Senior HCC Risk Adjustment Medical Coder

DANA REYNOLDS, CPC, COC

*** **** ***, ********, ** 30240 502-***-**** **********@*****.*** LinkedIn Network Ready PROFESSIONAL SUMMARY

Results-driven, dual-certified Senior HCC / Risk Adjustment Medical Coder with 14 years of robust healthcare experience in elite clinical data translation, auditing, and outpatient compliance architectures. Proven track record of maintaining exceptional data integrity metrics, optimizing Risk Adjustment Factor (RAF) validation, and mitigating compliance risks within high-volume Revenue Cycle Management (RCM) environments. Recognized expert in navigating both professional fee and outpatient facility billing systems, combining deep mastery of ICD-10-CM / CMS-HCC guidelines with advanced analytical auditing strategies. CERTIFICATIONS & SKILLS

Certifications: CPC (Certified Professional Coder) COC / CPC-H (Certified Outpatient Coder) HIPAA Certified Core Expertise: Risk Adjustment Validation CMS-HCC Categories Documentation Validation HEDIS Audit Strategy Technical Toolset: 3M Encoder CAS Verisk CCP2 Microsoft Office Suite (Advanced Excel) Regulatory Systems: ICD-10-CM Coding Protocols CPT Coding Architectures Medical Law & Professional Ethics PROFESSIONAL EXPERIENCE

OPTUM 06/2016 – Present

Senior Medical Coder / HCC & Risk Adjustment Subject Matter Expert Remote / National Division

• Analyze and precisely translate complex clinical diagnoses, outpatient procedures, and acute chronic illnesses into accurate numerical codes utilizing current ICD-10-CM, CPT, and CMS-HCC frameworks.

• Maintain an elite, high-velocity throughput standard of 11 multi-layered charts per hour (CPH) while consistently maintaining an exemplary 90%+ baseline score on critical monthly Clinical Quality Assessment (CMA) testing.

• Serve as a senior operational point of contact for complex case reconciliation, validating risk-adjusted diagnostic strings to prevent documentation discrepancies and downstream compliance exposure.

• Leverage comprehensive understanding of anatomy, physiology, and complex pharmacology coding pathways to ensure flawless audit readiness across commercial and Medicare Advantage payer mixes. HUMANA 09/2014 – 09/2015

Auditing Coder Specialist – Medicare Risk Adjustment Louisville, KY

• Executed high-level medical record reviews and intensive deep-dive audits to isolate, verify, and validate code assignments explicitly linked to complex Medicare Advantage CMS-HCC clinical categories.

• Engineered end-to-end documentation workflows and data entry system configurations for claim/encounter verification, boosting compliance accuracy metrics across specialized Healthcare Effectiveness Data and Information Set (HEDIS) timelines.

• Identified, evaluated, tracked, and thoroughly monitored diagnostic trends across Clinical Condition Categories within highly complex managed care environments.

• Utilized advanced health information management workflows and specialized analytics platforms including CAS, Verisk, 3M Encoder, and CCP2 to optimize first-pass compliance tracking.

• Earned formal corporate accolades including 'Most Recognized Associate' and 'My Organization Values My Contributions' awards for driving excellence in risk adjustment quality control audits. EDUCATION & FORMAL TRAINING

ATA COLLEGE — Louisville, KY Graduated: 2012

Associate Degree in Professional Medical Coding & Billing GPA: 4.0 / 4.0 Advanced Coursework: Medical Record Auditing, Medical Law and Ethics, Advanced ICD Coding Systems, Pathology, Pharmacology, and Advanced Anatomy & Physiology. PROFESSIONAL ASSOCIATIONS

• Active Member in Good Standing, AAPC (American Academy of Professional Coders)

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