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Pat Petty

Senior Consultant, Risk Adjustment

 

Patrick Petty is a Certified Professional Coder (CPC) with over 17 years of healthcare experience in the Managed Care/Payer setting. Patrick has specialized in all areas of Risk Adjustment in both the commercial and Medicare space for the past 10 years, including retrospective retrieval and coding programs, design, execution and oversight of large Clinical Documentation Improvement (CDI) programs, oversight of provider engagement programs around documentation and coding and prospective tool utilization, data leakage/submission monitoring, and leading end-to-end Risk Adjustment Data Validation (RADV) solutions in both the ACA and Medicare Advantage programs.

Prior to joining the GHG team, Patrick was most recently a Manager within Optum Advisory Services. His key responsibilities included designing and leading nine full RADV campaigns in both the MA and ACA space with high validation rates. Patrick also authored a comprehensive provider documentation and coding education program that was launched at several high-priority integrated delivery systems across the country.

Prior to Optum, Patrick spent 7 years in Humana’s Risk Adjustment business in multiple operational leadership, project management, and coding roles in both the corporate setting supporting the internal business, and in the market setting supporting local Medicare markets and providers manage success towards value-based arrangements.

Before Humana, Patrick spent 7 years in the Worker’s Compensation business at Sedgwick CMS/CompManagement. Key responsibilities included multiple coding roles for prior authorization, CPT audit, and operative report review, as well as pioneering improvement processes to aid in review and recovery of high-dollar facility bills.

In addition, Patrick also brings strong experience in project management, vendor oversight, compliance best practice review, revenue cycle consulting, and worker’s compensation compliance auditing.

Patrick earned his Bachelor’s degree from the University of Cincinnati, and is certified by the American Association of Professional Coders.

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