Risk Adjustment Coder with 8+ Years Experience
Resume:
Kiren Garcia
Risk Adjustment Coder
346-***-**** • Sugarland, 77498 • ***************@*****.***
Work Experience
HCC coder
Norwood healthcare • Houston, tx
**/**** – Present
Identified, collected, assessed, and documented information for audit cleanup initiatives. Maintained a 95% accuracy rate and production output. Adhered to all company guidelines concerning various payers and their specific requirements. Active member of the AAPC.
Proficiently utilized the Coding Book and its associated guidelines. Remote HCC Coder Seasonal
Monogram Health • Tennessee
10/2022 – 01/2025
Coded Medicare and commercial health records for home health services. Identified CAT Codes (Conditions that require assessment). Collected, assessed, monitored, and documented claim and encounter coding information pertinent to CMS Hierarchical Condition Categories (HCC) and RX HCC. Sustained an accuracy and production rate of 95% or higher. Followed all company guidelines regarding different payers and their requirements. Active member of the AAPC.
Proficient in utilizing the 2022 Coding Book and its guidelines. Proficient with coding encoders.
Handled other assigned duties as required.
Remote HCC Coder
Optum • Florida
01/2023 – 07/2025
Remote HCC Risk Adjustment Coder
Syllogistic Health Inc. • Phoenix, Az
01/2018 – 12/2024
Coded Medicare and commercial risk adjustment data. Identified, collected, assessed, monitored, and documented claim and encounter coding information relevant to CMS Hierarchical Condition Categories (HCC). Detail-oriented Risk Adjustment Coder with over 8 years of experience in coding Medicare and commercial health records as well as 5 years in risk adjustment coding. Proven ability to maintain a 95% accuracy and production rate while adhering to diverse payer guidelines. Proficient in ICD-10-CM, CPT, and HCPCS coding, with expertise in HCC and Risk Adjustment methodologies. Eager to leverage strong auditing, documentation review, and problem-solving skills to enhance coding quality and compliance for your organization.
Demonstrated proficiency in using 360 Analytics and recommended enhancements for the system. Conducted post-education chart audits to ensure accuracy and compliance. Performed proactive chart audits for quality assurance. Gained experience with a variety of Electronic Medical Record (EMR) platforms. Coded and abstracted medical records for risk adjustment purposes, mapping data to unique dates of service.
Meticulously identified and rectified inconsistencies, deficiencies, and discrepancies in medical documentation to support provider education audits. Resourcefully utilized various coding books for accurate coding. Active member of the AAPC.
Assisted coding leadership by providing recommendations for process improvements to enhance coding quality goals and outcomes.
Maintained up-to-date knowledge of ICD-9-CM/ICD-10-CM codes, CMS documentation requirements, and state and federal regulations.
Handled other assigned duties as required.
Possess excellent HCC recommendation skills.
credentialing specialist/billing and coding specialist SASpine, LLC • San Antonio, Tx
01/2018 – 11/2023
Managed daily Billing Department functions, including medical coding, charge entry, claims processing, payment posting, and reimbursement management.
Skilled in analyzing and resolving complex billing and coding issues. Provided credentialing services for all new provider hires with Commercial and Medicare insurances, and maintained their active credentialing status.
Collected, compiled, and performed audits of medical charts, billings, and other documentation. Analyzed and resolved billing and coding problems effectively. Remote HCC Risk Adjustment Coder
Advantmed Health Care • Houston, Tx
09/2021 – 10/2022
Coded Medicare and commercial risk adjustment data. Identified, collected, assessed, monitored, and documented claim and encounter coding information pertaining to CMS Hierarchical Condition Categories (HCC). Achieved and maintained an accuracy and production rate of 95% or higher. Adhered to all company guidelines concerning various payers and requirements. Active member of the AAPC.
Proficient in utilizing the 2022 Coding Book and its guidelines. Proficient with coding encoders.
Handled other assigned duties as required.
Medical coder
Change Healthcare • Houston
02/2021 – 09/2022
Coded Medicare and commercial risk adjustment data. Identified, collected, assessed, monitored, and documented claim and encounter coding information relevant to CMS Hierarchical Condition Categories (HCC). Maintained an accuracy and production rate of 95% or higher. Billing and Coding Specialist
Yassir Sonbol MDPA • Sugarland, tx
02/2015 – 09/2017
Oversaw daily Billing Department functions, including medical coding, charge entry, claims submission, payment posting, and reimbursement management.
Skilled in analyzing and resolving billing and coding issues. Coded doctor's services for office and hospital patients with 96% accuracy. Demonstrated excellent abilities to read, interpret, and generate reports. Maintained an in-depth understanding of evolving coding and billing procedures. Meticulously identified and rectified inconsistencies, deficiencies, and discrepancies in medical documentation.
Employed various coding books to ensure accurate coding. Collected, compiled, and performed audits of medical charts, billings, and other documentation. Examined patients' encounter forms to verify diagnosis codes and reconciled codes against services rendered.
Accurately input procedure and diagnosis codes into billing software to generate invoices. Utilized electronic charge capture practices, including the Billing and Account Receivables (BAR) system and medical billing clearinghouse accounts, to submit codes and invoices punctually. Followed up on past due invoices and delinquent accounts to minimize unpaid and outstanding balances. Documented patient data and medical records and performed routine medical record audits to ensure compliance with insurance company requirements.
Upheld and reinforced compliance with hospital policies and federal regulations such as HIPAA. Successfully set up and attested for MACRA 2017.
Established the Security Risk Analysis.
Education
Certified Billing Program
AAPC • Houston
2016 – 2016
Certified Coding Program
AAPC • Houston
2017 – 2017
01452239 AAPC number
Skills
MS Word Excel PowerPoint Outlook internet navigation scanning typing filing appointment scheduling basic booking taking messages faxing copying printing telephone answering HIPPA Regulations OSHA Regulations EMT-B License Limited Radiologist Technician License CPR certification CPI certification Certified Professional Biller License Certified Professional Coder License Patient chart auditing ability Hospital and physician inpatient and outpatient records ICD-10 CPT Languages
English Read, write, and speak Spanish Read, write, and speak References
Sheri Idlebird
Owner of company • Syllogistics
Collaborated directly as project team members on multiple projects. Liz Trevino
Office manager • Saspine LLC
Worked closely with on office operations and provider credentialing. Martha Romero
Billing • Saspine LLC
Coordinated with on billing processes and claim resolutions. Bridgette
Coder • Monogram
Worked together on coding assignments and quality assurance. HCPCS Superior customer relation skills customer centric attitude Excellent interpersonal skills high energy ability to communicate effectively at all levels of the organization High attention to detail strong organizational skills problem solving skills Ability to deal with ambiguity reprioritize tasks in response to unexpected changes in priorities/requests Close attention to detail Risk Adjustment Coding HCC Coding HHS and Medicare RADV Certified Coder (CPC, CRC, COC, CCS, CCS-P) Medicare Risk Adjustment Written and Verbal Communication
Clinical documentation improvement experience for inpatient and outpatient Managed Care Organization Experience Microsoft SharePoint Microsoft Teams
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