Kwame Appiah-Yeboah is AVP Risk Programs at Virginia Premier Health Plan with responsibility for Risk Adjustment, payment and vendor reconciliation. Kwame has a lot of Healthcare analytics experience, specifically in the Medicare and Medicaid arena. Prior to joining Virginia Premier, Kwame worked at Molina Medicaid Solutions, Verisk Health, and IntegriGuard LLC. Kwame holds a Ph.D. in Agricultural Economics from the University of Kentucky, Masters in Economics from Iowa State. Finally, Kwame has a Lean Six Sigma Black Belt certification issued by Virginia Tech and is CRC certified.
Management Consultant, Subrogation, Medicare Secondary Payer and Other Payer Liability
Brian Bargender is an internal consultant with Humana, one of the country’s largest Medicare Advantage organizations. In recent years, he has helped to lead Humana’s efforts to clarify and enforce the Medicare Secondary Payer (MSP) rules that pertain to Medicare Advantage and Medicare Prescription Drug plans. He is also responsible for monitoring trends that may impact subrogation and MSP recovery efforts, developing new cost avoidance and payment recovery projects and advising operational leaders regarding subrogation and MSP issues.
Brian has 17 years of experience in leading and improving health benefit subrogation and MSP operations. He is frequently invited to speak with liability, no-fault and workers’ compensation carriers to explain emerging MSP issues. He holds a Certified Subrogation Recovery Professional (CSRP) designation from the National Association of Subrogation Professionals and previously served as both a co-chair of NASP’s Wisconsin chapter and a health subrogation education track leader for NASP’s annual national conference.
Rafael Gonzalez, Esq. is President of Medicare and Medicaid Compliance, providing Medicare and Medicaid education to the auto, liability, no-fault, and work comp industries. Rafael has over 35 years of experience in the insurance, claims, legal, regulatory, legislative and compliance industries. He is one of the country’s leading authorities on Medicare and Medicaid secondary payer issues, including mandatory reporting, conditional payments, set aside allocations, approval, and administration, as well as special needs trust formation and administration. He blogs on all social safety net programs, including social security, affordable care, and social determinants of health. He speaks throughout the country on these substantive issues, teaches these subject matters at his local law/medical schools, and remains engaged in the legislative process at both the state and federal levels on these topics. He continues to be very active on social media, including LinkedIn, Twitter, Facebook, Instagram, and YouTube. Rafael can be reached at firstname.lastname@example.org or at 813.967.7598.
Kate Riordan is the Director of MSP Initiatives at ISO Claims Partners a national Medicare Secondary Payer compliance firm. Kate has completed and obtained CMS approval of hundreds of Medicare Set Asides during her tenure. She is fluent in Section 111 reporting requirements, the conditional payment recovery process, Medicare Advantage recovery and consistently assists clients in achieving settlements. She specializes in California claims and has participated in multiple client trainings on a national level. Prior to joining ISO Claims Partners, Kate worked in elder law and estate planning and brought significant experience in public policy and legislative initiatives. Kate received her J.D. from Suffolk University Law School with a concentration in Health Care law and received her B.A. in Government Affairs and Legal Studies from Bowdoin College. Kate is a member of the National Association of Medicare Set-Aside Professionals (NAMSAP) and the Medicare Advocacy Recovery Coalition (MARC) and is certified by the International Commission on Health Care Certification as a Medicare Set-Aside Certified Consultant. Kate is a member of the Massachusetts bar.
Scott is the Director of Risk Programs atVirigniaPremier Health Plan. Prior to joining Virginia Premier, Scott was the founder ofQuadralytics, a data analytic, software, and finance consulting company. Previously, he was the Senior Vice President, Analytics and Strategy, EMSI HEALTH where he was focused on expanding the company’s HEDIS, Medicare Stars, Medicaid Risk Adjustment and data analytics offerings to better meet the needs of health plans and other clients. He has extensive executive-level and health-plan consulting experience, having held managed care, risk adjustment and data analytics positions for more than 20 years. He has a Master of Business Administration (MBA) from Seattle University and a bachelor’s degree in accounting from Central Washington University. He holds the Certified Risk Adjustment Coder (CRC) designation from AAPC. Scott served on the RISE Advisory Board and has been involved with RISE for many years.
Denyse brings passion to every working experience. She understands that each client is unique and sometimes requires customized support. She excels at creating and maintaining strong and enduring business relationships.As CEO of Madena, Denyse directs the development and growth of Madena’s suite of healthcare solutions and tools. She has helped to revolutionize the industry with the proprietary Madena Reconciliation Tool and the Independent Certification of Plan Enrollment & Payment Data for CMS Attestations.Denyse and her team have conducted a number of full-scale reconciliation projects, recovering millions of dollars for Plan Sponsors. Under Denyse’s management, Madena leads the industry in audit and reconciliation support, software interfaces, and data mining and analysis.Prior to founding Madena in 2012, Denyse served as the Program Director for the CMS Retroactive Processing Contract (RPC) leading the design for the programs and operations still in practice today. From the inception of Madena, Denyse’s focus has been to bridge the gap between government agencies and plan sponsors, creating end-to-end compliance and success. Denyse is a problem solver and enjoys creating partnerships between the varied organizations that serve the government-sponsored healthcare industry. She is a natural teacher and sought-after trainer, and enjoys sharing her knowledge. Denyse’s enthusiasm for connection carries into her personal life, where she mentors children in at-risk home environments and was named Mentor of The Year for 2015 through the Denver Kids’ Program.
Jennifer brings nearly 20 years’ experience in Medicare Advantage with a unique perspective from both the provider and payer organizations.
Jennifer’s experience includes reconciliation and revenue enhancement and solutions, system and process reviews, and new system implementation, operations, and management. She served WellPoint as National Director of Business Reconciliation/Revenue Enhancement, and Kaiser Foundation Health Plans as the National Medicare Finance and Reconciliation Manager.
Jennifer works with health plans in performing end to end system and process assessments to identify areas of non-compliance and opportunities for efficiency. Her in-depth knowledge of CMS’ policies and procedures for enrollment, claims, customer service, compliance, pharmacy, grievance and appeals allows her to help health plans focus their compliance and improvement efforts.
Jennifer has an MBA in Healthcare Management from the University of Phoenix and a Bachelor of Arts in Organizational Psychology from Kent State University.