Outpatient Clinical Documentation Specialist; Highly skilled in integrated patient evaluation and management, risk
adjustment concepts, HEDIS, and medical records evaluation.
Proficient in identifying polychronic management of persistent, suspected, and confirmed conditions.
Adept at utilizing OSCR, Tableau, and Arcadia for data analysis and visualization.
Demonstrated expertise in project coordination, clinical documentation Integrity, reportability of specific diagnoses,
and claim analysis.
Active listener with effective verbal and written communication skills; Bilingual English/Spanish fluency.
Doctor of Medicine (MD) and General Nursing (RN) degrees obtained in Cuba; U.S. RN Licensure process in-progress.
Overview
14
14
years of professional experience
11
11
years of post-secondary education
Work History
Provider Data Analyst
CareAllies/Cigna
Houston, TX
03.2021 - 08.2023
CareAllies manages 95+ value-based care arrangements ranging from fee-for-service to pay-for-performance to full-risk (including
Medicare Advantage, Traditional Medicare, Commercial, and Individual & Family health plans)
Analyzed and maintained accurate provider data, conducted data audits, and implemented process improvements to enhance the efficiency and quality of provider network operations
Successfully reduced provider data discrepancies by 30% through meticulous data analysis and proactive data cleansing initiatives, leading to improved accuracy and reliability of provider information within the network
Developed and implemented a streamlined provider data validation process, resulting in a 20% reduction in data processing time, enhancing operational efficiency, and enabling faster network expansion
As a part of the Harris Readmission reduction program, conducted telephonic outreach to an excess of 100 high, medium and low risk readmission patients
Updated on a weekly and monthly basis completed attestations for provider, educator specialists
Created weekly, biweekly, and monthly outreach (HCC+HEDIS) reports for the educators
Notified IPS of return attestations and for the educators’ conflicting diagnosis.
Preventative Medicine, Physician Aid.
Dr. Edmundo Yrigoyen
Houston, TX
07.2018 - 08.2020
Thoroughly examined patients and elicited medical history data to use in assessing health and identifying conditions.
Integrated patients' files with robust electronic health record system.
Documented interactions using correct format, codes and facility standards for optimal medical care.
Participated in patient education sessions among targeted populations with prevalent health risk factors.
Adhered to universal precautions and other appropriate infection control practices.
Took leading role in delivery of healthcare services and regularly reviewed services to spot trends or errors.
Supervised care given by other professional or non-professional personnel and instructed on proper techniques.
Instructed patients and families on medical diagnoses and treatment options.
Preventative Medicine Care Coordinator - Physician Aide
Carlos Herrera, Heights Medical Clinic
Houston, TX
05.2014 - 06.2018
Collaborated with the physician in planning and executing preventative care programs for patients, managing patient education initiatives, and facilitating the coordination of preventive health screenings and interventions
Supported patient care excellence via planning and interpretation of programs.
Used company software and databases to maintain records of services performed and patient conditions.
Monitored, tracked, and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.
Collaborated with store manager to maintain daily operations.
Communicated with patients, ensuring that medical information was kept private.
Implemented successful healthcare program through professionalism, quality of care, medical teaching and patient satisfaction.
Supervised care given by other professional or non-professional personnel and instructed on proper techniques.
Preventative Medicine Care Coordinator - Physician Aide
HCA Healthcare, Florida & Texas
11.2009 - 05.2012
Collaborated with the medical team to coordinate preventive care initiatives, managed patient outreach and
education programs, and assisted in the development of personalized preventative health plans to optimize patient
well-being and disease prevention
HEDIS, Clinical documentation Integrity, Coordination of care (Value base
model)
HCA is a comprehensive healthcare network with providers and facilities across the United States.
Telemetry Technician
Bayshore Medical Center, Currently HCA Houston Healthcare Southeast
12.2011 - 05.2012
Participated in high-quality, patient-centered care by providing continuous observation and monitoring of cardiac
rhythms and other monitored vital signs, from a centralized monitoring location, assuring a safe patient care
environment
Interpreted cardiac rhythms, heart rate, and arrhythmias; notified the primary RN or charge RN when patient
parameters and waveforms were outside of established parameters in accordance with division policy.
EKG Technician
Fort Walton Beach Medical Center
11.2009 - 03.2011
Performed quality diagnostic EKG or Holter study with the capability to troubleshoot study difficulties and possible
study deficiencies for every age group; Educated patients on study being completed
Produced timely performance of digital EKG and computer upload, and EKG assignment for Physician Interpretation;
Timely and accurately report distribution to IP floors and Physician offices
3 years career experience as a RN (Registered Nurse) within a general hospital setting (Cuba)
4 years career experience as a PCP (Primary Care Physician) within Integral Medicine (Cuba)
7 Years career experience as a GP (General Practitioner) within a Pediatric Emergency room (Colombia)
Created clear, accurate documentation on patient status and activity during the shift while demonstrating knowledge
and respect of patient rights to privacy and protections of patient confidentiality.
Education
ACDIS) - undefined
Association of Clinical Documentation Integrity Specialists