QC II Risk Adjustment
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Retrospective/concurrent Risk Adjustment, MRA/CRA, Medicaid coding and auditing. Quality assurance and validation to address HCC diagnosis through CMS, vendor/client targeted criteria. Prevent loss and missed opportunities on targeted providers and timelines.
QC II Risk Adjustment - Episource (IKS Health) - Coppell, TX
(2023-09)
Retrospective/concurrent Risk Adjustment, MRA/CRA, Medicaid coding and auditing. Quality assurance and validation to address HCC diagnosis through CMS, vendor/client targeted criteria. Prevent loss and missed opportunities on targeted providers and timelines.
RA Coder/auditor, Risk Mitigation, Quality Assurance - Advantasure - Las Vegas, NV
(2022-05 - 2023-08)
Retrospective/concurrent Risk Adjustment, MRA/CRA, Evaluate risk, prevent loss, audit/quality check data submitted through RAPS/EDPS by vendors and providers. Ensure RADV risk mitigation records align with targeted criteria and HCC diagnosis. Address overpayments and missed opportunities of risk adjusting diagnosis through CMS guidelines.
RA Coder/auditor, Quality Assurance - Cotiviti Informatics - Richmond, VA
(2015-09 - 2022-05)
Retrospective/concurrent risk adjustment coding/auditing, MRA/CRA, quality assurance and validation, audit CAC (computer assisted coding), assist in training and education of providers, support staff and coders.
RA Coder/auditor - Record Flow - Santa Ana, CA
(2014-03 - 2015-08)
Retrospective/Concurrent MRA/CRA coding/auditing to highest specificity for optimal reimbursement, work independently, problem solve with positive attitude.
Profee medical coder - Eisenhower Med. Ctr. - Rancho Mirage, CA
(2013-04 - 2014-02)
Abstract, code and review medical records to the highest specificity of diagnosis and procedures for optimal reimbursement of professional and facility charges. Assist in training of providers and support staff.
RA Coding/auditing - Desert Oasis Healthcare - Palm Springs, CA
(2010-12 - 2013-03)
Retrospective case study, substantiate documentation for medical necessity, correct, abstract and code ICD-9/10 HCC codes. Assist in training of providers, support staff and coders.
CCS certification - Medical Coding Program - AHIMA (2012)
