Claudia Digiovanni

Claudia DiGiovanni possesses extensive experience in healthcare, primarily with Blue Cross & Blue Shield of Rhode Island. Currently serving as Clinical Lead for Risk Revenue and Senior Government Programs Reviewer, Claudia performs Hedis, RADV, and OIG audits alongside medical record reviews to secure accurate risk adjustment payments for CMS. Prior to these roles, Claudia worked from 1999 to 2010 as a Nurse Auditor and Recovery Auditor, conducting medical record and quality assurance reviews to guarantee compliance with billing policies and coding guidelines. Additionally, Claudia held the position of Clinical Trainer, focusing on the development and delivery of training programs for Medical Management staff, and served as a Utilization Review Nurse, assessing hospital admissions for service appropriateness and engaging in case discussions with healthcare professionals.