Episource is reinventing the way healthcare organizations manage their risk adjustment programs. From risk adjustment analytics, retrospective chart reviews, in-home and virtual health risk assessments, EDS submissions and quality reporting, we empower some of the most recognizable names in healthcare. With elegantly simple solutions, Episource helps payers navigate the chaos of the healthcare system to simplify healthcare.
Monday, March 29th
12PM – 12:45PM PT, 3PM – 3:45PM ET
Lowered utilization by patients in 2020 did largely reduce the capture of diagnosis codes for Medicare Advantage risk adjustment. However, there were plans that were resilient because of a strong RAF platform built in partnership with a vendor.
This presentation will review:
The unique and common traits of the patient and provider populations that contributed to trends
Risk-adjustment strategies utilized throughout 2020 and prior years which can be tied to impacts in claims count
Compliant program development during the PHE that will be employed moving forward
Senior Vice President of Product Development
Su has built extensive solutions for payers, including ACOs, Medicaid, MA, and the ACA exchange. She uses technology to integrate Revenue Programs with Quality and Care Management while maintaining a dedication to adding value to the beneficiary’s experience with the health plan through those solutions. Su has a Bachelors in Economics from Northeastern University in Boston, MA and is a Six Sigma Yellow Belt.
Vice President of Revenue Management
Blue Shield of California
Allison Kawamoto is Vice President of Revenue Management at Blue Shield of California. She is responsible for enterprise risk adjustment, covering 1.4M Medicare and ACA members. She oversees a team of program managers, actuaries, programmers, certified medical coders, and external vendors to ensure optimized accurate risk scores. She has over twenty years of healthcare experience focusing on provider unit cost negotiations, cost of healthcare strategies, advanced analytics, and encounter data. Allison is also a licensed certified public accountant in the state of California.
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Patrick has been an integral part of the Episource sales team since 2017. During this time he has helped forge relationships with health plans, ACO, IPAs, and medical groups that need assistance with all things risk adjustment. He has spent more than 20 years building deep partnerships with healthcare organizations. His extensive knowledge in Risk Adjustment and Quality solutions across Medicare Advantage, Commercial, and Medicaid lines of business includes: analytical suspecting, retrospective record retrieval and HCC coding, RAPS-EDS-EDGE error management and submissions, prospective in-home health assessments and telehealth visits for physician offices and health plans.
Greg Lea, Senior Sales Executive
Greg is responsible for overseeing Episource’s overall sales strategy and works to build partnerships with Health Plans, Medical Groups and IPAs across the country to ensure they are aware of the benefits of Episource’s Risk Adjustment product lines. With more than 15 years of healthcare management experience, he has served as Vice President of Client Services as well as opening and operating several offices for one of the nation’s largest healthcare services organizations.
Kim Francour, Vice President, Sales
As Vice President of Sales at Episource, Kim currently works with payers and providers on the East Coast. She has focused her career on collaborating with healthcare executives to improve patient care and positively impact business outcomes. She has partnered with a broad range of health plans and providers to deliver solutions ranging from risk adjustment, telehealth, payer-provider collaboration, consumer engagement, and AI/casual machine learning. Kim has a Bachelor of Arts from the University of Texas and currently resides in Boston, Massachusetts.
Walter McCall, Sales Executive
Walter holds a BA from Brigham Young University in Russian. He later received his MBA in Hospital Administration from the University of Phoenix. Walter is fluent in Russian, Czech, Slovak, German, and English. He got his start in Healthcare in the business offices of hospitals as an auditor of their under and overpayment errors. He has worked both on the payer and the provider side for both large and small companies, such as Optum, nThrive, and Encore. Walter knows the power of data and how it can truly be transformative to an organization that may have the information, but the inability to make it functional.
Victor Marshall, Sales Executive
Victor brings with him a strong background in identifying customer needs and designing strategic plans across operations, product management, information technology, data analysis, and CMS risk adjustment programs. Victor has a bachelor’s degree in electrical engineering from Howard University and an MBA from the University of North Carolina at Chapel Hill. He lives in the Washington DC Metro area.
Harshith Ramesh, Co-CEO
As Co-CEO of Episource, Harshith is primarily responsible for new product development and global operations. Prior to joining Episource, he was in the investment banking industry, focusing on M&A, restructuring, and capital markets assignments. He has worked for a range of global institutions, including Moelis & Co., Bain & Co., and Bear, Stearns & Co. Harshith earned his Bachelors at Tulane University, and an MBA from the Wharton School.
Sishir Reddy, Co-CEO
As co-founder and CEO of Episource, Sishir oversees the global organization of 1,500+ people, motivating and leading teams around the company’s vision and goals. By leveraging his extensive knowledge and experience in the healthcare industry, including revenue cycle management and medical coding services, he has helped make Episource a leading provider of Payer-focused solutions. Sishir received a BA in Chemistry from Claremont Mckenna College and a MIS from the Claremont Graduate University.