Risk Adjustment Clinical Documentation
Resume:
GENA MICHELLE
********@*******.***
Clinical Reviewer 2241 Armacost Dr -Henderson -NV, 89074 SUMMARY
Dynamic HCC Senior Clinical Reviewer with over 10 years of expertise in risk adjustment, leading to a significant enhancement in reimbursement efficiency. Holds certifications as Medical Doctor and AAPC, CPC and CRC with strong medical Knowledge and ICD-10 and CMS-HCC models. Proven ability to manage audits and collaborate effectively with healthcare teams, improving coding accuracy and documentation quality. Looking for a vacancy as a Clinical Reviewer or Clinical Documentation Improvement Job EDUCATION
AAPC CDEO, Clinical Documentation improvement
Las Vegas, USA
Feb 2025 - Present
AAPC CRC, Certified Risk Adjustment Coder
Las Vegas, USA
Nov 2015 - Nov 2016
AAPC CPC, Certified Professional Coder
LasVegas, USA
Nov 2012 - Nov 2013
AHIMA CCA, Certified Coder Associate
Las Vegas, USA
Nov 2010 - Nov 2011
Cairo University Master’s Degree in internal Medicine Cairo, Egypt
May 1990 - May 1995
Grade: 2.9
Cairo University Bachelor Degree in Internal Medicine and surgery Cairo, Egypt
Aug 1980 - Dec 1986
Grade: 2.8
WORK EXPERIENCE
W3. Consulting HCC Senior Clinical Reviewer
Las Vegas, USA
Jun 2024 - Dec 2024
• Contracted job for 6-month project - Remote / Telecommute.
• Ensure accurate and compliant HCC coding, resulting in improvement in coding accuracy and reducing audit discrepancies.
•Identify and resolve discrepancies in clinical documentation, enhancing risk adjustment support and improving overall documentation quality.
•Collaborate with healthcare providers to optimize documentation practices, ensuring alignment with updated HCC coding guidelines and improving coding efficiency. W3. Consulting
Las Vegas, USA
Jun 2023 - Dec 2023
HCC Senior Clinical Reviewer
• Contracted job for 6-month project - Remote / Telecommute.
• Ensure accurate and compliant HCC coding, resulting in improvement in coding accuracy and reducing audit discrepancies.
•Identify and resolve discrepancies in clinical documentation, enhancing risk adjustment support and improving overall documentation quality.
•Collaborate with healthcare providers to optimize documentation practices, ensuring alignment with updated HCC coding guidelines and improving coding efficiency. cognisght
Las Vegas, USA
Jun 2021 - Dec 2022
HCC Coder2
· Medicare Risk Adjustment, MRA Coder 2 and Clinical documentation
• improvement. Review medical records to assign accurate ICD-10-CM and HCC codes, ensuring compliance with Medicare Risk Adjustment (MRA) and clinical documentation improvement (CDI) guidelines.
• Identify and resolve gaps in clinical documentation to support accurate risk adjustment and coding. · Collaborate with healthcare providers to improve documentation quality and ensure it reflects the severity of patient conditions.
Tessellate /Advantasure
Las Vegas, USA
Jul 2016 - Mar 2019
HCC Coder 2
• Utilize electronic health records (EHR), coding software, and other tools to extract and review medical documentations
• practices comply with federal, state, and payer-specific regulations.
• Maintain proficiency in coding software and systems used for risk adjustment and HCC coding.
• Work collaboratively with other coders, clinical reviewers, and risk adjustment teams to achieve Healthcare partners of Nevada
Las Vegas, USA
Feb 2012 - Aug 2016
organizational goals.
Medicare Risk adjustment Coder
• Utilize electronic health records (EHR), coding software, and other tools to review medical records and documentation and abstract HCC 's .
• Work collaboratively with providers and other coders, clinical reviewers, and risk adjustment teams to Cardiovascular and thoracic Surgery
center
Las Vegas, USA
Jan 2012 - Feb 2013
achieve organizational goals.
• Abstract and assign appropriate ICD10 codes and CPT.
• Query providers for insufficient documentation and support documented HCC Diagnoses. Medical Coder
• Review operative reports for accuracy, completeness, and compliance with coding and regulatory standards.
• Assign precise CPT and ICD-10-CM codes based on documented surgical procedures and diagnoses.
• Identify and resolve missing, unclear, or incomplete information in documentation.
• Ensure documentation supports medical necessity and aligns with billing and reimbursement
•
requirements.
Collaborate with surgeons and coding teams to improve documentation quality and resolve issues CERTIFICATIONS
Jan 2016
Jan 2013
Jan 2011
May 1995
Certified Risk Adjustment Coder - AAPC
Certified Professional Coder - AAPC
Certified Coding Associate - AHIMA
Master Degree by Cairo university - International Medical Graduate
Dec 1986 Bachelor Degree by Cairo University - International Medical Graduate SKILLS
personal Attributes: Strong Medical clinical knowledge, Energetic, enthusiastic, and self-motivated, Initiative and responsible, with super Well attention organized to details, Ability to work independently or as a part of teamwork. Clinical Knowledge: Strong understanding of medical terminology, anatomy, physiology, and disease processes. Ability to interpret clinical information, such as diagnoses, treatments, and patient outcomes Coding Expertise: Proficiency in ICD-10-CM coding and familiarity with CPT, HCPCS, and DRG systems. Knowledge of CMS- HCC (Hierarchical Condition Category) and other risk adjustment models. Analytical Skills: Ability to analyze medical records for completeness, accuracy, and compliance with documentation standards. Identify gaps or inconsistencies in clinical documentation that could impact coding, billing, or patient care Attention to Detail: Meticulous review of medical records to ensure all relevant diagnoses, procedures, and patient conditions are documented. Detect errors or omissions in documentation that could affect reimbursement or compliance Communication Skills: Collaborate effectively with physicians, nurses, and other healthcare providers to clarify documentation and resolve discrepancies. Provide clear and constructive feedback to improve documentation practices Regulatory and Compliance Knowledge: Understanding of healthcare regulations, including CMS guidelines, HIPAA, and coding compliance requirements. Ensure documentation supports medical necessity, quality reporting, and risk adjustment
Critical Thinking: Ability to assess complex medical records and make informed decisions about documentation improvements. Identify opportunities to enhance documentation for better patient care and accurate reimbursement. Technology Proficiency: Experience with electronic health records (EHR) systems, coding software, and data analysis tools. Comfortable using technology to extract, review, and analyze clinical documentation VOLUNTEERING
las vegas, USA
Jan 2010 - Present
volunteer expert in medical services, Coptic Church of Las Vegas Assisted individuals in understanding medical diagnoses, treatment plans, and insurance- related documentation
Collaborated with church volunteers and healthcare professionals to connect members with appropriate medical resources and services
Provided educational assistance for junior medical coder
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