Certified Medical Coder - CPC - HCC/Risk Adjustment Coder

Divya Kanjarla

**********@*****.*** Mobile: 703-***-****

Professional Summary:

Certified Professional Coder (CPC) Medical coder with hands-on experience in Hierarchical Condition Category (HCC) Risk Adjustment coding and medical record review & Strong understanding of ICD-10-CM guidelines and documentation review.

Education:

Bachelor of Pharmacy from Jawaharlal Nehru Technological University (2015) – India.

Certification:

Certified Professional Coder (CPC) – Active (AAPC)

HCC / Risk Adjustment Coding Training – Internship Completed

Additional Skills:

HCC Risk Adjustment Coding

ICD10CM Diagnosis Coding

Medical Record Review

Centers for Medicare & Medicaid Services Risk Adjustment Guidelines

Documentation Validation

Electronic Health Records (EHR)

Professional Experience:

Codestat Health Solutions Pvt Ltd 05/2023 to 03/2026

Job Title: Medical Coder

Job Duties:

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 are documented and meet criteria for annual reporting under Hierarchical Condition Category (HCC).

Initiate provider queries when documentation is unclear, conflicting, or incomplete

Ensure diagnoses meet MEAT criteria (Monitor, Evaluate, Assess, Treat)

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.

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