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Sean Ryder

Value Based Program Manager
Blue Cross Blue Shield of Arizona

Sean Ryder

Value Based Program Manager
Blue Cross Blue Shield of Arizona

Sean Ryder

Value Based Program Manager
Blue Cross Blue Shield of Arizona

101 for modernization of each step of the claims continuum. 8 separate discussion across:

  • Itemized Bill Reviews
  • DRG Validations
  • Claim Receipts
  • Clinical Review
  • Provider Reviews
  • Resolutions
  • Formal Appeal
  • The Changing World Of Payment Integrity As It Relates To VBC
  • Implementing various strategies to encourage appropriate utilization of emergency outpatient facilities, such as: network management, preauthorization and utilization reviews, promoting alternative care settings, and investing in care coordination programs to prevent unnecessary readmissions.
  • A look to how data analytics can be leveraged to identify patterns of overbilling or potential fraud within emergency outpatient facilities
Track 1: Payment Integrity
  • Unveiling the audit landscape and understanding the importance of timely responses
  • Expediting audit responses through the establishment of a dedicated audit response team, implementing standardized documentation and track systems, and utilizing advanced technologies
  • Discussing the value of analyzing audit findings and leveraging them as opportunities for continuous improvement in revenue cycle management
Track 2: Revenue Cycle Management & Revenue Integrity
  • Investing in strategies that promote effective care transitions, care coordination, patient education, and data analysis
  • Working with providers to identify patients at higher risk of readmission
  • Reducing avoidable readmissions to achieve better overall quality of care and support cost savings
Track 1: Payment Integrity