This Q&A with Alex Yanes is part of our Innovators series. Alex explains how empathy, security, and product thinking guide the technology powering modern payment integrity for health plans.
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Payment Integrity
Engineering the Future of Payment Integrity: A Conversation with Alex Yanes, VP of Engineering
From Manual Muscle Memory to Modern Payment Integrity: A Conversation with Dana Ryan, Senior Manager Client Success
This Q&A with Dana Ryan is part of our Innovators series. Dana shares lessons learned from 20+ years helping health plans unlearn old processes, embrace automation, and see ROI from their PI programs.
Consistency Is the New Scalability: A Conversation with Stephanie Gibbons, Vice President Clinical Operations and Internal Audit Management
This Q&A with Steph Gibbons is part of our Innovators series. Steph breaks down the core principles driving her approach to transforming health plan operations including clinical nuance, operational discipline, and a deep respect for the work.
Bridging Product, Data, and Operations: A Conversation with Chandler Wilson, Senior Product Owner
This Q&A with Chandler Wilson is part of our Innovators series. Her 15-years’ experience in payment integrity and healthcare technology brings insights into how aligning systems, people, and strategy in Pareo® helps health plans turn data complexity into operational clarity.
A Lifelong Advocate for Health Plans: A Conversation with Kimberly Fadden, SVP of Client Management
This Q&A with Kimberly Fadden, a 40-year healthcare technology leader, covers payment integrity, client advocacy, and navigating cost pressures with trust and transparency as part of our Innovators series.
Beyond Disruption: 5 Strategies Every Health Plan Needs for 2026
When industry disruption is constant, your strategy needs flexibility. Here’s what successful payment integrity leaders are doing now to prepare for 2026 and beyond.
Behind the Data: A Conversation with Quzonna Reed, Business Systems Analyst
This Q&A with Quzonna Reed, who has worked with ClarisHealth for over six years helping health plans transform their data to power smarter payment integrity with Pareo®, is part of our Innovators series.
Driving the Future of Payment Integrity: A Conversation with Tom Noack, SVP of Product Strategy
This Q&A with Tom Noack, who has deep roots in the community from years of hands-on experience leading PI teams at a top 10 payer – where he was instrumental in bringing on Pareo®is part of our Innovators series.
Reimagining Payment Integrity: How Health Plans Can Optimize Using a Modern Operating System Built for the Future
Are payment integrity strategies stuck in the past? This strategic brief explores 4 concepts health plans can use to update business models and optimize using a modern operating system built for the future.
Power of Payment Integrity Conference Reveals 5 Strategic Insights
Payment integrity leaders from the country’s top health plans came together for the Power of Payment Integrity Conference. They found strength in community, innovative ideas, and 5 powerful themes that will drive progress in the industry.
Managed Medicaid Plan Finds Technology Partner to Grow Payment Integrity Savings
Kern Health Systems selects Pareo® One technology-enabled payment integrity services to shore up claims accuracy efforts. Using an integrated, provider-first approach, ClarisHealth auditors identify $3M in first 9 months for the Medicaid MCO.
Buying payment integrity technology: 6 considerations
More health plans see the value in reducing administrative complexity to improve costs and payment accuracy. This step-by-step guide for payment integrity leaders buying enterprise technology ensures you reach those goals.
Payment Integrity Leaders Reveal What Will Move the Industry Forward
Payment integrity leaders from the country’s top health plans take time to collaborate at POP Conference 2024. They find strength in community, innovative ideas, and a focus on 4 primary industry drivers.
Improving Payment Integrity with a Building Blocks Methodology
Payers need a proven framework for payment integrity to create financial value, handle change, and engage at the highest levels of organizational strategy. This 5-step methodology works whether the directive is accelerating growth, building from scratch, or somewhere in between.
Payers Reduce Administrative Costs by Going Back to Basics with Payment Integrity
In the face of economic and hiring constraints, payment integrity leaders are prioritizing these 4 best practices to shift to an enterprise strategy that offers proven value.
Health Plan Leaders Speak Out on Building the Payment Integrity Organization of Tomorrow
Whether or not health plan leaders implement a fully centralized PIO, sharing information on an enterprise payment integrity technology platform helps overcome challenges and meet strategic opportunity.
Study Reveals Payers Recover Overpayments 50% Faster with Enterprise Technology
In an industry that has struggled to quickly and meaningfully address healthcare claims payment accuracy, digital transformation once again proves its value. How can payers best take advantage of the potential of enterprise technology?
Payment Integrity Leaders Ready For A New Normal
With the ever-changing outlook of the payment integrity industry, now is the time to get ahead by making strategic investments in change.
Are You Hurting Provider NPS with Your Payment Integrity Efforts?
Look out for these 4 elements of payment integrity that may negatively impact provider NPS (net promoter scores) with your network providers. The Net Promoter Score (NPS) – an established metric traditionally managed by insights and marketing departments – can drive...
The Strategic Approach to Claims Cost Containment
Competing with other health plan functions for technology priority can lead to missed audit claims cost savings potential. An integrated payment integrity strategy breaks down these internal silos. With so many moving – and vital – parts within a payer organization,...
ClarisHealth on the Breaking Health Podcast
Listen to this conversation about building the right team and technology to help health plans tackle their entire payment integrity continuum. ClarisHealth CEO Jeff McNeese sat down with Steve Krupa, CEO of Healthedge and contributing host at Healthegy, for the latest...
The Strategy Nearly Every Health Plan Considers: Outsource vs. Insource
Slim margins, fewer resources, and consolidation have made it harder for health plans to compete. Could balancing outsource vs insource efforts accelerate their goals? With shrinking margins, fewer and fewer internal experts, and increasing consolidation, health plans...
6 Steps to a Successful Prepay Strategy
Health plans can take control of their own prospective provider audits instead of over-relying on services vendors with the help of advanced technology and access to proven analytics. We’ve written before about why it’s important for health plans to start thinking...
5 Reasons for Health Plans to Choose a Scalable Payment Integrity Technology Platform
Are you using an assortment of software tools to do work better suited to a platform? You might be missing out. When your health plan starts looking to upgrade your payment integrity and fraud management processes with technology, what do you turn to? A tool or a...
4 Payer Responses to Primary Care Challenges
Primary care providers are the foundation of the healthcare system. With the pandemic putting its future at risk, health plans can take 4 steps to address this challenge. It’s been said that the coronavirus pandemic hasn’t created any new problems; it’s just escalated...
Health Plans Return to Payment Integrity
3 claims trends associated with the healthcare industry getting back to business, and how health plans can smoothly resume payment integrity efforts. Now that the crisis-volume of COVID-19 cases has started to ease across the country, delayed elective procedures and...