With over 15 years of healthcare experience, Mandvi Tandon has proven success designing, implementing, and optimizing end-to-end risk adjustment operations to improve financial performance, compliance, and quality outcomes. She is adept at assessing workflows, identifying revenue and documentation gaps, and developing strategic, data-driven solutions that strengthen risk adjustment factor (RAF) accuracy and regulatory readiness.
Before joining Wakely Consulting Group, an HMA Company, Mandvi served as a subject matter expert, redesigning coding workflows, centralizing key performance indicators (KPI) dashboards, and leading strategic initiatives to streamline operations. Prior to her consulting work, she worked with Belong Health as their vice president of risk adjustment and quality and Healthcare Partners as director of risk adjustment. Her work mitigated risk adjustment data validation (RADV) audit risk by maintaining a 99.9% accuracy and completion rate, ensuring full compliance with the Centers for Medicare and Medicaid Services (CMS) Risk Adjustment Data Validation requirements. She also led the development of compliance dashboards and risk taxonomies to proactively identify operational gaps and strengthen CMS and state regulatory submissions.
A skilled communicator, Mandvi oversees vendors, provider education and engagement, and cross-functional collaboration to ensure risk adjustment programs are sustainable, compliant, and aligned with organizational goals. Mandvi has led multi-disciplinary teams of clinicians, analysts, and operations staff to deliver large-scale projects aligned with CMS and National Committee for Quality Assurance (NCQA) standards. She has also partnered with executive leadership to design data-driven frameworks for audit readiness, risk stratification, and sustainable program growth.
Mandvi’s risk adjustment expertise extends to value-based care operations across Medicare Advantage, Medicaid and Affordable Care Act (ACA) lines of business. She has designed and executed integrated risk adjustment and Star quality strategies to enhance care outcomes and payer performance. Implementing enterprise-wide initiatives, her efforts have improved RAF accuracy by 30% and generated over $3 million year over year in additional revenue through optimized documentation and coding workflows.
Demonstrating her technical proficiency in data analytics and performance optimization, Mandvi has partnered with data science and actuarial teams to design predictive models for risk stratification and population health management and leveraged analytics platforms to improve documentation completeness and coding accuracy. She actively contributes to strategy development for emerging models in value-based care, prospective analytics, and NLP-driven chart reviews.
Mandvi earned her Bachelor of Medicine & Surgery from the Himalayan Institute of Medical Sciences and her executive healthcare leadership certification from Cornell University. She is a certified professional coder and a Lean Process Improvement green belt.
