Gloria Ann Rodriguez

Houston, TX ***** 713-***-****

ad2tpp@r.postjobfree.com www.linkedin.com/in/gloria-ann-rodriguez-mha

Risk Adjustment Manager

Lead Teams & Implement Procedures & Technologies that Improve Efficiency & Streamline Operations

Detail-oriented healthcare professional with extensive experience supporting business operations by managing staff, coordinating operations, and ensuring exceptional outcomes. Dedicated leader who creates positive and productive work environments by communicating with team members, setting clear goals, and monitoring performance. Adept at empowering associates to engage, collaborate, and work together to achieve organization’s mission.

ICD-10-CM, CPT, & HCPCS CMS HCC Risk Adjustment

HHS HCC Risk Adjustment Project Management

Value-based-care Budget Planning

Communication HEDIS Measures

Problem-Solving RADV & RAC Audits

Professional Experience

CENTERWELL SENIOR PRIMARY CARE, Houston, TX 2020 - 2023

Medical Coding Manager

Managed risk adjustment and quality control for over 38 primary care centers in multiple states to ensure secure and available coding data to authorized personnel. Supervised coding staff and educated providers on clinical documentation integrity to support medical necessity. Ensured adherence to coding guidelines, company policies, and regulatory requirements related to coding of claims.

Developed and implemented action plans, improving percentage of prospective and retrospective reviews by 80% within coding department.

Coordinated provider education with coding team and Medical Director, delivering continued training for practitioners on risk adjustment and importance of complete and accurate documentation.

Conducted periodic quality analysis of coded claims, ensuring accuracy of services and procedures rendered and addressing discrepancies promptly.

OPA 1, LTD (Orthotics and Prosthetics), Houston, TX 2019 - 2020

General Manager

Led daily operations of 5 locations, production department, and administrative staff. Negotiated yearly service contracts with insurance carriers, creating strategies to improve company’s performance and outcomes. Controlled budgeting, financials, and supply chain management.

Established accreditation with American Orthotic and Prosthetic Association (AOPA) for all 5 locations by developing and implementing organization’s policy manual.

Instituted protocol for State Department of Licensing spot inspections, ensuring compliance.

Influenced documentation changes to improve services rendered by interfacing with owner, orthotists, and prosthetists.

Gloria Ann Rodriguez ad2tpp@r.postjobfree.com Page Two

VILLAGE MD, Houston, TX 2018 - 2019

Coding Educator

Oversaw quality assurance documentation integrity of over 20 multi-specialty providers. Evaluated provider documentation for clarity, completeness, and consistency to ensure optimal code selection. Educated providers on coding guidelines, practices, and documentation integrity. Maintained clear and consistent communication with stakeholders around documentation trends and provider education needed.

Performed audits of provider documentation, identifying trends and providing educational feedback based on findings and improvements needed.

Drove optimal clinical and financial outcomes through provider documentation assessment, coding competency, and improvement opportunity identification.

KELSEYCARE ADVANTAGE INSURANCE, Houston, TX 2013 - 2018

Supervisor Risk Adjustment and Quality Assurance

Managed risk adjustment and quality assurance for over 150 multi-specialty providers. Led coding staff and workflow of retrospective reviews to support and improve risk adjustment reporting to Centers for Medicare and Medicaid Services (CMS).

Led and executed responses to RADV audits, collaborating with CMS, vendors, and internal stakeholders to ensure accuracy and data validation.

Coordinated and summarized action plans for HEDIS reporting with NCQA officer, driving improved patient outcomes and experiences.

Education

Master of Health Administration (MHA), University of Phoenix, Phoenix, AZ

Bachelor of Science (BS), Business Management, University of Phoenix, Phoenix, AZ

Certifications

Certified Professional Coder (CPC), AAPC

Certified Documentation Expert Outpatient (CDEO), AAPC Certified Professional Medical Auditor (CPMA), AAPC

Certified Risk Adjustment Coder (CRC), AAPC

Certified Hematology and Oncology Coder (CHONC), AAPC Approved Instructor

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