Health Care Coder with CPC Certification
Resume:
S
GLEINNYS SAAVEDRA
*********@*****.********, 33165
SUMMARY
Successful professional with more than 20 years in the Health Care industry with over 8 years in Medicaid, Medicare, HHS, ACA and IVA/RADV. Motivated, personable business professional. Talent for quickly mastering technology, Diplomatic and tactful with professionals at all levels Accustomed to handling sensitive and confidential records Flexible and versatile-able to maintain a sense of humor under pressure. Poised and competent demonstrated ability to easily transcend cultural differences. Thrive in deadline-driven environments excellent team-building skills.
Complete Code Capture to include a wide range of ICD-10-CM diagnoses, all types of examinations and conditions, Standard Determinants of Health capture as well as pertinent family history codes
SKILLS
Attention to detail
Medical terminology
Analytical skills
Attention to detail
Capturing HCC
Model V24, V28 and RxHCC
Communication skills
Knowledge if Insurance Policies
Time management
Ability to continue learning and
Growing.
Different EHR as:
Epic, ECW, EMR, MRM, Virtix coding tools, Centauri, E-Tools, Edifecs and others.
ICD-10 Coding Manual Book.
HCC Coder.
Episource Encoder
Find a Code
Microsoft Outlook
EDUCATION, CERTIFICATIONS & CREDENTIALS:
Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC), certified on April 9, 2022.
Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC), certified on April 9, 2022.
Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC), certified on April 9, 2022.
Medical Assistant & Phlebotomy through Tech High School — January 2001.
Computer Business Applications through Tech High School — January 2000.
Bachelor’s degree through IPUEC Matanzas, Cuba – July 1992 - July 1996
DUTIES:
Review and validate complex medical documentation to accurately identify reportable diagnoses and ensure precise ICD-10-CM code assignment in full compliance with established coding guidelines, regulatory requirements, and payer-specific policies. Perform comprehensive coding audits aligned with standards from the Centers for Medicare & Medicaid Services (CMS), Affordable Care Act (ACA), and U.S. Department of Health and Human Services (HHS), ensuring adherence to both federal and state-specific regulations. Identify, analyze, and resolve coding discrepancies, insufficient documentation, and potential compliance risks in accordance with Office of Inspector General (OIG) Work Plan priorities and audit guidelines. Collaborate with providers and clinical staff to communicate audit findings, obtain documentation clarification, and deliver targeted education and recommendations to improve coding accuracy, specificity, and overall documentation integrity. Apply advanced coding knowledge across multiple encounter types, including Initial Visits, Annual Wellness Visits (AWV), Follow-up (F/U) visits, Outpatient (OP) services, and Inpatient (IP) admissions and Discharge Summaries. Ensure appropriate diagnosis of sequencing, accurate capture of conditions impacting care (including risk-adjusted conditions when applicable), and strict adherence to official ICD-10-CM guidelines, payer policies, and audit defensibility standards. Maintain a strong focus on compliance, preventing overcoding and undercoding, and ensuring all reported diagnoses are fully supported by clinical documentation in accordance with industry best practices.
JOB EXPERIENCE:
OMEGA HEALTHEDGE HOLDING INC- HCC Medical Coder
Boca Raton, FL
Feb 2026 – Current
Assign accurate ICD-10-CM diagnosis codes, including full diagnosis coding for Medicaid populations, according to Omega quality standards and client-specific protocols. Review clinical documentation to determine appropriate diagnosis in accordance with CMS Gls. Ensure compliant coding of office visits, hospital services, consultations, and telemedicine encounters to support accurate reimbursement and minimize denials for Medicaid and other payers. Collaborate with Omega’s audit and quality assurance teams to resolve discrepancies and maintain internal benchmarks for accuracy and productivity. Support Clinical Documentation Improvement (CDI) efforts by identifying incomplete or ambiguous documentation and querying providers when necessary. Maintain current knowledge of payer requirements, coding updates, and HIPAA compliance standards as outlined by Omega training programs. Meet or exceed productivity goals as specific projects required while ensuring consistent coding accuracy and turnaround times for clients.
Remote Position.
Virtix Health - HCC Medical Coder
Phoenix, AZ
May 2025 – Feb 2026
I accurately assign ICD-10-CM codes to inpatient and outpatient records, including full diagnosis coding for Medicaid population, in compliance with ECLAT’s standards, client requirements, CMS and state Medicaid Full Code Gls, and HIPAA protocols. Skilled in analyzing physician documentation to ensure correct coding, DRG assignment, and optimal reimbursement while consistently meeting accuracy (95%+) and productivity benchmarks (7–8 records/hour). Experienced in resolving coding errors, supporting CDI initiatives, and staying current with federal guidelines through ongoing training. I also contributed to the HHS Risk Adjustment Data Validation (RADV/IVA) process by validating HCC assignments using ICD-10-CM, AHA Coding Clinic, and CMS guidelines in line with 2024 protocols.
Remote Position.
Clinical Care Medical Center – HCC Medical Coder & QA
October 2021 – May 2025
Performed advanced review and validation of outpatient and inpatient medical records to ensure accurate ICD-10-CM code assignment, proper sequencing, and full compliance with federal regulations and payer-specific guidelines. Executed comprehensive coding audits to evaluate documentation integrity, identify unsupported diagnoses, and detect overcoding and undercoding risks, ensuring audit defensibility and regulatory compliance. Applied expert knowledge of coding and compliance standards established by the Centers for Medicare & Medicaid Services (CMS), U.S. Department of Health and Human Services (HHS), and Office of Inspector General (OIG), maintaining adherence to federal and state requirements. Analyzed clinical documentation to ensure all reported conditions were clinically supported, appropriately documented, and compliant with official ICD-10-CM guidelines and payer policies. Communicated audit findings to providers and internal teams, providing clear, actionable recommendations to improve documentation accuracy, coding specificity, and overall compliance performance.
Reviewed multiple encounter types, including initial visits, follow-ups, annual wellness visits (AWV), outpatient services, and inpatient admissions, ensuring consistency and accuracy across all levels of care. Supported audit readiness initiatives by identifying trends, mitigating compliance risks, and promoting best practices in coding and documentation standards.
Cano Health - HCC Medical Coder, Team Lead & QA
Miami, FL
September 2019 – October 2021
Led risk adjustment coding initiatives, overseeing both prospective and retrospective chart reviews to ensure accurate capture of chronic conditions impacting Risk Adjustment Factor (RAF) scores. Executed advanced HCC coding and validation in compliance with guidelines from the Centers for Medicare & Medicaid Services (CMS), Medicare, Medicaid, and the Affordable Care Act (ACA). Reviewed and validated medical records to ensure all reported diagnoses were clinically supported and met risk adjustment requirements, including proper documentation of MEAT criteria (Monitor, Evaluate, Assess, Treat). Supported Risk Adjustment Validation (RAV) and Internal Validation Audit (IVA) initiatives by auditing diagnosis coding against clinical documentation and CMS requirements, ensuring audit readiness and compliance. Identified missed, unsupported, and incorrectly coded diagnoses, improving data integrity, coding accuracy, and overall compliance performance. Applied expert knowledge of ICD-10-CM, CMS-HCC models, and official coding guidelines, including appropriate exclusion of symptoms when definitive diagnoses were documented. Collaborated with providers and cross-functional teams to enhance documentation specificity, close coding gaps, and support accurate risk score optimization across assigned patient populations. Monitored team productivity and quality metrics in high-volume coding environments, ensuring adherence to organizational standards and turnaround times. Provided guidance, training, and support to coding staff to maintain consistency, accuracy, and compliance across all coding activities.
InterAmerican Medical Center – Med Assistance, HCC Coding & Billing
Miami, FL
April 2012 – Sept 2019
Supported daily clinical and administrative operations in a high-volume outpatient setting, ensuring efficient patient flow and quality patient care. Obtained and documented vital signs, medical histories, chief complaints, and medication lists within the electronic medical record (EMR) system. Prepared patients for examinations and assisted providers during visits by coordinating care, documenting clinical information, and facilitating follow-up instructions. Processed physician documentation for billing and coding purposes, ensuring accuracy, completeness, and proper linkage between clinical documentation and reported diagnoses. Promoted internally to a Medical Coding role based on demonstrated proficiency in documentation review and coding accuracy.
Assigned ICD-10-CM diagnosis codes based on provider documentation, ensuring compliance with coding guidelines and payer requirements. Reviewed clinical documentation to identify reportable conditions, support accurate code selection, and prevent coding discrepancies. Assisted in capturing appropriate MRA/HCC-related diagnoses to support risk-adjusted documentation and reporting. Performed administrative responsibilities including scheduling, insurance verification, patient check-in/check-out, and coordination of referrals and authorizations. Maintained compliance with HIPAA regulations and clinic policies while ensuring confidentiality and accuracy of patient records.
Leon Medical Center – Surgical Coordinator
Miami, FL
July 1, 2010 – April 30, 2012
Coordinated scheduling of minor and invasive surgical procedures, ensuring accurate alignment of provider availability, facility resources, and patient needs. Verified insurance coverage, obtained prior authorizations, and ensured all required documentation was completed prior to procedures to avoid delays or denials. Communicated with patients to provide pre-operative instructions, procedure details, and post-operative care guidance, ensuring patient understanding and compliance. Collaborated with physicians, surgical teams, and external facilities to coordinate procedure logistics, referrals, and required pre-surgical clearances. Reviewed and organized medical records, lab results, and diagnostic reports to ensure completeness and readiness for scheduled procedures.
Managed surgical calendars, tracked procedure statuses, and followed up on cancellations, rescheduling, and pending requirements. Assisted with billing coordination by ensuring accurate documentation and appropriate linkage between procedures and supporting clinical information. Maintained compliance with healthcare regulations, including HIPAA, and ensured confidentiality and accuracy of all patient records.
Ramon G. Iglesias – Medical Assistant
Miami, FL
February 1, 2007 – July 31, 2010
Supported daily clinical operations in an outpatient setting, assisting providers with patient care, and ensuring efficient workflow. Obtained and recorded vital signs, medical histories, and chief complaints in the patient's record. Prepared patients for examinations by rooming, updating documentation, and ensuring readiness for provider evaluation.
Assisted physicians during patient visits by documenting information and facilitating patient flow. Maintain accurate and organized medical records, ensuring completeness of clinical documentation. Performed basic administrative duties including patient check-in/check-out, appointment scheduling, and coordination of patient flow. Followed clinic protocols and maintained compliance with patient confidentiality standards (HIPAA).
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