Risk Adjustment Medical Coding

Shanthi Rufus Perli, CPC

************@*****.*** +1-267-***-****

Professional Summary

Certified Professional Coder (CPC) with 4+ years of experience in medical coding (HCC risk adjustment, ICD-10-CM) and 6 years in Research analyst with a strong academic foundation in pharmacy. Skilled in risk adjustment coding, EHR systems

(Epic, 3M, Cerner, Athena), and HCC analytics platforms (Apixio, Cotiviti, Inovalon). Demonstrated ability to achieve 95 to 98% coding accuracy, exceed productivity targets, and maintain compliance with CMS and HIPAA regulations. Open to full-time, remote, or on-site medical coding opportunities. Skills

• Medical Coding: ICD-10-CM Coding CPT Coding HCPCS Coding Medical Terminology Proficiency

• Revenue Cycle: Claims Submission & Processing Denial Management & Appeals Coding-related Error Resolution Revenue Cycle Optimization

• Compliance: Regulatory Compliance (HIPAA) Documentation Standards Audit & Quality Review

• Tools & Systems: Electronic Health Records (Epic, Cerner, Athena) Medical Coding Software/Encoders (3M, Optum, TruCode) Claim Submission Software HIPAA-Compliant Systems

• Professional Impact: Training & Mentorship in Coding Documentation Improvement Risk Adjustment & RAF Scoring

Professional Experience

HCC Coder – Augustas Healthcare Solution’s

May 2025 – Present

• Assign ICD-10-CM diagnosis codes in alignment with CMS-HCC guidelines to ensure accurate risk adjustment.

• Consistently achieve 95–98% accuracy rate, contributing to improved RAF (Risk Adjustment Factor) scores and compliance outcomes.

• Collaborate with denial management teams to resolve coding-related rejections and support clean claims submission.

• Utilize Epic and 3M Encoder for efficient chart abstraction, coding validation, and documentation review.

• Uphold HIPAA standards, safeguarding patient confidentiality and ensuring documentation integrity. Medical Coder – Omega Healthcare, Bangalore, India Feb 2019 – Aug 2023

• Reviewed medical records and assigned appropriate ICD-10-CM codes for HCC risk adjustment and insurance reimbursement.

• Maintained 95%+ coding accuracy during internal QA reviews and external audits, reducing error-related denials.

• Exceeded daily productivity targets by processing high-volume charts per day, balancing speed and accuracy.

• Identified documentation gaps and collaborated with providers to improve clinical documentation and HCC capture rates.

• Conducted comprehensive chart reviews to ensure accurate risk adjustment coding and supported compliant reimbursement.

Research Analyst – OMICS International, Hyderabad, India Jun 2012 – Jan 2019

• Conducted data research and analysis for healthcare-related projects, ensuring accuracy and consistency in published reports.

• Supported cross-functional teams with research-driven insights that improved data reporting and operational workflows.

Software & Systems Experience

• Skilled in navigating EHR systems: Epic, Cerner, Athena.

• Proficient with professional coding software: 3M, Optum Encoder, TruCode.

• Familiar with HCC analytics platforms: Apixio, Cotiviti, Inovalon. Compliance & Continuing Education

• Maintain full compliance with CMS, HIPAA, and regulatory standards in all coding activities.

• Engage in regular coding updates and training on HCC risk adjustment guidelines.

• Support internal compliance by contributing to coder training sessions and documentation improvement initiatives.

Added Contributions

• Improved organizational RAF scores by accurately identifying and coding high-impact chronic conditions.

• Partnered with clinicians to strengthen documentation practices, leading to better HCC code capture rates.

• Assisted in preparing medical records for external audits and provided justifications for coding selections as required.

Certifications

• AAPC – CPC (Certified Professional Coder) Certification ID: 01680876 Valid through September 30, 2025

• CDMS Tool: Inform 4.6 – Trained in Medical Coding and Pharmacovigilance Education

• MBA in Health Administration Systems, Lamar University - 2025

• Bachelor of Pharmacy, DCRM Pharmacy College (JNTU) - 2011

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