| Page 5 | Kisaco Research
 

Sam Schwager

Co-Founder & CEO
SuperDial

Sam Schwager

Co-Founder & CEO
SuperDial

Sam Schwager

Co-Founder & CEO
SuperDial

In a market flooded with AI-powered RCM tools, how do you separate real innovation from empty buzzwords? This panel will guide payers, providers, and RCM leaders through what really matters when evaluating AI vendors, highlighting key red and green flags, how to measure real-world impact, and clarifying what “AI” actually means in today’s healthcare environment

Author:

Sam Schwager

Co-Founder & CEO
SuperDial

Sam Schwager

Co-Founder & CEO
SuperDial

Accurate risk adjustment coding is a cornerstone of effective payment integrity, directly impacting reimbursement accuracy and audit risk. This session will explore how health plans can strengthen HCC coding through targeted audits, technology solutions, and coder education—ensuring proper risk score capture, reducing payment errors, and supporting defensible, compliant payment practices.

Author:

Josh Miller

Director, Payment Integrity
Prominence

Josh Miller

Director, Payment Integrity
Prominence
Understand the strategic considerations behind deciding whether to insource or outsource key operational functions, such as billing and pre-certification, and how to assess both financial and operational impacts.
Learn how to evaluate vendor relationships effectively, including identifying the true costs of outsourcing, recognizing areas for potential in-house solutions, and assessing when to pivot away from third-party vendors for long-term sustainability.
 

Matt Perryman

Chief Analytics & Insight Officer
Alivia Analytics

Matt Perryman

Chief Analytics & Insight Officer
Alivia Analytics

Matt Perryman

Chief Analytics & Insight Officer
Alivia Analytics
The healthcare industry is at a turning point: payers and providers alike are demanding more from payment integrity than opaque rules engines and audit surprises. While black-box vendors have long promised value, their lack of transparency can lead to costly misalignment, internal dependency, and missed opportunities for learning and waste prevention.
This session will explore the hidden costs of opacity in traditional payment integrity models and offer a modern alternative. We’ll examine how health plans can reclaim ownership of their payment integrity strategy by shifting to AI-powered platforms to empower internal audit teams (0-pass) phase, promote internal learning, reduce overdependence on black-box vendors, and align audit logic with clinical evidence.
Attendees will learn how connecting prior authorization and claims data earlier in the care lifecycle can help identify root issues before they become payment errors. Beyond preventing waste, this approach can strengthen provider relationships, improve internal capabilities, and ultimately drive more proactive, accurate decision-making.
Using real-world insights, we’ll show how a collaborative, clinical intelligence-driven model can give payers a sustainable edge in accuracy, agility, and provider trust.

Author:

Monique Pierce

Payment Solutions & Operations
Cohere Health

Monique started her Payment Integrity career in COB at Oxford HealthPlans.  After the merger with UnitedHealthcare, she led multiple teams and was responsible for creating innovative programs. Monique joined SCIO Health Analytics in 2014 and was responsible for system and process improvements before being promoted to VP of client engagement and business optimization   In 2020, Monique joined start-up Devoted Health and created a full suite of programs from the ground up.   Based on a passion for metrics and measuring performance, she centralized and standardized all programs reducing implementation time and maximizing savings.   Today, Monique is driving opportunities to improve claim payment by designing and developing new prior auth and claim reconciliation products at Cohere Health.  

Monique Pierce

Payment Solutions & Operations
Cohere Health

Monique started her Payment Integrity career in COB at Oxford HealthPlans.  After the merger with UnitedHealthcare, she led multiple teams and was responsible for creating innovative programs. Monique joined SCIO Health Analytics in 2014 and was responsible for system and process improvements before being promoted to VP of client engagement and business optimization   In 2020, Monique joined start-up Devoted Health and created a full suite of programs from the ground up.   Based on a passion for metrics and measuring performance, she centralized and standardized all programs reducing implementation time and maximizing savings.   Today, Monique is driving opportunities to improve claim payment by designing and developing new prior auth and claim reconciliation products at Cohere Health.  

Not all automation is created equal. This session helps healthcare leaders cut through the noise and get real about what “agentic” means in practice. If you’ve been burned by bots that couldn’t scale—or are evaluating solutions now—this talk will help you make smarter choices.
Learning Objectives:
Distinguish between RPA, chatbots, and agentic AI
Learn how agentic systems adapt, escalate, and self-manage
Discover where agentic AI delivers outsized value in RCM
Get a checklist for evaluating automation depth and risk

Author:

Vanessa Moldovan, CRCR, CPC, CPB, CPMA, CPPM, CPC-I

Head of RCM Strategy
Magical

Vanessa Moldovan, CRCR, CPC, CPB, CPMA, CPPM, CPC-I

Head of RCM Strategy
Magical

Author:

Raffaello d'Amor

Head of Product
Magical

Raffaello d'Amor

Head of Product
Magical
 

Raffaello d'Amor

Head of Product
Magical

Raffaello d'Amor

Head of Product
Magical

Raffaello d'Amor

Head of Product
Magical