Divya Ammulu

Certified Professional Coder (CPC) Medical coder with hands-on 3 years of experience in HCC Risk Adjustment coding Coding from 2023–2026. Skilled in ICD-10-CM , CPT, and HCPCS coding with strong knowledge of CMS, Medicare guidelines, clinical documentation review, and coding compliance. Experienced in reviewing medical records, maintaining high coding accuracy, and meeting productivity targets in work environments. Detail-oriented, adaptable, and committed to quality healthcare documentation.

Medical Coder - Codestat Health Solutions Pvt Ltd

(2023-05 - 2026-03)

Reviewed and analyzed patient medical records for accurate code assignment.

• Assigned ICD-10-CM, CPT, and HCPCS codes following coding guidelines and compliance standards.
• Performed HCC Risk Adjustment coding based on CMS and Medicare regulations.
• Worked on strong attention to coding accuracy and documentation.
• Maintained productivity and quality standards while working.
• Collaborated with healthcare providers to clarify incomplete or unclear documentation.
• Ensured HIPAA compliance and confidentiality of patient information.
• Used EMR/EHR systems for coding and chart review processes.
• Stayed updated with coding changes and healthcare regulations.
• Analyze patient charts, physician notes, lab results, and encounter documentation.
• Ensure all relevant diagnoses are captured accurately.
• Use coding systems like ICD-10-CM.
• Assign codes that reflect chronic and acute conditions impacting patient care.
• Work with models such as Hierarchical Condition Category (HCC)
• Identify conditions that contribute to a patient's risk score.
• Follow guidelines from Centers for Medicare & Medicaid Services (CMS).
• Maintain compliance with coding regulations and audit standards.
• Avoid upcoding or unsupported diagnoses.
• Work with physicians and clinical staff to improve documentation quality.
• Clarify unclear or incomplete medical records.
• Validate submitted codes before final submission
• Assist in reporting and tracking risk scores and trends.
• Perform retrospective and prospective chart reviews to capture missed diagnoses from prior visits
• Reconcile codes between different data sources (claims, encounters, EHRs)
• Validate Chronic conditions as MEAT Criteria (Monitor, Evaluate, Assess, Treat) for annual reporting under Hierarchical Condition Category (HCC).
• Initiate provider queries when documentation is unclear, conflicting, or incomplete
• Support Clinical Documentation Improvement (CDI) initiatives.
• Review encounter data before submission to Centers for Medicare & Medicaid Services (CMS)
• Flag unsupported or non-compliant codes to prevent denials or audit risk.
• Ensure all eligible conditions are captured without overcoding.
• Identify opportunities where documentation supports additional specificity using ICD-10-CM
• Assist in accurate RAF (Risk Adjustment Factor) calculation support.
• Monitor coding accuracy rates and productivity metrics.
• Use dashboards and analytics tools to identify trends in risk capture.

Bachelor of Pharmacy - Pharmacy - Jawaharlal Nehru Technological University (2015)