Consistency Is the New Scalability: A Conversation with Stephanie Gibbons, Vice President Clinical Operations and Internal Audit Management

Transforming Clinical and Coding Operations: Q&A with Steph Gibbons

Amanda Bair: What drew you into clinical operations and coding transformation?

Stephanie Gibbons: I got pulled into this work because it’s one of the few places that I see in healthcare where you can connect more opportunities together. I’ve always had a keen eye for operational efficiency, and that really shaped my career path.

What keeps me hooked is the combination of complexity and impact. Regulations, volumes, and client expectations are changing constantly. I love building teams and systems that can adapt to that pace without sacrificing quality. Better operations aren’t just efficient; they lead to better decisions, stronger outcomes, and a healthier end-to-end experience.

AB: When you think about the clinical and coding services your team delivers, what do you wish every health plan leader better understood about a tech-forward approach?

SG: A tech-enabled approach isn’t about replacing expertise. It’s about amplifying it.

Our clinical reviews, DRG validations, and shift-left prepay work all rely on strong clinical and coding judgment. Technology wraps consistency and scalability around that judgment. Leaders should be asking: Is my technology standardizing decisioning? Is the workflow consistent? Are results dependent on who touched the claim?

Consistency equals scalability.

Tech should also support smarter claim targeting by using automation, analytics, and emerging AI to prioritize the highest-yield opportunities instead of spreading teams thin across low-value work. Leaders should have strategic plans that look at least three years ahead to stay out in front of where the industry is headed.

AB: You talk a lot with PI leaders. Was there an “aha” moment that really illustrates where the market is going?

SG: Shift-left strategies create real “aha” moments for clients. Prepay offers more opportunity than post-pay because you’re focusing on billing accuracy before payment goes out the door. Analytics can generate more opportunities in prepay than post-pay ever will and reduces administrative cost burdens.

If I could give one piece of advice, it would be: build your strategy intentionally. Prepay creates more impact, but only if your operating model, processes, and targeting techniques are ready for it.

AB: What’s a common misconception about modernizing PI operations?

SG: That implementing a tool will solve everything. Whether you think of a case management solution, or even a platform like Pareo^®, you’ve got to be focused on the operating model shift.

Processes, governance, metrics, change management—that’s where transformation happens.

I spend a lot of time helping clients define their version of success. Is that financial? Is it accuracy, quality, turnaround time, provider abrasion? Overturn rates and appeals? Once we define that, we build the operating model, the staffing plan, and the measurement approach to get there.

AB: You support different types of users—frontline reviewers, super users, managers. What have you learned about helping them get the most out of Pareo?

SG: Adoption comes from confidence. And it starts with your frontline reviewers.

Make sure they have the tools that they need to be successful. Do they understand clearly how to use the platform? Are they all using it consistently? Are they filling in the appropriately established portions of Pareo when they’re conducting an audit?

Clean workflows and clear rationale reduce ambiguity, which then helps managers and super users have a deeper understanding of the performance of the logic and even of the workflows.

That’s why our standardization efforts matter so much. When everyone uses the platform the same way, everyone can realize the same outcomes.

AB: Where is the market headed, and what excites you most about that direction?

SG: Definitely the move to prepay. You see provider trends faster. You get better savings. And more plans are realizing they can build internal PI programs instead of relying solely on external auditors.

I’m also excited about the overlap between clinical review and potential data mining opportunity through waste and error record reviews. There’s so much opportunity to use clinically trained staff to inform analytic design. PI has historically lived in silos, but it’s all the same mission: helping providers bill the right way.

AB: What role does your team play in this next phase for the industry—and for ClarisHealth?

SG: Scaling with consistency. We use the platform ourselves, and we advise clients on how to use it. That gives us a unique perspective and allows us to identify enhancements or future opportunities based on real-world needs.

Our goal is to help clients adopt consistent processes, measure their programs effectively, and leverage automation and AI so they can scale quickly without losing accuracy. That’s how we move the entire market forward.

AB: How do you recharge outside of work?

SG: I have four kids that range from 6 to almost 16. So that is what I spend most of my time engaged with. We love to travel. We are big adventure people with a travel trailer, and since we live in Minnesota, we take full advantage of the summer months. My husband even created a desk space for me in the camper so I can work while we’re on the road. We call it the “mobile command center.” We have a goal to try to get to all 50 states, and we’re making good progress.

Conclusion

In a field often defined by complexity, Steph brings uncommon clarity — the kind that comes from living the work, not just managing it. Her approach blends clinical nuance, operational rigor, and a genuine respect for the people behind every workflow.

As health plans embrace prepay strategies, build consistency, and turn Pareo into a true operating backbone of PI, Steph and her team are proving what’s possible. The future of clinical operations is already taking shape. And it’s faster, clearer, and more collaborative than what came before.