Maria Ruiz
Royal Palm Beach,FL
Summary
Seeking a position as a Professional Medical MRA Coder/Auditor where I can leverage My extensive medical knowledge and organizational abilities to' Support health compliance and facilitate facility needs.
Overview
17
17
years of professional experience
Work History
QA MRA CODER
SECONDWAVE DELIVERY SYSTEM
REMOTE
03.2023 - 02.2024
- Review medical records to ensure accurate reporting based on documentation
- Review medical record information to identify all appropriate coding based on CMS HCC categories
- Performed randomly audit on internal HCC Risk Adjustment Coders, but with a certain percentage assigned to project
- Maintain communication with Coders and management on errors, trends, educational opportunities, etc
- Responsible for performing QA on a specific project or for a particular client
- Provide coders' ongoing education for and identified missed/incorrect ICD-10 codes or incorrect/missing/inappropriate client-based note
- Move from different sets of client guidelines with minimal difficulty
- Provide education through detailed feedback within audits
- Maintain a 95% quality average at a diagnosis level.
MEDICAL CODING AUDITOR - MRA CODING SPECIALIST
HUMANA
REMOTE
05.2021 - 06.2022
- Extract clinical information from a variety of medical records and assign appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records
- Audit coded charts assigned by quality supervisor per the client guidelines
- Conduct internal and external reviews of coding accuracy, policies and procedures of a medical provider to ensure efficient and cost-effective delivery of care
- Work HCC suspect reports
- Confirm appropriate diagnosis related group (DRG) assignments
- Analyze, enter and manipulate database
- Respond to or clarified internal requests for medical information
- Make decisions regarding own work methods, occasionally in ambiguous situations
- Follow established guidelines/procedures.
MEDICAL CODER MRA SPECIALIST
HUMANA
MIAMI, FL
08.2018 - 05.2021
- Provide real time support and coordination with Primary Care Providers and Care Coordinators for MRA coding, HEDIS and STARS
- Maintains fee schedules for Medicare, fee for service, Health Maintenance Organizations
- Prepare the medical charts and track on Data Link, EXCEL & SCIO Health analytics spreadsheets on patients
- Complete appropriate paperwork/documentation/system entry regarding claim/encounter information
- Monitor coding changes to unsure that most current information is available
- Work HCC suspect reports
- Accurately coding and submitting encounters on a timely basis
- Researching and addressing code questions for multiple provider offices as directed.
REFERRAL COORDINATOR
IMC HEALTH
MIAMI, FL
03.2016 - 08.2018
- Knowledgeable of ICD-9 and ICD-10 codes and CPT-Codes
- Extensive knowledge in Anatomy and physiology, Medicine and disease
- Repetitively used the phone and computer to collect and transfer data to various computer systems
- Processed all referrals via phone, fax, and web and scheduled the evaluation date/time successfully
- Ensure proper diagnoses and insurance coverage are established prior to appointments
- Initiation and evaluation of referrals for home care, sleep studies and other ancillary medical purposes
- Experience in all aspect of insurance: Medicare, Medicaid and third-party payers.
CUSTOMER SERVICES
KEY BISCAYNE SERVICES
KEY BISCAYNE, FL
03.2010 - 12.2015
- Handles incoming calls or inquiries from prospective customers or clients
- Assists customers effectively by solving customer disputes
- Provides customer additional information or explains services
- Discusses products offered and ensures customer satisfaction
- Completes supporting paperwork and data entry as required.
CUSTOMER SERVICES
MI TIENDA TRAVEL
BERGENFIEDL, NJ
01.2007 - 01.2010
- Provides customer additional information or explains services
- Discusses products offered and ensures customer satisfaction
- Completes supporting paperwork and data entry as required
- Handles incoming calls or inquiries from prospective customers or clients.
CLINICAL RISK ADJUSTMENT CODER
SECONDWAVE DELIVERY SYSTEM
REMOTE
06.2022
- Reviews medical records to determine if specific disease conditions were correctly reported based on documentation
- Ensures project activities follow applicable coding guidelines, government and federal regulations
- Identify valid face to face encounters
- Attend conference calls as necessary to provide information and/or feedback
- Research and resolution of coding projects as assigned
- Promotes transparency and collaborates with project team members to ensure effective coordination.
Education
Excelsior Technical Institute NMB
08.2017
American Academy of Professional Coders (AAPC)
06.2017
Diploma -
High School
12.2006
Skills
- Strong understanding of ICD-10-CM and CPT requirements and procedures
- Knowledge of HEDIS measures & principles
- Excellent data entry skills
- Elevated level of proficiency relating to medical terminology and strong healthcare background
- Experience on Eclinicalworks, AthenaNet, MDvita, MDflow, Excel, Microsoft, and Outlook
- Ability to adapt to changing priorities while managing a wide range of projects
- Teamwork orientation
- Possess strong organizational skills and attention to detail
Languages
English
Proficient
C2
Spanish
Proficient
C2
Timeline
QA MRA CODER
SECONDWAVE DELIVERY SYSTEM
03.2023 - 02.2024
CLINICAL RISK ADJUSTMENT CODER
SECONDWAVE DELIVERY SYSTEM
06.2022
MEDICAL CODING AUDITOR - MRA CODING SPECIALIST
HUMANA
05.2021 - 06.2022
MEDICAL CODER MRA SPECIALIST
HUMANA
08.2018 - 05.2021
REFERRAL COORDINATOR
IMC HEALTH
03.2016 - 08.2018
CUSTOMER SERVICES
KEY BISCAYNE SERVICES
03.2010 - 12.2015
CUSTOMER SERVICES
MI TIENDA TRAVEL
01.2007 - 01.2010
Excelsior Technical Institute NMB
American Academy of Professional Coders (AAPC)
Diploma -
High School
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