Lynne Padilla

About Lynne Padilla

I’m a healthcare leader passionate about helping health plans, providers, and vendor partners succeed in risk adjustment—while keeping compliance, accuracy, and member outcomes at the center.Over the past 15+ years, I’ve led large-scale Medicare Advantage, Medicaid, and HHS Marketplace vendor coding operations, including a $200M+ business that grew by more than 50% year-over-year. My experience spans all areas in risk adjustment coding, RADV & OIG audit readiness, CMS/HHS regulatory alignment, AI/NLP platform development & automation, vendor management, and building high-performing teams that deliver quality at scale.I’ve had the privilege of supporting & partnering with more than 50 health plans—including the five largest in the U.S—designing & executing strategies that safeguard revenue, improve coding accuracy & completeness, and ensure audit preparedness. Whether building a new operational model, integrating technology, or guiding RADV mitigation, I focus on solutions that work in the real world.If you’re interested in advancing risk adjustment performance, scaling operations, or leveraging technology to drive better outcomes, let’s connect.

Experience

1. SVP Risk Adjustment & Quality

   HealthEdge

   Oct 2025 — Present · US

Skills

• Cpt
• Hedis
• Medical Coding
• Medical Records
• Icd-9
• Training
• Leadership
• Quality Assurance
• Hcpcs
• Hipaa
• Healthcare Management
• Medicare
• Medical Billing
• Healthcare Consulting
• Icd-9-Cm
• Healthcare
• Healthcare Industry
• Medicaid
• Revenue Cycle
• Strategy
• Clinical Research
• Practice Management
• Program Management
• E-Learning
• Strategic Partnerships
• Risk Adjustment
• Hccs