Staff Software Engineer

Lyric, a leader in healthcare payment accuracy, has acquired ClaimShark, a payment integrity technology platform. ClaimShark's solutions will be integrated into the Lyric 42 Platform, enhancing AI-driven offerings for health plans.

As HLTH 2024 prepares to convene in Las Vegas, the anticipation for groundbreaking insights and transformative discussions is palpable. To get a glimpse into the key themes and predictions shaping this year’s event, we reached out to 21 digital health executives for their expert perspectives.From the rise of generative AI and the evolving role of virtual care to the increasing focus on health equity and value-based care, these industry leaders offer a diverse range of perspectives on the most pressing challenges and promising opportunities facing the healthcare ecosystem.Join us as we delve into their predictions and explore the trends that are poised to redefine the future of healthcare at HLTH 2024.Ryne Natzke, chief revenue officer, TrustCommerce, a Sphere company, a provider of end-to-end integrated healthcare payments and security softwareAI, AI, and more AI! I’m looking forward to seeing how AI is being applied to help clinicians, patients, and other staff members provide better patient experiences and outcomes. Everything is moving so quickly that it will be exciting to get an update on where the industry is going.James Aita, director, Strategy and Business Development, Medicomp Systems, a physician-driven provider of diagnostically connected patient data solutionsOf course AI is the hot topic at HLTH this year–but with the new regulations from ASTP/ONC, the question is how can it be usable, trustworthy, transparent and helpful. I’m also interested in seeing who else is making AI and clinical data helpful at the point of care to reduce the burden on clinicians and inform patient care.Lyle Berkowitz, MD, CEO, KeyCare, the nation’s first Epic-based virtual care companyI always look forward to HLTH and seeing presentations of the newest cutting-edge technology and ideas. This year, I’m expecting deeper and wider use cases of AI to lead the charge. But in addition to technology innovations, I’m also hoping we will hear about other people and process topics such as how to set up virtual care teams and how to rethink primary care physician compensation to better align around adoption of automation and team-based care.Kazu Okuda, MD, CEO and co-founder of Universal Brain, whose platforms use brain-function measurement to drive precision psychiatryThe emergence of personalized treatment is an exciting field that I expect to take center stage at HLTH this year

Mark Turner, Vice President, Clinical Content, LyricIn the fast-evolving and intricate landscape of payment integrity, the value of prepay editing is paramount. As powerful AI and advanced analytics are being applied earlier in the claim adjudication process, the importance of next-generation claim editing capabilities will separate health plan leaders from laggards.If you’re equating claims editing with medical savings alone—you’re missing the boat and the opportunity. Because forward-thinking payment integrity and claims operations leaders recognize that prepay editing, and its underlying best practices, improve administrative costs, plan member satisfaction, and provider relationships.  Here are ten best practices of prepay editing, which health plans should be using today:Staying Agile with Regulatory UpdatesIn a sector governed by stringent regulations, it’s crucial for health plans to stay updated on policies and regulations from authorities that include CMS and the AMA. This proactive approach helps ensure compliance and efficiency, positioning your plan as a leader in payment integrity. Fostering Strategic Alignment in Claims EditingFinding the right balance between maximizing savings and maintaining positive provider relations is critical. Building “better bridges” between plans and providers involves both applying traditional sources of rules, as well as plan policies rooted in evidence-based data and resources. This approach improves trust and transparency, leading to more sustainable, mutually beneficial relationships with providers.   3.  Harnessing AI for Enhanced AnalyticsAI offers transformative potential in analyzing healthcare claims, enabling plans to identify trends and anomalies effectively. When combined with human oversight, AI becomes a powerful tool for enhancing decision-making processes. This technology should be utilized to amplify the capabilities of your team, including experienced medical directors and certified coders, ensuring a deeper and more accurate analysis of claims data.Periodically Reviewing CarveoutsRegular re-evaluation of exclusions and the scenarios that lead to them is essential