Day 3: Building Compliant Workflows & Evaluating AI Vendors
- 24th April 2026
- 12:00 PM to 1:30 PM (ET)
Defensible by design. From regulatory context to operational reality.
Days 1 and 2 set the table. The regulatory environment has changed. The AI architecture matters. But all of it lives or dies in operational practice, in workflows, coder routines, and the questions asked of vendors before contracts are signed.
A defensible workflow doesn’t happen by accident. It’s designed: with two-way coding, encounter-linked documentation, MEAT evidence trails, and clear handoffs between AI and human reviewers.
This final session translates Days 1 and 2 into action. We walk through what audit-ready workflows look like, where most AI implementations stumble, and exactly what to ask any AI vendor before signing a contract.
You’ll walk away with:
How to build risk adjustment workflows that produce audit-ready documentation by default
What two-way coding (adds AND deletes) looks like in operational practice
The AI vendor evaluation framework: questions every health plan should ask before signing
Where AI implementations commonly stumble and what successful rollouts look like
How to align coders, clinicians, and compliance teams around a single source of truth
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Panelists
Wynda Clayton, MS, RHIT – Lead Presenter
Director of Risk Adjustment Coding & Compliance
Wynda was a RADV auditor when the program first started and maintains close contact with current CMS auditors. She brings a unique perspective on how CMS reviews documentation and what AI-powered tools will change about the audit process.
Christopher Lally – Speaker
VP of Operations
Chris brings over 30 years of healthcare operations expertise, including extensive experience in risk adjustment, revenue cycle management, and AI-powered coding solutions across industry-leading organizations. At RAAPID, he leads the implementation of advanced AI platforms that help healthcare organizations capture complete patient risk profiles while staying audit-defensible.
Raxit Goswami – Speaker
VP of Research and Development
Raxit is a healthcare AI researcher with over 15 years of experience in clinical NLP, knowledge graphs, and machine learning. A published author with 70+ academic citations, he focuses on building explainable AI systems that deliver audit-defensible coding accuracy. At RAAPID, Raxit leads the development of Neuro-Symbolic AI solutions that enhance risk adjustment precision and regulatory compliance.
“The OIG isn’t auditing your vendor, they’re not auditing your coders. They’re auditing the organization you work for. Whoever signs off on the technology is responsible for the impact when it comes time for the audit. So demand absolute transparent proof of the clinical logic. Be shameless about it.”
Christopher Lally
VP of Operations · 30+ years in healthcare operations and risk adjustment
Christopher Lally
VP of Operations · 30+ years in healthcare operations and risk adjustment
Who Should Attend
At organizations including Medicare Advantage plans, ACA health plans, ACOs, value-based provider groups, and third-party administrators
- Chief Executive Officer (CEO)
- Chief Operating Officer (COO)
- Chief Compliance Officer (CCO)
- Chief Information Officer (CIO)
- VP of Risk Adjustment
- Director of Compliance
- Risk Adjustment Manager
- Coding Manager/Director
- Revenue Cycle Director
- Quality Assurance Director
- Audit Manager
- Operations Director
