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Unmasking Unidentified Risk Using Analytics and Artificial Intelligence

  • July 28, 2020
  • 1:00 PM – 2:00 PM ET
  • Online
about

As health insurance providers struggle to find a balance between risk revenue and risk identification costs (e.g., medical record reviews, home visits), our experts will share their real-life experience with risk adjustment (RA) program operations and analytic best practices. Our speakers will specifically highlight how one health insurance provider took internal control of its RA analytics and better supported its program goals. Our presenters also will explain how artificial intelligence is identifying wasteful interventions precisely. Together, these practical lessons will help attendees achieve new levels of efficiency and effectiveness in their ACA and Medicare Advantage programs.

Attendees will specifically learn how to:

  • Develop and operate a customized RA solution that uses an ideal mix of in-house and outsourced RA functions
  • Use artificial intelligence, machine learning, and clinical data to further improve RA efficiency and effectiveness by identifying risk that often goes unnoticed

Speakers


Deepak Goel
Senior Director of Risk Management Solutions
Blue Health Intelligence (BHI)

Deepak Goel is a Senior Director of Risk Management Solutions for BHI. He has extensive experience in Medicare Advantage, ACA commercial, and Medicaid risk adjustment, and helps clients improve risk score accuracy using prospective and retrospective interventions. He has deep experience in RAPS, EDS, Edge Sever submission, and RADV. Deepak earned his Master’s degree in Electronics Communication and Computer Engineering from Nottingham University in the United Kingdom.


Roxanna Cross
AVP, Product Management
Blue Health Intelligence (BHI)

Roxanna Cross is an AVP, Product Management for BHI. She has substantial health care information technology and product management experience in the health payer market. With deep knowledge in risk identification and stratification, medical management, and decision support using predictive and prescriptive modeling. Cross helps clients bridge business objectives with industry best practices. Roxanna is a graduate of the Advanced Technology program at Villa Julie College, located near Baltimore, Maryland.


Ed Pinter
Director of Risk Management
Arkansas BlueCross BlueShield

Ed Pinter is a Director of Risk Adjustment for MA and ACA members at Arkansas Blue Cross and Blue Shield. He has extensive experience in healthcare underwriting, medical management decision support, product operations, and risk adjustment. During his 30-year career at Arkansas BCBS, Ed has applied his data analytics and mathematical expertise to assess risks, optimize revenue, and close performance gaps. He earned his Bachelor of Science degree in Mathematics from the University of Arkansas.

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