Navigating increasingly complex clinical audits
Published:
December 17, 2025
Clinical audits are becoming increasingly complex, demanding, and time-consuming. What should be a shared focus on patient care and payment accuracy often becomes a source of friction—driven by inconsistent criteria, documentation challenges, and labor-intensive review processes.
In this fireside chat, payment integrity experts explore the realities of modern clinical audits. Listen in to hear the challenges faced by PI teams, dive deeper into sepsis audits as a high-stakes example of clinical and operational complexity—and walk away with actionable insights your teams can apply today.
Meet the Speakers
Lalithya Yerramilli
Head of Payment Integrity Solutions
Lalithya Yerramilli
Head of Payment Integrity Solutions
Lalithya Yerramilli is a healthcare technology leader with over 20 years of experience driving innovation at the intersections of analytics, payment integrity, and care optimization. She founded Zigna AI, where she focused on bringing transparency and efficiency to healthcare reimbursement. Previously, she was a member of the executive leadership team at SCIO Health Analytics, leading a global analytics organization and driving growth to support a $1B pipeline. Lalithya holds a master’s in Engineering, Quantitative Finance, and Statistics from Rutgers University, and an undergraduate degree in Engineering from Osmania University.
Connie Yoerges
Senior Director of Payment Solutions, Clinical Strategy
Connie Yoerges
Senior Director of Payment Solutions, Clinical Strategy
Connie Lynn Yoerges is Cohere Health’s senior director of payment solutions, clinical strategy. Connie has worked in payment integrity for over a decade, with a firm belief in building a healthcare system that respects both provider care and accurate, timely reimbursement. As both a Registered Nurse and a Licensed Clinical Social Worker, she spent more than 15 years applying her nursing knowledge in acute care hospitals, subacute facilities, and acute rehabilitation organizations. Connie resides in Fleming Island, Florida, but enjoys and values working across global teams.
Erin Stawarz
Senior Product Marketing Manager
Erin Stawarz
Senior Product Marketing Manager
Erin Stawarz is Cohere Health’s senior product marketing manager.
Watch the conversation to learn:
- Why clinical audits are so challenging: From lengthy medical records to complex coding and policy interpretation, auditors face mounting pressure to deliver accurate decisions quickly and consistently.
- Why sepsis pushes audits to the limit: Evolving definitions (Sepsis-2 vs. Sepsis-3, SOFA, qSOFA), inconsistent documentation, and differing payer policies create downstream impacts on reviews, appeals, and provider trust.
- Where payer–provider gaps emerge: How misalignment between documentation and interpretation leads to delays, denials, and administrative burden on both sides.
- How technology can help bridge the divide: How precision, transparent AI—paired with human clinical expertise—can support faster reviews, clearer decisioning, and more transparent communication.
Learn how health plans are rethinking clinical audits—not just as a payment integrity challenge, but as an opportunity to improve collaboration, accuracy, and trust across the healthcare ecosystem.
