2015 Annual Training Conference & Anti-Fraud Expo

Priscilla Alfaro, MD
Medical Director
Anthem, Inc.


Dr. Alfaro is a National Medical Director for Reimbursement Policy Management (RPM) with Anthem Government Business Division. She provides clinical direction to the various areas within RPM, including Provider Education, Hospital Bill Audit, Medical Coding, Reimbursement Policy, Post-Service Clinical Claim Review, and Code Editing. In addition, she provides clinical and coding guidance to MSIU and Program Integrity for Medicare and Medicaid. Prior to joining Anthem, she was employed as the medical director for the Texas Office of Inspector General. She has published an article on Health Care Fraud, Waste, and Abuse in the AAP News in 2010 and made presentations on the transition to ICD-10. She is a Board-Certified Pediatrician and spent 20 years in clinical practice. She is also a Certified Professional Coder, Certified Professional Medical Auditor, Certified Outpatient Coder, and Certified Fraud Examiner. She is a member of AMA, AAP (National, TX, and Hawaii chapters), AAPC, NAMAS, Travis County Medical Society, Texas Medical Association, ACFE, and the National Association of Managed Care Physicians.

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