Rae A. McIntee, DDS, MD, MBA, FACS, CPE
Medical Director Clinical Solutions (Supporting Payment Integrity & SIU)
Louisiana Blue
Understand the strategic considerations behind deciding whether to insource or outsource key operational functions, such as billing and pre-certification, and how to assess both financial and operational impacts.
Learn how to evaluate vendor relationships effectively, including identifying the true costs of outsourcing, recognizing areas for potential in-house solutions, and assessing when to pivot away from third-party vendors for long-term sustainability.
Matt Perryman
Chief Analytics & Insight Officer
Alivia Analytics
The healthcare industry is at a turning point: payers and providers alike are demanding more from payment integrity than opaque rules engines and audit surprises. While black-box vendors have long promised value, their lack of transparency can lead to costly misalignment, internal dependency, and missed opportunities for learning and waste prevention.
This session will explore the hidden costs of opacity in traditional payment integrity models and offer a modern alternative. We’ll examine how health plans can reclaim ownership of their payment integrity strategy by shifting to AI-powered platforms to empower internal audit teams (0-pass) phase, promote internal learning, reduce overdependence on black-box vendors, and align audit logic with clinical evidence.
Attendees will learn how connecting prior authorization and claims data earlier in the care lifecycle can help identify root issues before they become payment errors. Beyond preventing waste, this approach can strengthen provider relationships, improve internal capabilities, and ultimately drive more proactive, accurate decision-making.
Using real-world insights, we’ll show how a collaborative, clinical intelligence-driven model can give payers a sustainable edge in accuracy, agility, and provider trust.
Monique Pierce
Payment Solutions & Operations
Cohere Health
Monique started her Payment Integrity career in COB at Oxford HealthPlans. After the merger with UnitedHealthcare, she led multiple teams and was responsible for creating innovative programs. Monique joined SCIO Health Analytics in 2014 and was responsible for system and process improvements before being promoted to VP of client engagement and business optimization In 2020, Monique joined start-up Devoted Health and created a full suite of programs from the ground up. Based on a passion for metrics and measuring performance, she centralized and standardized all programs reducing implementation time and maximizing savings. Today, Monique is driving opportunities to improve claim payment by designing and developing new prior auth and claim reconciliation products at Cohere Health.
Not all automation is created equal. This session helps healthcare leaders cut through the noise and get real about what “agentic” means in practice. If you’ve been burned by bots that couldn’t scale—or are evaluating solutions now—this talk will help you make smarter choices.
Learning Objectives:
Distinguish between RPA, chatbots, and agentic AI
Learn how agentic systems adapt, escalate, and self-manage
Discover where agentic AI delivers outsized value in RCM
Get a checklist for evaluating automation depth and risk
Vanessa Moldovan, CRCR, CPC, CPB, CPMA, CPPM, CPC-I
Head of RCM Strategy
Magical
Raffaello d'Amor
Head of Product
Magical
Magical
Website: https://www.getmagical.com/
Magical helps to securely transfer patient data between systems. Autofill forms and databases in your EHR system or on insurance portals without expensive integrations or APIs. Magical’s no-code solution allows teams to connect and move information between different systems and apps—instantly.
Raffaello d'Amor
Head of Product
Magical
As the healthcare landscape evolves, the future of payment integrity depends on stronger, more transparent relationships between payers and providers. This session will explore how shifting from adversarial audits to aligned, data-driven collaboration can lead to more sustainable results. Using real case examples, we’ll discuss how leaders are redesigning their PI strategies to prioritize trust, accuracy, and efficiency.
Laika Kayani
Vice President, Product Management, Payment Integrity
Optum
Optum
Website: https://business.optum.com/en/operations-technology/payment-integrity.html
Optum is a leading information and technology-enabled health services business dedicated to helping health plans achieve payment accuracy and improve cost savings across the claim lifecycle.
Laika Kayani
Vice President, Product Management, Payment Integrity
Optum
Peter Monson
SIU Director
UCare HP