Kristen Viviano, MHA, CPC, CRC-I
West Coxsackie
Summary
Accomplished leader blending over a decade of experience in healthcare coding, analytics, education, and product management. Expertise lies in enhancing communication across stakeholders, leading high-performing teams to deliver quality outcomes, and adeptly implementing risk adjustment strategies. A product manager with a robust background in healthcare, proficient in leveraging industry knowledge to drive innovation, optimize processes, and deliver impactful solutions that align with organizational goals.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Senior Solutions Manager, Risk Coding Solution
Veradigm
04.2024 - Current
- Partnered with other product leaders to design, scope, develop, and market top departmental initiative.
- Maintained strong relationships with key clients through regular communication and exceptional service delivery.
- Enhanced client satisfaction by providing tailored solutions to meet their specific needs.
- Championed the adoption of industry best practices within the organization, elevating overall performance standards.
- Regularly reviewed project outcomes against initial objectives to ensure alignment with client expectations and deliver consistent results.
- Reduced operational costs by identifying areas of inefficiency and implementing cost-saving measures where appropriate.
- Mentored junior staff members, fostering a positive learning environment that encouraged professional growth.
- Collaborated with sales team to understand customer needs and develop tailored solutions.
- Led discussions and data gathering to build out reports and dashboards around platform utilization.
Product Manager, OP CDI
3M
01.2023 - 04.2024
- Drive business and customer initiatives to improve the HCC products offered by 3M
- Serve as the expert in risk adjustment, coding guidelines, Medicare Advantage HCCs, Commercial HCCs, and CRGs
- Communicated progress updates at regular intervals with senior leadership
- Identified product gaps and generated innovative ideas to expand market share, improve customer experience and drive growth
- Created processes and procedures that ensure high quality products are delivered on time
- Engage and learn from various healthcare customers to ensure the product can meet their HCC/coding workflow needs in a compliant, efficient manner
- Developed product roadmaps to help guide the development of new product features
- Managed cross-functional teams across departments, including engineering, marketing, and sales
- Drafted presentations for internal review meetings and external events such as trade shows or conferences
- Participated in design reviews to ensure usability standards are being met throughout the product development cycle
- Monitored industry trends and identified opportunities for innovation within the product portfolio
- Worked with sales teams to land customer wins in complex deals
- Worked with engineers to improve user experience and confirm builds meet user specifications
Senior Healthcare Consultant
3M
09.2021 - 12.2022
- Lead strategy and training sessions that support clients to improve cost and quality outcomes
- Lead, manage, and deliver projects for assigned clients
- Educate and train clients and internal users in the use of 3M HIS classification methodologies and products
- Develop policies and business requirements for clients and assist in converting to technical specifications
- Oversee data analytic activities, review reports, and develop analyses for presentation to team members and clients
- Co-author responses to requests for information from CMS on behalf of 3M HIS
- Provide subject matter expertise to internal teams to support new product versions, tools, sales initiatives, market penetration activities, educational opportunities and/or training
- Lead HCC training and product development within HIS PPS consulting team.
Manager, Clinical Documentation Improvement
Devoted Health
01.2021 - 08.2021
- Oversaw a diverse team of CDI specialists in providing educational support to external partners to improve accuracy of coding and documentation
- Coached, mentored and trained team members in order to improve their job performance
- Established processes to ensure efficient workflow throughout the organization
- Developed education materials targeting risk adjustment documentation and coding improvement as well as HEDIS and quality metric improvement
- Utilized advanced analytics to identify key areas of opportunity within physician organizations, report on performance, and educate teams on reporting enhancements and compliance
- Assisted multiple markets’ leadership with engagement strategies, provide risk adjustment guidance as needed, and oversee critical documentation review processes.
Manager, Risk Adjustment Coding Operations
Capital District Physicians’ Health Plan
06.2019 - 12.2020
- Managed daily operations of the Risk Adjustment coding team comprised of 19 individuals with multiple disciplines, and a team of 32 off-shore medical coders and auditors
- Developed a new platform to facilitate coding data entry and communication with provider offices
- Oversaw development and standardization of educational material to enhance coding practices
- Created monthly reports for senior management summarizing operational performance metrics
- Successfully managed retrospective coding processes across multiple lines of business which led to an overall $10 million dollar increase in revenue for CDPHP
- Performed analytics, targeted research, and report creation to coding for all aspects relevant to the organization
- Acted as subject matter expert and leader in the initiative to begin coding review for NYS Medicaid members using the NYS CRG methodology which resulted in positive financial gain
- Developed and maintained relationships with providers by traveling to offices to educate and consult staff on risk adjustment, accurate ICD-10 coding, and compliant documentation practices.
Risk Adjustment Coding Supervisor
Capital District Physicians’ Health Plan
03.2017 - 06.2019
- Supervised a team of risk adjustment specialists, acted as project owner for the startup of a new coding platform which resulted in significant increases in workflow efficiency and a 15% increase in coder productivity
- Analyzed data to determine coding trends, prioritize workflows, and assess revenue impact while presenting risk adjustment coding changes to staff.
Provider Practice Consultant II
BlueShield of Northeastern New York
03.2015 - 03.2017
- Compiled and analyzed utilization data to understand trends and coordinated with a clinical support team to deliver consistent support and improve efficiency
- Coordinated responses to government and regulatory audits including, but not limited to: CMS, Health Provider Network (HPN), NYS DOH, Medicaid Managed Care telephone and IPRO, directory, and exchange audits
- Identified opportunities for process improvement within the practice environment
- Created reports and presented findings to senior staff members
Medical Coding Auditor
BlueShield of Northeastern New York
11.2013 - 03.2015
- Completed facility and provider audits and evaluations to ensure corporate and regulatory compliance
- Interacted with providers and hospital staff of all levels to facilitate record reviews, discuss review findings, and communicate identified audit issues to contracted providers, legal counsel and other stakeholders.
Education
Master of Health Administration -
Ohio University
Athens, OH04.2020
Bachelor of Science in Health Information Management -
CUNY School of Professional Studies
New York, NY05.2017
Skills
- Product Roadmaps
- Agile Software Development
- Teamwork and Collaboration
- Interpersonal Communication
- Jira, Confluence
- Staff Management
- Data Analytics
- Customer Training
- Salesforce
- SAS Enterprise Guide
- Public Speaking
- Medicare/ACA Hierarchical Condition Categories (HCCs)
- 3M Clinical Risk Groups (CRGs)
- Cross-functional team coordination
- Sales support
Certification
- Certified Risk Adjustment Coder (CRC), 05/2017
- Certified Professional Coder (CPC), 07/2012
- AAPC Approved Instructor (CRC-I), 02/2022
Conference Presentations
- "Leveraging AI in the Medical Industry | PANEL", AAPC DocuCon 2024, October 2024
- "AI Coding World & Why Coders are Still Needed", AAPC RiskCon 2024, June 2024
- "Taking an Action-Oriented Approach Toward HCC Capture", MGMA Leaders 2023, October 2023
- "A Specialist’s Role in Risk Adjustment", AAPC RiskCon 2023, June 2023, Virtual
- "Provider Engagement | PANEL", AAPC RiskCon 2023, June 2023, Virtual
- "Hierarchical condition category (HCC) services and clinical risk groups (CRGs)", 3M Client Experience Summit, May 2023
- "Payer and Provider Collaboration/Engagement and Best Practices", AAPC RiskCon 2022, June 2022, Virtual
- "Levels of Risk Contracts Considerations – Value-Based Payments Versus Risk Adjustment | PANEL", AAPC RiskCon 2022, June 2022, Virtual
- "Difference Between Models ACA, CMS, and Medicaid | PANEL", AAPC RiskCon 2022, June 2022, Virtual
- "Operationalize CDI Implementation | PANEL", AAPC DocuCon 2022, April 2022, Virtual
- "Business Writing: Communicate Effectively and Professionally", AAPC Elevate 2021, December 2021, Virtual
- "Case Study: Spotlight on A Win-Win Partnership Between a Payer and Their Primary Care Providers", RISE West 2020, September 2020, Virtual
- "Navigating the Gnarly Challenges of HCC Coding: Episode 2", The RISE Association, June 2020, Virtual Webinar
Timeline
Senior Solutions Manager, Risk Coding Solution
Veradigm
04.2024 - Current
Product Manager, OP CDI
3M
01.2023 - 04.2024
Senior Healthcare Consultant
3M
09.2021 - 12.2022
Manager, Clinical Documentation Improvement
Devoted Health
01.2021 - 08.2021
Manager, Risk Adjustment Coding Operations
Capital District Physicians’ Health Plan
06.2019 - 12.2020
Risk Adjustment Coding Supervisor
Capital District Physicians’ Health Plan
03.2017 - 06.2019
Provider Practice Consultant II
BlueShield of Northeastern New York
03.2015 - 03.2017
Medical Coding Auditor
BlueShield of Northeastern New York
11.2013 - 03.2015
Bachelor of Science in Health Information Management -
CUNY School of Professional Studies
Master of Health Administration -
Ohio University
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