Kristi Reyes

About Kristi Reyes

Results-oriented healthcare leader with over a decade of experience driving scalable, compliant risk adjustment coding operations across Medicare, Medicaid, and ACA lines of business. I oversee a diverse team of up to 250+ coders, vendors, managers, and directors, delivering high-quality outcomes across retrospective, prospective, concurrent CDI, Risk Mitigation, and RADV/HRADV programs.My expertise spans the full operational lifecycle—from production, training, onboarding, and quality assurance to clinical documentation improvement (CDI) and risk mitigation. I partner with health plans to enhance risk adjustment performance, streamline operations, and support accurate, data-driven RAF outcomes.Known for building high-performing teams and actionable strategies, I bring a balance of regulatory insight and operational execution to every engagement—ensuring programs meet both business and compliance goals.

Experience

1. Director, Risk Adjustment Coding Operations

   HealthEdge

   May 2015 — Present · Las Vegas, NV, US

   Formerly known as: UST Healthproof/Advantasure/Tessellate/Data Driven Delivery Systems Lead and direct a team of both onshore and offshore risk adjustment directors, managers, and 250+ coders, providing guidance, support, and mentoring to ensure consistent quality and productivity- Develop and implement strategic initiatives to optimize risk adjustment coding processes, resulting in increased accuracy and compliance with risk adjustment program guidelines- Collaborate with cross-functional teams, including providers, data analysts, and compliance officers to drive alignment and achieve key business objectives- Implement performance metrics and reporting mechanisms to monitor team productivity, identify areas for improvement, and drive operational efficiency- Proactively identify coding trends, emerging regulations, and industry best practices to enhance coding accuracy and mitigate compliance risks- Foster a culture of continuous learning and professional development, organizing training programs and educational resources to enhance the skills and knowledge of the coding team- Provide consulting services to health plan clients evaluating risk and opportunities for their risk adjustment coding programs based on regulatory guidance and client goals- Former roles at USTHP include: Director, Coding Education and Quality; Manager, Coding Operations

Education

• Western Governors University

  Master of Business Administration - MBA, MBA, Healthcare Management

• Western Oregon University

  BS Biology, Pre-Professional/Chemistry

  2003 — 2008

Skills

• Trainer (Coder and Physician)
• U.s. Health Insurance Portability and Accountability Act (Hipaa)
• Train the Trainer
• Working with Physicians
• Medicare Advantage
• Physicians
• Operating Budgets
• Medical Terminology
• Leadership
• Icd-9
• Risk Management
• Team Management
• Hedis
• Medicine
• Project Management
• Management
• Hospitals
• Provider Education
• Performance Management
• Healthcare Consulting
• Data Validation
• Healthcare Information Technology
• Electronic Medical Record (Emr)
• Cpc-Hospital
• Health Information Management
• Cpc
• Icd-10 Proficient
• Clinical Auditing
• Medical Billing
• Cpma
• Healthcare Management
• Production Management
• Healthcare Information Technology (Hit)
• Medicaid
• Operations Management
• Customer Service
• Hcc
• Quality Auditing
• Emr
• Documentation Compliance