KIM SCHOON
Saint Ignatius,MT
Summary
Strategic operations leader with over 20 years of experience enhancing performance and driving transformation in healthcare environments. Expertise in developing high-performing teams, managing risk adjustment initiatives, and ensuring compliance and financial integrity. Collaborates effectively across clinical and operational teams to achieve measurable outcomes. Committed to advancing value-based care and fostering continuous improvement in organizational processes.
Overview
19
19
years of professional experience
Work History
Risk Adjustment Operations Manager
CommunityCare of Oklahoma Health Plan
Remote | Tulsa, Oklahoma
01.2025 - 01.2026
- Launched organization’s first risk adjustment operations program, establishing governance frameworks.
- Led internal RADV audits and vendor evaluations to ensure adherence to CMS compliance standards.
- Improved regulatory adherence and accuracy through meticulous record retrievals and coding activities.
- Streamlined operational processes to enhance service delivery efficiency.
- Analyzed operational data to identify areas for improvement and adjustment.
- Directed operations staff by providing guidance, training, and support in order to meet company objectives.
- Developed SOPs to document workplace procedures, enhancing standardization and operational consistency.
- Created CDI training resources and audit feedback materials, improving accuracy in RAF assessments.
- Cultivated cross-functional teams achieving 98% accuracy in audits, supporting operational excellence.
- Collaborated with actuarial quality and compliance teams to integrate program goals with enterprise strategy.
Program & Product Risk Adjustment/HEDIS Solutions
UST HealthProof
Remote
08.2020 - 09.2024
- Directed HEDIS and Risk Adjustment operations for national clients with average 98% audit accuracy.
- Led and partnered with engineering and architectural teams to develop new product tools: Risk Adjustment and HEDIS abstraction systems and enhancements.
- Collaborated with stakeholders to define product vision and strategy.
- Developed product roadmaps that guided development processes effectively.
- Prioritized features and enhancements based on user feedback and market trends.
- Developed product testing plans and documentation SOPs to streamline coding and abstraction processes.
- Monitored KPI data and productivity insights to enhance client delivery and compliance performance.
- Guided and developed cross-functional teams to improve project management practices and quality outcomes.
Risk Adjustment Operations Manager
Cambia Health Solutions (Regence BCBS)
Remote, WA
09.2010 - 07.2020
- Led enterprise-level Medicare and ACA risk adjustment operations with a team of more than 60 coding professionals.
- Directed audits—retrospective, prospective, RADV—achieving 97% accuracy in compliance metrics.
- Promoted provider education and CDI initiatives, enhancing documentation completeness and HCC accuracy.
- Executed performance improvement plans, reducing process turnaround times by 20%.
- Managed collaboration for medical records retrieval with onshore and offshore teams, facilitating efficient access to 50,000 records.
- Presented innovative audit and coding strategies at RISE and AAPC conferences as an organizational representative.
Coding Auditor and Quality Reporting
Franciscan Medical Group / Internal Medicine NW
Tacoma, WA
05.2007 - 09.2010
- Performed thorough chart-to-claim audits, confirming DRG, CPT, and HCPCS assignments via computer-assisted coding (CAC).
- Conducted audits for specialties including cardiovascular, internal medicine, OB/GYN, oncology, and urology.
- Collaborated with billing departments to improve claims accuracy for Medicare, Medicaid, and commercial payers.
- Reduced denials through educational audits with actionable data-driven feedback.
- Provided CDI and documentation support to multi-specialty providers, achieving high coding accuracy and claim integrity.
Education
Voc-Tech Diploma - Coding And Billing Healthcare 1998-1999
Everest Tech (Eaton Tech Institute)
Federal Way, WA06-1999
Skills
- Risk adjustment management
- Conducting RADV audits
- ICD-10 coding expertise
- CPT and HCPCS proficiency
- Care gap analytics
- Performance management
- Performance tracking
- Operational efficiency
- Cost reduction
- Process improvement
- Process re-engineering
- SOP development
- KPI optimization
- Product development
- Stakeholder engagement
- Cross-functional collaboration
- Strategic planning
- Customer relationship management
- Quality training
- Problem solving
- SOW and SLA management
Certifications and Engagement
- Certified Risk Adj. Coder (CRC), AAPC, 2004
- Speaker & Facilitator, RISE & AAPC HealthCon Conferences
- ICD 10 CM/PCS Educator & Ambassador, AHIMA, 2011-2015
Leadership Highlights
- Spearheaded enterprise-level Risk Adjustment and HEDIS programs impacting $10M+ revenue streams and 2M+ member populations.
- Built and scaled cross-functional teams of 60+ professionals across multiple states and offshore locations.
- Achieved 100% CMS compliance in RADV audits, mitigating regulatory risk and safeguarding organizational revenue.
- Drove Care Gap oversight and provider engagement initiatives, elevating quality ratings to 4.5-5 stars.
- Developed governance frameworks, SOPs, and job aids, standardizing processes and improving operational efficiency.
- Enhanced coding productivity and sustained 98% accuracy across internal and vendor audits.
- Partnered with executive leadership to align risk adjustment strategy with actuarial and quality objectives, driving measurable improvements in RAF accuracy and compliance.
Timeline
Risk Adjustment Operations Manager
CommunityCare of Oklahoma Health Plan
01.2025 - 01.2026
Program & Product Risk Adjustment/HEDIS Solutions
UST HealthProof
08.2020 - 09.2024
Risk Adjustment Operations Manager
Cambia Health Solutions (Regence BCBS)
09.2010 - 07.2020
Coding Auditor and Quality Reporting
Franciscan Medical Group / Internal Medicine NW
05.2007 - 09.2010
Voc-Tech Diploma - Coding And Billing Healthcare 1998-1999
Everest Tech (Eaton Tech Institute)