corella works closely with providers in navigating patient-centric value-based care. 

Author:

Lourdes Centeno Fanjoy

Payment Policy Manager
Mass General Brigham

With over 15 years of experience in revenue cycle management, compliance, payer policy advising, and executive presentations, Lourdes is a results-oriented leader dedicated to optimizing operational strategies and driving corporate success. Her resource allocation, process redesign, and capacity planning skills enable her to enhance profit margins and achieve strategic goals. Lourdes brings expertise in Medicare and Medicaid reimbursement policies, ensuring effective and compliant financial practices.

... read more

Lourdes Centeno Fanjoy

Payment Policy Manager
Mass General Brigham

With over 15 years of experience in revenue cycle management, compliance, payer policy advising, and executive presentations, Lourdes is a results-oriented leader dedicated to optimizing operational strategies and driving corporate success. Her resource allocation, process redesign, and capacity planning skills enable her to enhance profit margins and achieve strategic goals. Lourdes brings expertise in Medicare and Medicaid reimbursement policies, ensuring effective and compliant financial practices.

As fraud schemes become increasingly complex, healthcare organizations must stay ahead of evolving threats that impact both clinical and financial integrity. This session will explore the latest fraud trends across the healthcare landscape - from billing manipulation and phantom providers to evolving schemes in hospice, home health, telehealth, and behavioral health. Join industry leaders as they share real-world examples, warning signs to watch for, and proactive strategies for detecting, preventing, and responding to fraud across care settings.

Payment Integrity

Author:

Michael Devine

Director Special Investigations Unit
L.A Care
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Michael Devine

Director Special Investigations Unit
L.A Care

Author:

Peter Monson

Sr. Manager, Special Investigations Unit
UCare HP

Peter Monson is the Sr. Manager of the Special Investigations Unit at UCare, where he leads a team dedicated to preventing, detecting, and correcting fraud, waste, and abuse in health care claims. With more than a decade of investigative and leadership experience across health plans and state government, he has overseen some of the most significant Medicaid fraud cases in Minnesota’s history and has redesigned investigative practices to maximize efficiency and impact.

In addition to his role at UCare, Peter previously served as President of the Midwest Insurance Fraud Prevention Association, fostering collaboration between private insurers and government agencies to strengthen fraud prevention efforts. He holds a Bachelor of Science in Criminal Justice and minor in Psychology from North Dakota State University.

... read more

Peter Monson

Sr. Manager, Special Investigations Unit
UCare HP

Peter Monson is the Sr. Manager of the Special Investigations Unit at UCare, where he leads a team dedicated to preventing, detecting, and correcting fraud, waste, and abuse in health care claims. With more than a decade of investigative and leadership experience across health plans and state government, he has overseen some of the most significant Medicaid fraud cases in Minnesota’s history and has redesigned investigative practices to maximize efficiency and impact.

In addition to his role at UCare, Peter previously served as President of the Midwest Insurance Fraud Prevention Association, fostering collaboration between private insurers and government agencies to strengthen fraud prevention efforts. He holds a Bachelor of Science in Criminal Justice and minor in Psychology from North Dakota State University.

Author:

Mandi Heiple

Director of Payment Integrity
Medica

Mandi Heiple is the Director of Payment Integrity at Medica, where she leads a high-performing team dedicated to ensuring accurate, compliant, and efficient claims payment across commercial and government lines of business. She oversees end-to-end payment integrity strategy – from prospective editing and coding validation to retrospective audits. Her teams drive measurable savings while protecting provider relationships and improving member experiences.

With over 20 years in healthcare operations and payment integrity, Mandi has focused on designing and implementing solutions that close process gaps, reduce improper payments, and strengthen compliance frameworks.

... read more

Mandi Heiple

Director of Payment Integrity
Medica

Mandi Heiple is the Director of Payment Integrity at Medica, where she leads a high-performing team dedicated to ensuring accurate, compliant, and efficient claims payment across commercial and government lines of business. She oversees end-to-end payment integrity strategy – from prospective editing and coding validation to retrospective audits. Her teams drive measurable savings while protecting provider relationships and improving member experiences.

With over 20 years in healthcare operations and payment integrity, Mandi has focused on designing and implementing solutions that close process gaps, reduce improper payments, and strengthen compliance frameworks.

Author:

Karen Weintraub

Executive Vice President
HEALTHCARE FRAUD SHIELD

With 25 years of data and 20 years of healthcare experience, Ms. Weintraub is currently responsible for the design and development of the company’s healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures. Prior to joining Healthcare Fraud Shield, managed SIUs on various healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity. Ms. Weintraub received a BA in Criminal Justice from the University of Delaware and an MA in Criminal Justice from Rutgers University. Ms. Weintraub is a Certified Professional Coder for Payers (CPC-P), a Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders, a Certified Dental Coder (CDC) from the American Dental Association, and the founder of the Hamilton, NJ AAPC chapter. She is also an Accredited Healthcare Fraud Investigator (AHFI) from the National Healthcare Anti-Fraud Association (NHCAA). Ms. Weintraub Taught CPT Coding, Fraud & Audits, and Medical Billing, Laws and Ethics and the local community college. 

... read more

Karen Weintraub

Executive Vice President
HEALTHCARE FRAUD SHIELD

With 25 years of data and 20 years of healthcare experience, Ms. Weintraub is currently responsible for the design and development of the company’s healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures. Prior to joining Healthcare Fraud Shield, managed SIUs on various healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity. Ms. Weintraub received a BA in Criminal Justice from the University of Delaware and an MA in Criminal Justice from Rutgers University. Ms. Weintraub is a Certified Professional Coder for Payers (CPC-P), a Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders, a Certified Dental Coder (CDC) from the American Dental Association, and the founder of the Hamilton, NJ AAPC chapter. She is also an Accredited Healthcare Fraud Investigator (AHFI) from the National Healthcare Anti-Fraud Association (NHCAA). Ms. Weintraub Taught CPT Coding, Fraud & Audits, and Medical Billing, Laws and Ethics and the local community college.