Lisandra Sepulveda

Detail-oriented, AAPC Certified Medical Coder with over 4 years of dedicated outpatient coding, billing, and revenue cycle experience within major health systems. Proven track record in optimizing reimbursement accuracy, conducting provider documentation audits, and managing complex claims exceptions to secure financial viability. Skilled at collaborating with healthcare practitioners and cross-functional teams to ensure strict compliance with CPT, HCPCS, and ICD-10-CM guidelines.

Anesthesia Medical Coder - Albany Medical Center - Albany, NY

(2022-09)

• Assigned accurate CPT, ASA crosswalk, and ICD-10-CM codes for complex surgical and outpatient cases.
• Optimized and secured compliant reimbursement by calculating anesthesia units, total minutes, base units, and physical status modifiers (P1–P6).
• Applied provider-specific modifiers (e.g., AA, AD, QK, QX, QZ) in strict accordance with government regulations and third-party payor reimbursement guidelines.
• Significantly reduced claim denial rates by performing pre-bill audits on complex surgical records, resolving documentation deficiencies related to medical necessity.
• Established strong collaborative relationships with providers and medical staff to improve documentation quality for post-operative pain management services.

Charge Entry Specialist - Community Care Physicians - Latham, NY

(2022-03 - 2022-09)

• Managed the charge entry and charge reconciliation process across assigned outpatient practices.
• Verified the accuracy and completeness of CPT and ICD-10-CM code assignments prior to claim submission.
• Maintained, reviewed, and resolved encounter errors and billing exception worklists within the RCX system to reduce overall claim turnaround time.
• Generated monthly billing reports for leadership to ensure 100% of provider charges were accurately captured and tracked.
• Manually processed, reviewed, and inputted complex hospital and practice charges alongside patient demographics.

Medical Billing & Coding Specialist (Multiple Specialties) - Hometown Health - Schenectady, NY

(2021-08 - 2022-03)

• Reviewed multi-specialty provider coding documentation to ensure proper selection of ICD-10 and CPT codes.
• Conducted formal audits on E/M charges and assigned appropriate billing levels based on documentation support.
• Corrected, adjusted, and resubmitted delayed or denied claims based on comprehensive medical record reviews and payer guidelines.
• Worked in close alignment with healthcare practitioners to address specific coding trends, optimizing documentation accuracy across the clinic.

Medical Assistant - The Arc of Rensselaer County (OPWDD) - Troy, NY

(2019-09 - 2021-03)

• Conducted monthly internal audits of individual medical records to maintain regulatory compliance and information data integrity.
• Documented clinical updates and updated internal medical records post-appointment with strict adherence to patient privacy and confidentiality protocols.

Certified Medical Assistant – Internal Medicine - St. Peter's Health Partners - Albany, NY

(2016-11 - 2019-01)

• Managed clinical workflow, provider scheduling, and patient coordination in a fast-paced physician practice environment.
• Maintained high customer service satisfaction scores by promptly responding to administrative inquiries and resolving patient account logistics.

Medical Coding Certification - Medical Coding - Bryant and Stratton College

Associates Degree - Medical Assisting - Bryant and Stratton College