Medical Risk Adjustment Coder (Bilingual)
Resume:
Martha Díaz Suarez
Medical Risk Adjustment Coder Graduated Nurse
Cape Coral, Florida
Email: *************@*****.*** Phone: 786-***-****
Contact Information
*** ** **** **, **** Coral, FL 33909
*************@*****.***
Professional Summary
Bilingual (English/Spanish) Medical Risk Adjustment Coder with over 3 years of professional experience specializing in ICD-10, HCC, and HCPCS coding, risk adjustment models (Medicare Advantage & ACA), and documentation validation. Proven expertise in reviewing clinical records, assigning accurate codes, and ensuring compliance with CMS, AMA, and HIPAA regulations.
Since 2022, I have worked with UnitedHealth Group / Optum as a Risk Adjustment Coder, performing retrospective and prospective reviews, validating diagnoses, and collaborating with providers to ensure accurate documentation and code capture. I am highly skilled in eClinicalWorks (ECW) for medical chart review, data extraction, and coding accuracy optimization. My analytical mindset, attention to detail, and ability to work independently make me a strong asset to any healthcare team.
I am certified as a CPC and CRC, with a solid understanding of hierarchical condition categories (HCC) and risk adjustment methodologies. My focus is on quality, compliance, and accurate risk capture to support optimal reimbursement and patient care outcomes.
Additionally, I am a graduated nurse currently preparing for my nursing certification exam. This clinical background strengthens my understanding of medical documentation, patient care processes, and healthcare compliance, enhancing my performance as a Risk Adjustment Coder.
Professional Experience
UnitedHealth Group / Optum – Medical Risk Adjustment Coder
09/2022 – Present
• Reviewed and validated clinical documentation and patient records.
• Assigned accurate ICD-10 and HCC codes for Medicare Advantage and ACA risk adjustment models.
• Performed both retrospective and prospective risk adjustment reviews.
• Collaborated with providers and clinical staff to clarify documentation and ensure coding accuracy.
• Utilized eClinicalWorks (ECW) for chart review, documentation validation, and data extraction.
• Identified coding opportunities to impact quality, compliance, and reimbursement.
• Maintained current knowledge of CMS guidelines, HCC coding rules, and HIPAA regulations.
• Educated providers on documentation improvement and coding best practices.
Certifications & Core Competencies
• Certified Professional Coder (CPC) – AAPC
• Certified Risk Adjustment Coder (CRC)
• Graduated Nurse – Currently preparing for Nursing Certification Exam
• Advanced knowledge of ICD-10, CPT, HCPCS, and HCC
• Strong proficiency with MRM (Medicare Risk Model) and HCC hierarchy
• Expertise in eClinicalWorks (ECW) and other EHR platforms
• Extensive knowledge of LCD and NCD Coverage Guidelines
• Experienced in internal audits, RAF score optimization, and risk analysis
• Proficient in Microsoft Excel, Word, and data reporting tools
• Strong analytical skills and attention to detail
• Excellent written and verbal communication skills
• In-depth understanding of CMS compliance and HIPAA regulations
• Ability to work independently and collaboratively
• Bilingual – English and Spanish
Career Objective
To leverage my extensive experience in medical coding, risk adjustment, and audit support to contribute to a dynamic healthcare organization. I aim to ensure coding accuracy, regulatory compliance, and high-quality documentation that enhances both patient outcomes and reimbursement integrity.
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