Jordan Limperis
Data Scientist
LA Care
Highly motivated Data Scientist with a strong background in healthcare data and systems. Experienced in Inpatient Hospital and Laboratory Epic Systems, where I applied data-driven insights to improve clinical and operational efficiency. Currently, I am pursuing my career at L.A. Care, focusing leveraging advanced machine learning techniques to analyze noisy data, ensuring accuracy and efficiency in healthcare operations, particularly in payment integrity.
Crystal Son
Executive Director of Enterprise Data Analytics Solutions
HCSC
Crystal Son is an Executive Director of Enterprise Data Analytics Solutions at Healthcare Service Corporation (HCSC). She has 19 years of experience in deriving intelligence from data.
At HCSC, she leads the Strategic Initiatives & Partnerships team, a department that focuses on cross-functional, collaborative analytics delivery on key programs such as Payment Integrity and Stakeholder Engagement, enterprise data and analytics strategy and planning, as well as design and execution of HCSC’s Responsible AI program. She is passionate about real-world applications of data-driven insights, storytelling through data, and building high-performance teams.
Christopher Draven
Senior Director of Payment Integrity Analytics & AI
HCSC
Christopher Draven is Senior Director of Payment Integrity Analytics & AI at HCSC where he leads a cross-functional team focused on delivering actionable insights and savings. He has over 25 years experience in healthcare, starting in direct patient care.
Bruce Lim
Deputy Director, Audits and Investigations
California Department of Health Care Services (DHCS)
Bruce Lim serves as the Deputy Director, Audits and Investigations, for the California Department of Health Care Services (DHCS) and is the designated Program Integrity Director for Medi-Cal, California’s Medicaid program. Mr. Lim is a certified public accountant (CPA) with over 32 years of audit and financial management experience in both the private and public sectors. Past employers include Kenneth Leventhal and Company, CPAs (Ernst & Young Kenneth Leventhal Real Estate Group), Packard Bell NEC, and the California Department of Food and Agriculture.
Beth Franke
Staff Vice President, Payment Integrity Coordination of Benefits
Elevance/Anthem
Beth Franke started her career in the healthcare industry over 30 years ago. During that time, she has held management and leadership positions within large healthcare organizations such as Elevance Heath, Humana, Inc. and Kindred Healthcare and served as principal consultant for the Commonwealth of Kentucky, launching the state’s first self-funded health insurance model. She has also managed multi-discipline teams within special investigations, claims, enrollment and billing, corporate applications, mobile strategy, care management and enterprise project management office. Her current role as Staff Vice President has positioned her to oversee the Coordination of Benefits organization in Payment Integrity with over 500+ associates.
Beth has a BS in Mathematics and Computer Science from Centre College. She is a Project Management Professional (PMP), a Certified Professional Coder (CPC) and earned a Master Six Sigma Black Belt (MBB) certification from Villanova University. She also serves as a certified professional coach and was recognized as an Emerging Leader at Elevance Health.
Beth and her husband line in Louisville, KY and have five adult children. She enjoys hiking, biking and traveling with her family and is also active with several volunteer organizations, providing food, shelter, and other needed services for those less fortunate.
Exchange in conversations with other attendees to understand how enhanced data exchange can streamline workflows, reduce administrative burdens, and improve overall efficiency off the back off the payer-provider panel on Day 1. Review the role of interoperability and data sharing in improving fraud detection, claim accuracy, and cost management that were discussed throughout the event.
Medical Cost Containment
Edward Marx
Chief Executive Officer
Marx Advisory
The youngest child of Holocaust survivors, Ed moved to the United States at age 10. At 16, he served as a medical clinic janitor where he discovered his healthcare calling. Ed took successive positions as combat medic, anesthesia tech, strategic planner and technology manager. He quickly learned how the convergence of clinical, business and digital saved lives. His passion ignited, he jumped feet first into technology and operations in the C-Suite of Cleveland Clinic, NYC Health & Hospitals, Texas Health Resources and University Hospitals.
Intermixed, Ed served the supplier side as well. He was CEO for consulting firm Divurgent, global CDO for Tech Mahindra Health & Life Sciences and CIO of the Advisory Board. Concurrently, he served 15 years as an Army combat engineer officer and combat medic. Today, Ed is focused on his own advisory practice.
Ed does a fair amount of speaking, writing and podcasting. He authored healthcare bestsellers including “Voices of Innovation” and “Healthcare Digital Transformation”. He is currently writing a book for Mayo Clinic on “Patient Experience” and “Voices of Innovation - Payers”. His podcast “DGTL Voices” is “Top 3%” globally. His Blog, CEO Unplugged, surpassed 1M views. Ed recently started a YouTube channel to expand his audience.
Most importantly, Ed is husband to Simran who holds a Doctor of Nursing (DNP). They love to dance and climb mountains. They have 5 grown children and 4 grandchildren. To stay fit, he is captain of TeamUSA Triathlon.
For more career information you can find me:
Twitter https://twitter.com/marxtango
LinkedIn https://www.linkedin.com/in/edwardmarx/
Website https://www.marxadvisory.com/
In this interactive workshop, attendees will review and discuss their own experiences with AI, data analytics, and fraud prevention strategies covered during the conference. The session will focus on how these tools can be used for early issue detection and claims management, while also addressing new federal rules and fraud trends shared by regulatory experts. Walk away with actionable insights tailored to your organization’s challenges.
Payment Integrity
4L Data Intelligence
Website: https://4ldata.com/
4L Data Intelligence™ is leading the way in a new era of healthcare program and payment integrity using the patented power of Integr8 AI Risk Detection™ technology to find, fight and prevent FWA in near real-time. Integr8 AI™, coupled with our continuously credentialed provider database, creates a revolutionary provider-centric capability to dynamically detect FWA you cannot see with stacks of traditional claims data-centric editing and analytics solutions.
The 4L FWA Prevention™ solution rapidly detects and prevents FWA at five points across the claims management workflow including pre pre-payment, pre-payment and post-payment positions. At each point, patented Integr8 AI technology dynamically and continuously detects provider behaviors, relationships and outliers without the limitations of rules-based and claim data-centric solutions. In short, it enables you to see what providers are doing individually, in relationship with all other providers, and in relationship to all other claims on each-and-every claim submitted.
4L FWA Prevention pre-payment and post-payment detection and prevention results are continuously delivered in four complementary modules. These are:
- Provider Integrity Edits
- Adaptive Claims Edits
- Billing Behaviors Analysis
- Provider Schemes Analysis.
For SIU teams, the new 4L SIU Hub™ packages the expanded range of Integr8 AI powered FWA detection behaviors and schemes into easy to use views with comprehensive investigation and lead management tools. This new capability increases FWA detection, reduces complexity and increases speed-to-decision on lead triage and investigation. All so you can Find, Fight and Prevent FWA Fast™.