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by aiforpi | Jan 16, 2024 | Uncategorized | 1 comment
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Ms. Galimi is a Healthcare Market Lead within the Healthcare & Life Sciences Practice at Gartner consulting. Ms. Galimi has more than 45+ years of healthcare experience providing direct, on-demand IT and business analysis and advice to healthcare providers, payers and government agencies relating to IT strategies, software systems, risk assessments, vendor assessments, operational processes and transformation initiatives. Expertise in claims, care management, provider network management, enrollment, billing, customer service, EHR, revenue cycle management and PACS systems, processes and vendor selections. Recent engagements with Healthcare Payers, Providers and Life Sciences at Gartner consulting include the following:
Prior to joining Gartner, Ms. Galimi was a Strategic Planning Executive at Harvard Pilgrim Health Care. Ms. Galimi completed a number of projects including; IT systems plans for 14 health centers, managed the implementation of the Epic suite of projects and PACS within the 14 health centers, facilitated and developed new IT service-level agreements between the health centers and Harvard Pilgrim Health Care’s IT departments.
Previously, Joanne was a consultant for Ernst & Young. Representative engagements: IT strategic plans for CIOs of large healthcare payers within the US; System selection projects for health insurance organizations looking for EHR and core administrative systems; Business process re-engineering for healthcare payers, hospitals and physician practices, and IT risk assessment to reduce IT risks and improve business value. Ms. Galimi holds a bachelor of science degree in management from the University of Massachusetts.
Dr. Bielinski is the Vice President of Customer Success at Codoxo. She has a Doctor of Pharmacy degree from the University of Illinois College of Pharmacy in Chicago (UIC), and she is also an Accredited Healthcare Fraud Investigator (AHFI). Prior to Codoxo, she spent 15 years at SCIO Health Analytics, an EXL Company, where she was the Chief Pharmacy Officer, with responsibility for building several clinical cost containment programs. She also developed the Retail Pharmacy FWA program which included pharmacy fraud investigations and compliance audits. She also served as a Vice President of Strategic Accounts at EXL, managing multiple payer and PBM clients. Dr. Bielinski was also an Industry Thought leader, with multiple publications and speaking engagements. Prior to SCIO, she spent many years as the Chief Operating Officer for a regional home infusion, home health, and DME company.
Derik Ciccarelli is Codoxo’s Director of Fraud Scope Operations with 30+ years of investigative and insurance defense experience. In his current role at Codoxo, he helps healthcare payers and agencies detect fraud through data-driven business intelligence. Derik’s expertise lies in conducting risk assessments of national, regional, and corporate healthcare policies along with providing exceptional service to clients to ensure compliance with all legal requirements and professional standards. Derik received his Six Sigma Certification which led him to become highly adept at leading process improvements, creating solutions to improve software performance and workflow process.
Kelly Bennett is a graduate of the University of Tampa and Florida State University, College of Law. She has been a practicing member of the Florida Bar since 1997. She is the past President of the National Association for Medicaid Program Integrity, is a Certified Fraud Examiner, a Certified Inspector General, and an Accredited Health Care Fraud Investigator. Her entire career thus far has been in state government. She has extensive litigation and legal consultation experience, and has been collaborating and problem-solving regarding healthcare fraud and abuse since 2001.
AJ is a serial entrepreneur with over 20 years of experience in pharmacy benefits, finance, andvsoftware development. As the CEO of Capital Rx, his mission is to upgrade America’s healthcare infrastructure to deliver the highest level of client service and patient engagement while reducing total cost of care. AJ has spent his career studying the pharmaceutical supply chain and developing solutions that have continually redefined the pharmacy benefit industry to achieve this goal. Before Capital Rx, AJ was a co-founder of Truveris, where he served for eight years as CEO, CIO, and a board member, leading the company to record growth (Deloitte FAST 500 and Crain’s Fast 50). Prior to Truveris, AJ co-founded SMS Partners, a joint venture with Realogy (RLGY), and in 2010 exited the partnership with a buyout. In his first venture, AJ started Victrix, a pharmaceutical supply chain consultancy, which was successfully sold to Chrysalis Solutions in 2007.
AJ is a graduate of Manhattanville College, where he studied finance while playing varsity soccer and rugby.
Jim joins us with a wealth of experience in the Payment Integrity space. His career began at Subrogation Advantage where he was accountable for finance and technology. He helped grow and sell the company to Ingenix. At Ingenix (Optum), Jim worked on all elements of payment integrity including Subrogation, Fraud and Abuse, Clinical review, DRG Audit, COB, Overpayment and predictive modeling. Jim later served as the VP of Payment Integrity for BCBS of Minnesota where he consolidated all payment integrity teams delivering significant performance improvement. After BCBS of Minnesota, Jim served as the President and CEO of WholeHealth Living, a Specialty PPO and subsidiary of Tivity Health where he was focused on growing their commercial business. Most recently, Jim served as the General Manager for the Commercial facing Payment Integrity business at Carelon, a subsidiary of Elevance Health.
Lynn Garbee is a Partner at HealthScape Advisors, a Chartis Company. Lynn brings 25+ years of experience as a health plan executive leader. She has in-depth experience in strategy development, planning, and execution as well as product design. Lynn specializes in advising payers in end-to-end provider strategies, especially value-based care program design and specialty health and the operationalization of these programs in payer environments. She also has significant proficiency in claims operations and payment integrity.
Lynn joined HealthScape from Signify Health, in which she led Product Management for Value-Based Care programs. In her role, she was responsible for the P&L of a portfolio of value-based products, ranging from total cost of care to episode of care services. She drove a vision to enable chronic care management and facility avoidance by identifying patients in the home, activating them early in the care journey, and prescribing next-best action for patient and provider at every step.
Prior to Signify, Lynn led Provider Enterprise Strategy for Cigna Health Plans, where she drove the long-term vision for provider reimbursement and network design, partnering with prominent value-based providers to co-create long-term risk solutions optimizing affordability and quality of care. Previously at Cigna, Lynn was accountable for progressive and innovative provider reimbursement strategies, creating a national playbook of FFV risk bearing approaches resulting in 650 value-based contracts covering 67% of total cost of care and achieving industry-leading trend management.
Before joining Cigna, she led the Solution Design team for Change HealthCare, helping payer clients in addressing claims payment and payment integrity challenges. Lynn has directed operations for several entrepreneurial healthcare ventures focused on value-based reimbursement, with an emphasis on episodes of care, and led the payment policy team and the contract management area of a major health plan.
Lynn holds Bachelor of Arts degrees in Health Care Policy and Economics from Brown University and a Master of Business Administration in Health Care Management and Operations from the Wharton School of Business.
Dr. Ahmed is the CEO and Founder of Codoxo. He founded Codoxo (formerly named FraudScope) to help make our healthcare system more affordable and effective. Codoxo’s Unified Cost Containment Platform uses AI to identify inaccurate payments earlier than traditional techniques, which helps ensure our scarce healthcare dollars go to real patient care. Dr. Ahmed developed this technology as a part of his Ph.D. dissertation at the Georgia Institute of Technology. A report by the JASON advisory group, the prestigious scientific advisory panel to the US government, reinforced that his doctoral research tackled some of the biggest challenges within the emerging health data infrastructure in the United States. Dr. Ahmed was honored to be included in the 40 Under 40 lists by Georgia Tech and the Atlanta Business Chronicle. Several media outlets have interviewed Dr. Ahmed about his work in reducing healthcare fraud, waste, abuse, and error. When he’s not eliminating payment inaccuracies, you’ll find him volunteering for various causes and spending time with his family.
U.S. Congressman Jay Obernolte proudly represents California’s 23rd District in the U.S. House of Representatives, which includes portions of San Bernardino, Los Angeles, and Kern Counties.
Rep. Obernolte proudly serves on the House Energy and Commerce Committee, the Science, Space, and Technology Committee, and the Budget Committee. He is the former Chairman of the House of Representative’s Task Force on Artificial Intelligence during the 118th Congress and is the only currently serving member of Congress with a graduate-level degree in AI.
Previously, Rep. Obernolte served as a member of the California State Legislature representing the state’s 33rd Assembly District and as Mayor of the City of Big Bear Lake. Throughout his time in elected office, Rep. Obernolte has developed a strong track record of working across the aisle and was among the most bipartisan members of Congress according to The Lugar Center and Georgetown University’s McCourt School of Public Policy’s Bipartisan Index.
Rep. Obernolte lives in Big Bear Lake with his wife, Heather. They have two sons, Hale and Troy. In addition to owning a videogame development studio, Rep. Obernolte is a certified flight instructor and a teacher of martial arts. He holds a B.S. in Engineering and Applied Science from the California Institute of Technology (Caltech), an M.S. in Artificial Intelligence from the University of California, Los Angeles (UCLA), and a Doctorate in Public Administration from California Baptist University (CBU).
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