CHRYSTEN REINOLD
CareSource
North Andover,MA
1
Certification
2027
years of professional experience
Spearheaded enterprise risk adjustment programs to enhance RAF accuracy, bolster CMS compliance, and optimize financial performance. Recognized for building high-performing teams, managing $40 million operational budgets, leading organizations of 20 professionals, and delivering measurable improvements in coding accuracy, provider engagement, operational efficiency, and enterprise Risk Adjustment performance.
Work History
Director, Quality Risk Adjustment Programs & Operations
4 Years 6 Months- Provide executive leadership for enterprise Risk Adjustment operations across Medicare Advantage, Medicaid, and Marketplace products, directing prospective and retrospective coding initiatives, provider engagement, member outreach, medical record retrieval, operational strategy, and vendor partnerships supporting organizational revenue integrity and CMS compliance.
- Key Contributions
- Lead enterprise Risk Adjustment operational strategy supporting organizational revenue objectives and long-term Medicare Advantage growth.
- Partner with executive leadership across Finance, Analytics, Clinical Operations, Provider Relations, Compliance, Quality, and Information Technology to align enterprise Risk Adjustment initiatives with organizational priorities.
- Direct enterprise provider engagement strategies utilizing targeted education, documentation improvement initiatives, analytics, and performance feedback to improve coding accuracy and provider documentation.
- Built and scaled an internal operational model generating $4.7 million in annual savings while improving operational efficiency, RAF accuracy, and return on investment.
- Develop enterprise KPIs, executive dashboards, productivity metrics, and operational reporting used to monitor program performance and guide strategic decision-making.
- Own departmental operating budgets, vendor relationships, contract negotiations, service-level agreements, and administrative expense management.
- Lead technology initiatives by defining business requirements supporting scalable operational platforms and future organizational growth.
- Establish operational governance, policies, procedures, and compliance standards ensuring adherence to CMS regulations and organizational requirements.
- Direct outsourced coding, medical record retrieval, quality assurance, and provider engagement vendors while monitoring contractual performance and operational outcomes.
- Collaborate with Analytics to forecast revenue, monitor operational performance, develop financial accruals, and identify strategic Risk Adjustment opportunities.
- Lead enterprise initiatives integrating Risk Adjustment and HEDIS strategies to simultaneously improve quality performance and RAF capture.
Legal Compliance Advisor
6 Years- Served as enterprise subject matter expert for Medicare Advantage Risk Adjustment regulations, CMS compliance, RADV, HCC coding, provider oversight, and operational compliance.
- Selected Accomplishments
- Built and implemented enterprise oversight and monitoring programs supporting CMS, OIG, and DOJ audits.
- Advised executive leadership regarding Medicare Risk Adjustment regulations, CMS guidance, HPMS updates, and compliance strategy.
- Conducted enterprise compliance investigations, operational audits, and corrective action planning.
- Led provider and vendor compliance investigations in collaboration with Special Investigations Unit.
- Reviewed provider contracts to identify operational and regulatory Risk Adjustment implications.
- Developed compliance recommendations protecting organizational revenue integrity and minimizing regulatory risk.
- Served as trusted advisor regarding Risk Adjustment operations, coding accuracy, provider compliance, and CMS policy interpretation.
Quality Review & Audit Lead Analyst – RADV Response Team
- Led responses to CMS contract and targeted RADV audits.
- Reviewed audit findings, validation rates, and appeal opportunities.
- Provided coding compliance education and audit feedback across operational teams.
- Maintained expertise in evolving CMS Risk Adjustment regulations, HCC methodology, and OIG guidance.
- Supported continuous CMS audit readiness through operational improvements and compliance oversight.
Quality Review & Audit Senior Representative
- Audited coding submissions for Medicare Advantage compliance.
- Identified coding trends, documentation deficiencies, and educational opportunities.
- Educated coders and providers on regulatory requirements and coding accuracy.
Medical Records Coder
- Performed Medicare Advantage HCC coding and documentation review supporting CMS submission requirements.
HCC Contract Auditor
- Conducted Risk Adjustment audits for physician groups and hospital systems.
- Educated physicians and coders on documentation improvement and CMS compliance.
- Prepared audit findings identifying coding opportunities and compliance risks.
Coding Specialist
- Performed Risk Adjustment coding, HEDIS abstraction, provider education, and compliance review supporting Medicare Advantage submissions.
Education
Juris Doctor
Admitted to the Massachusetts Bar
Bachelor of Arts
Skills
Enterprise Risk Adjustment Strategy
Medicare Advantage Leadership
Risk Adjustment Operations
CMS Risk Adjustment Methodology
HCC Coding & RAF Optimization
Provider Network Engagement
Provider Documentation Improvement
RADV Audit Readiness
Regulatory Compliance
Executive Leadership
Financial Planning & Budget Management
Revenue Integrity
Performance Analytics & Reporting
Operational Transformation
Cross-Functional Governance
Quality & HEDIS Integration
Vendor Strategy & Contract Negotiation
Policy Development
Technology & Process Optimization
Organizational Change Management
EXECUTIVE HIGHLIGHTS
- Lead enterprise Risk Adjustment operations supporting Medicare Advantage, Medicaid, and Marketplace programs across multiple markets.
- Direct a multidisciplinary organization of 20 managers, auditors, provider educators, coding professionals, and operational staff, fostering a high-performance culture focused on accountability, innovation, and continuous improvement.
- Manage approximately $40 million in annual operating and vendor expenditures, aligning investments with strategic business objectives while optimizing administrative costs and operational efficiency.
- Delivered $4.7 million in annual administrative savings through operational transformation, insourcing initiatives, and vendor optimization.
- Increased coding accuracy to greater than 95% through targeted provider education, enhanced quality assurance processes, and operational oversight.
- Expanded audit coverage from 2% to more than 10% by redesigning quality assurance and compliance programs, improving coding integrity and organizational audit readiness.
- Increased provider participation across all markets through strategic provider engagement initiatives, education programs, and performance feedback processes.
- Enterprise leader in CMS Risk Adjustment, HCC coding methodology, RADV preparedness, provider documentation improvement, and Medicare Advantage compliance.
Accomplishments
- Achieved $4.7 million in annual administrative savings while improving operational efficiency and Risk Adjustment performance.
- Lead enterprise Risk Adjustment operations supporting Medicare Advantage, Medicaid, and Marketplace business lines.
- Direct enterprise provider engagement, prospective and retrospective coding programs, and medical record retrieval initiatives.
- Develop organizational Risk Adjustment policies, compliance frameworks, and operational governance.
- Lead vendor strategy, contracting, budget management, and performance oversight.
- Successfully build and develop high-performing operational, coding, auditing, and provider education teams.
- Implemented and operational ones concurrent risk adjustment claims review program
LANGUAGES
Fluent in Italian
Fluent in Spanish
Certification
- Certified Professional Coder (CPC)
- Certified Risk Adjustment Coder (CRC)
- Certified Professional Compliance Officer (CPCO)
Timeline
Director, Quality Risk Adjustment Programs & Operations
CareSource
01.2022 - CurrentRead More
Legal Compliance Advisor
Cigna Medicare
01.2016 - 01.2022Read More
Tufts University
Bachelor of Arts
Read More
University of Miami School of Law
Juris Doctor
Read More
HCC Contract Auditor
Stericycle (Physician Chart Auditors)
Read More
Medical Records Coder
Read More
Quality Review & Audit Senior Representative
Read More
Quality Review & Audit Lead Analyst – RADV Response Team
Read More
Coding Specialist
Altegra Health
2014 - 2015Read More