Medicare Coding Specialist (CCS) with RADV/MEAT Expertise

THERESA OFELIA RAMOS, CCS

Los Angeles, CA Mobile: 323-***-**** Email: ***********@*****.*** Ahima ID # 286406

PROFESSIONAL SUMMARY

Detail-oriented and highly motivated Certified Coding Specialist (CCS) with 3 years of experience in medical coding at MD CONNECTION company.. Eager to contribute strong analytical skills and a willingness to learn in a fast-paced healthcare environment. Medical coder specializing in Medicare Advantage CMS-HCC abstraction, with three years of experience performing retrospective and concurrent chart review across CDPS, CRG, DxCGG, and CMS-HCC models. Skilled in ICD-10-CM abstraction, MEAT/TAMPER VALIDATION, RADV-ready documentation review. Strong accuracy, analytical reasoning, and remote workflow discipline.

CORE COMPETENCIES

•Medicare Advantage CMS-10-CM Abstraction

•MEAT/TAMPER Documentation Validation.

•Behavioral Health & SUD Coding

•Medicare RADV Support

•Retrospective Concurrent Review

•EMR: EPIC, CERMER

•Coding Tools: 3M, Epic,

•Clinical:Pathophysiology, Pharmacology, Medical Terminology, Anatomy.

•Operations. High-Volume Productivity, Technical Specification Analysis.

•Business:Contract,Auditing, Regulatory Compliance, Professional Querying.

EDUCATION & CREDENTIALS

•Certified Coding Specialist (CCS) AHIMA August 2022

•Licensed Vocational Nursing (LVN) Program Marian College, Los Angeles, CA Completed 3 of 4 Terms from November 2022 to December 2024

•Bachelor of Science in Foods and Nutrition Philippine Normal University, Manila PH Graduated March 1989

PROFESSIONAL EXPERIENCE

HCC Medicare Coder August 2022 – March 2026 MD CONNECTION

•Responsible for reviewing clinical documentation and accurately assigned ICD-10-CM diagnosis in accordance with official coding guidelines, payer requirements and organizational policies.

•This role ensures complete and compliant data capture to support quality reporting, reimbursement and healthcare analytics.

•Ensure documentation supports MEAT criteria (Monitor, Evaluate, Assess, Treat).

•Strong understanding of HCC models and CMS risk adjustment guidelines.

•Maintain 95-97% accuracy standards and productivity.

•Stay current with coding updates, guidelines and regulatory changes.

•Protect patient confidentiality and adhere to HIPAA standard

•Performed high-volume Medicare chart review across CDPS, CRG, and DxCG models, ensuring accurate ICD -10-CM abstraction, documentation validation coding,. Medical Risk adjustment (CDPS, CRG, DxCG, State HCC). Medicare Advantage CMS-HCC (V24-V28), ICD-10-CM Abstraction. MEAT/TAMPER Documentation and Validation

•Medicare RADV Support

Clinical Caregiver 2003 – 2022

•Clinical Monitoring: Assessed and recorded vital signs (BP, SPO2, Blood Glucose) and monitored for clinical manifestations of chronic conditions such as COPD, Hypertension, and Diabetes.

•Documentation & Reporting: Maintained detailed daily progress notes and clinical logs; ensured all documentation met standards for medical necessity and continuity of care.

•Medication Management: Oversaw complex medication schedules and monitored for contraindications or adverse reactions, utilizing Pharmacology training from LVN coursework. Provider Collaboration: Acted as a clinical liaison, providing "hand-off" reports to Home Health Nurses and Physicians to ensure accurate care plan updates.

•Provider Collaboration: Acted as a clinical liaison, providing "hand-off" reports to Home Health Nurses and Physicians to ensure accurate care plan updates.

Nursing Assistant Kingsley Manor Senior Living Community – Los Angeles, CA 2017 – 2019

•Provider Collaboration: Acted as a clinical liaison, providing "hand-off" reports to Home Health Nurses and Physicians to ensure accurate care plan updates.

•Provided direct patient care including ADLs, mobility assistance, vital signs, and safety monitoring across Assisted Living, Memory Care, and Skilled Nursing units.

•Observed and documented changes in patient condition, intake/output, and care activities in compliance with facility protocols and HIPAA standards.

•Supported residents with chronic conditions such as dementia, diabetes, CHF, COPD, and post acute rehabilitation needs.

•Collaborated with RNs, LVNs, CNAs, therapists, and interdisciplinary teams to maintain accurate care plans and ensure continuity of care.

•Assisted with infection control procedures, fall prevention strategies, and emergency response workflows.

•Strengthened clinical understanding of disease processes, terminology, and documentation — foundational knowledge that supports accuracy in medical coding and chart review.

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