SENIOR EXECUTIVE CODER - CPC CERTIFIED - CorroHealth - On-site
(2024-04)
CPC-certified Medical Coder with hands-on experience in ICD-10-CM, ICD-10-PCS, and CPT coding across multiple payer and risk adjustment projects.
- Accurately reviewed and coded inpatient, outpatient, and professional claims in compliance with CMS, ICD-10, and CPT guidelines.
- Worked on Medicare Advantage (MA), ACA, and Commercial Risk Adjustment projects, ensuring accurate HCC capture and RAF optimization.
- Performed medical record abstraction and coding validation using the Cotiviti tool for retrospective and concurrent reviews.
- Demonstrated strong expertise across multiple client projects including: Humana MRA (Cotiviti Tool) – Risk adjustment coding and HCC validation, Virtix Humana – Medical record review and coding compliance, Elevance MRI – Retrospective medical record review and diagnosis coding, Centene ACA – Affordable Care Act coding and documentation review, Centene MA – Medicare Advantage risk adjustment coding
- Ensured high coding accuracy and productivity while meeting client-defined TAT and quality benchmarks.
- Identified documentation gaps and coding discrepancies, supporting compliance with CMS and payer audit standards.
- Collaborated with QA teams and project leads to resolve coding edits, feedback, and audit findings.
- Maintained strict adherence to HIPAA, data security, and compliance policies.
- Adapted quickly to multiple workflows, tools, and client requirements across diverse projects.
