AMANDA AREVALO
Greer,South Carolina
Summary
Detail-oriented, enthusiastic Registered Nurse and Certified Risk Adjustment Coder with over 7 years experience in the healthcare industry. With a strong foundation in clinical care and deep expertise in medical coding and documentation, I bring a unique perspective to healthcare revenue integrity. My experience spans the full spectrum of the revenue cycle, from abstracting accurate diagnosis codes to ensuring documentation aligns with regulatory standards. I'm known for identifying discrepancies, improving coding accuracy, and supporting compliance efforts that drive reimbursement success. Leveraging a keen eye for detail and a thorough understanding of healthcare workflows, I consistently contribute to streamlined processes and reduced error rates. I approach challenges with analytical thinking and a collaborative mindset, always focused on enhancing both financial performance and patient care documentation. My background allows me to bridge clinical insight with operational excellence in every role I take on.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Risk Adjustment Coder
CSI Companies - Apixio
Jacksonville, FL
09.2024 - 07.2025
- Analyze, import, and abstract ICD-10-CM codes for each chart as determined by CSI Companies and meet client expectations of requested scope of work for the specific project (HCC Coding), utilizing HCC Coder (encoder software)
- Conduct comprehensive reviews of patient records in accordance with HIPAA regulations/HIPPA legislation, upholding a high level of accountability by confirming that records are complete and accurate while performing code validation for timely and error-free claims processing
- Perform ongoing analysis of patient records for appropriate coding compliance with government regulations such as CMS (Centers for Medicare and Medicaid Services) Risk Adjustment diagnosis coding guidelines while meeting industry standards of ethical coding; with knowledge of Medicare Advantage populations
- Determine valid face to face encounters including legibility and valid signature requirements
- Responsible for meeting daily production goal standards and healthcare quality improvement goal on a consistent basis, assisting with quality assurance
- Attend team meetings as necessary to provide feedback and/or provide information Reviewed documentation for contract compliance prior to claims submission, minimizing auditing risk and supporting 100% alignment with payer guidelines
- Assisted with claims adjudication processes by verifying that the medical records supported submitted diagnoses and procedure codes Reviews and abstracts critical medical diagnosis codes from over 1,000 pages of medical records per case, ensuring accurate clinical documentation including progress notes, radiology reports and laboratory findings, that aligns with MEAT (Monitor, Evaluate, Assessment, Treatment) principles, resulting in enhanced coding accuracy and compliance with federal regulations and state regulations
- Utilized clinical knowledge to accurately assign risk adjustment codes, ensuring compliance with regulatory requirements
- Conduct reviews and validate coding and clinical documentation to support risk adjustment initiatives, ensuring compliance with revenue integrity requirements and improving reimbursement accuracy, contributing to an increase in revenue cycle performance
AML/BSA Analyst
Robert Half - TD Bank
Greenville, SC
12.2023 - 06.2024
- Analyzed reports for discrepancies and suspicious activities
- Followed standard AML policies and procedures, and processes throughout project execution
- Collected and examined financial statements and documentation with enhanced due diligence, applying finance principles to assess precision, risk, and compliance while maintaining data privacy and security policies
- Utilized knowledge of AML regulatory standards, including BSA, US Treasury guidelines, and US Patriot Act
- Assessed compliance with banking laws and reported suspicious entries and actions while meeting business requirements
- Documented and reported all findings in Oracle case management software
- Provided detailed business documentation summaries based on research and data analysis for final case recommendation
- Performed periodic reviews and enhanced due diligence on high-risk customers, while utilizing quality measures
- Responded to management requests and serves as a point of contact who responds to inquiries regarding documentation accuracy, consistently adjusting required language to align with compliance standards during enhanced due diligence reviews
- Contributed to team development in the high-risk department by actively participating in team meetings, sharing insights, and offering suggestions for streamlining enhanced due diligence reviews, improving overall team efficiency
- Served as a liaison while supporting ongoing education initiatives by conducting one-on-one in-service training sessions and providing hands-on guidance to staff, promoting compliance and consistency in documentation standards
Data Entry Specialist
CSI Companies - Munson Healthcare
Jacksonville, FL
09.2023 - 11.2023
- Entered HCPCS/CPT Revenue codes in excel spreadsheet based on data in Vitalware with the use of medical terminology
- Verified charge entry data against pricing references in Vitalware, contributing to accurate chargemaster maintenance and reducing the risk of compliance-related denials
- Processed requests for code clarification by collaborating with team members and referencing compliance Guidelines and best practices, ensuring accurate HCPCS selection and reducing risk of coding errors
- Maintained accuracy and operational efficiency when abstracting data
- Met requested daily productivity standards
Patient Support Specialist
University of South Carolina Upstate
Spartanburg, SC
06.2023 - 08.2023
- Communicated with students in-person/phone/email, organized/scheduled appointments while utilizing customer service-oriented skills/administrative support/customer support while maintaining a professional demeanor
- Executed Peoplesoft for submitting deposits and payment requests
- Regularly generated and reviewed reconciliation reports to monitor payment trends, identify anomalies, and support month-end financial close processes while performing other administrative tasks, such as filing and scanning
- Gathered/updated reports on housing/immunization data while comparing data in Excel utilizing VLOOKUP
- Updated student holds on accounts in Banner related to Health Services holds based on immunization Compliance
- Performed policy analysis on immunization tracking processes, leveraging Excel to generate insights that enhanced revenue cycle analytics and informed decision-making, leading to more efficient management of student health compliance
- Played a pivotal role in special assignments to monitor and ensure immunization compliance within a college setting
- Performed detailed audits of medical billing data against clinical documentation using Patient Accounting systems, identifying discrepancies and resolving issues that improved charge accuracy, leading to a 12% reduction in billing errors across shared services
- Collaborated with IT leadership to request and refine system-generated reports on student immunization compliance and housing assignments, supporting health regulation adherence across over 1,000 students
- Assisted with troubleshooting daily technical issues within student health systems, ensuring minimal disruption to operations and maintaining data accuracy critical to public health compliance
EMR Abstractor
CSI Companies - Prisma Health
Jacksonville, FL
02.2021 - 04.2023
- Analyzed and compiled medical information from Electronic Health Record Cerner/Allscripts into Epic
- Maintained strict adherence to healthcare compliance standards by auditing and compiling medical records across multiple Electronic Medical Records systems, reducing regulatory risk and supporting accurate claims processing
- Clinical documentation (data entry) including diagnoses, medications, vital signs, surgical/medical history, obstetrical history, Allergies, and pharmacy
- Followed clinical protocols and identified issues with ability to read by noticing and correcting discrepancy in clinical data
- Maintained accuracy and efficiency when abstracting charts
- Met requested daily productivity standards
EMR Abstractor
SB Administrative Services, LLC
Bohemia, NY
04.2019 - 06.2020
- Maintained a disciplined and detail-oriented approach when transferring data from paper documentation into Electronic Health Record system such as Cerner
- Clinical documentation (data entry) including diagnoses, medications, vital signs, surgical/medical history, obstetrical history, allergies and pharmacy with the use of medical terminology
- Followed clinical protocols and identified issues with ability to notice and correct discrepancy in clinical data
- Maintained accuracy and efficiency when abstracting charts
- Maintained confidentiality and integrity to protect patient confidentiality in all clinical systems
Data Analyst
Lehigh Technical and Professional
Hauppauge, NY
08.2018 - 12.2018
- Analyzed and updated data into Excel spreadsheets with strong ability to prioritize tasks
- Entered data into E-claims (Pegasys) Corrected report-generated errors using detailed error logs, increasing data integrity and reducing claim rework by 20%
- Utilized SharePoint to update data in Microsoft Office products such as Excel Maintained data integrity of all provider set-ups and provider contracts loaded to the claims system
- Attended and participated in internal meetings with coworkers and supervisors while establishing and maintaining effective work relationships (ability to collaborate)
- Assisted with the education and training staff (new staff) by breaking down complex technical information into easy-to follow instructions, enhancing onboarding efficiency and staff confidence
RN Chart Abstractor
MaxiReturn
Staten Island, NY
03.2018 - 08.2018
- Demonstrated technical aptitude by efficiently navigating and learning multiple EHR systems, including Cerner, NextGen, and Epic, to accurately compile and analyze OB/GYN medical data into Epic EHR system
- Clinical documentation (data entry) including diagnoses, medications, vital signs, surgical/medical history, obstetrical history, allergies and pharmacy with the use of medical terminology
- Followed clinical protocols and identified issues with ability to notice and correct discrepancy in clinical data
- Maintained accuracy and efficiency when abstracting charts
- Met requested daily productivity standards
- Maintained integrity to protect patient confidentiality
Registered Nurse
Suffolk County Department of Health Services
Yaphank, NY
10.2017 - 02.2018
- Triaged and handled all emergencies, performed assessments, charting, and daily stats in a correctional facility (behavioral health setting)
- Assisted with troubleshooting daily technical issues within student health systems, ensuring minimal disruption to operations and maintaining data accuracy critical to public health compliance
- Applied therapeutic communications with interpretation, verified, and monitored physician orders monthly.
- Transcribed orders to MAR, and administered medications on an as-needed basis
Registered Nurse
Hudson River Healthcare
Patchogue, NY
03.2015 - 03.2017
- Handled in-office visits, triaged via phone and in person, performed initial assessments
- Developed reports using OB-GYN prenatal chart data to analyze patient care patterns, providing insights that supported the optimization of prenatal care services and enhanced revenue cycle integration, extracted/transmitted prenatal charts to hospital
- Applied therapeutic verbal and written communication skills with interpretation, assisted MD with procedures
- Administered vaccines/medications to adults/children
- Booked inductions/C-sections per MD request and provided follow-up care
- Supported team development by delivering informal education sessions with new hires, addressing workflow questions, and reinforcing best practices in patient care and compliance
- Took on an educational leadership role in the absence of the nurse manager by guiding staff through daily operations and mentoring new hires to foster confidence and competence
- Conducted diabetes education and management for patients for preventive care
- Established rapport with physicians and healthcare providers by leveraging strong interpersonal communication skills
- Maintained meticulous Excel spreadsheets tracking OB charts for deliveries, demonstrating strong organizational and data management skills, efficient tracking of patient information supports accurate quality reporting and analysis, facilitating improved patient care and documentation practices
- Assisted in launching a satellite office and trained nursing staff on OB/GYN assessment workflows
- Demonstrated expertise in the diligent follow-up of missing orders and unresolved patient concerns, streamlining communication processes and documentation accuracy between patients and healthcare teams
- Facilitated daily follow-up communication with providers to clarify and confirm patient orders, including urinalysis and medications, ensuring comprehensive documentation and adherence to treatment protocols
Licensed Practical Nurse
Seafield Center
Westhampton Beach, NY
10.2011 - 01.2012
- Conducted a thorough utilization review of provider standing orders and physical admission assessments in a drug rehabilitation setting to validate and support personalized treatment plans based on patient medication profiles
- Transcribed orders to MAR, and administered medications on an as-needed basis
- Triaged and handled all emergencies, performed assessments, charting, and daily stats in a behavioral healthcare setting
Education
Bachelor of Science - Information Systems, Healthcare Informatics
Saratoga Springs, NY
Saratoga Springs, NY12-2021
Associate of Applied Science - Registered Nurse
Selden, NY
Selden, NY05-2013
Skills
Professional Skills
- Microsoft Office Suite (MS Office) - Microsoft Excel (intermediate), Microsoft Word, Microsoft Outlook, Microsoft Access, Microsoft Powerpoint, and Microsoft 365
- Google Workspace - Gmail, Google calendar, Google sheets, Google Drive, Google Docs
- ICD-10 coding (ICD-10-CM)
- HCPCS, CPT codes, Revenue codes
- medical coding conventions
- concurrent, prospective, and retrospective reviews (Review Medical Charts)
- Critical Thinking/Computer literacy
- Anatomy and physiology, pharmacology, knowledge of medical terminology, knowledge of disease processes
- CMS (Centers for Medicare and Medicaid Services) regulatory requirements
Personal Skills
- Strong organizational skills/Administrative skills
- Detail oriented/Attention to detail
- Team-player and ability to work independently
- Fast learner and problem-solving skills
- Strong analytical thinking skills
- Written and verbal communication skills
- Leadership skills/strong work ethic
- Health Information Management/Health care experience/Time management skills
- Typing 40-50 WPM, 10-key, tech-savvy,
- Bilingual in English/Spanish
EMR/EHR systems
- Epic
- NextGen
- eCW
- Point and Click
- Allscripts
- Medent
- Cerner
Certification
- Registered Nurse, New York State Education Department, Valid through June 2028
- Registered Nurse, Compact Nursing License, South Carolina Department of Labor, Licensing, and Regulation, Valid through April 2027
- Certified Risk Adjustment Coder (CRC), American Academy of Professional Coders (AAPC), Valid through May 2026
Affiliations
- American Academy of Professional Coders (AAPC), May 31, 2026
- National Society of Leadership and Success, Lifetime
Professional Highlights
- Selected as 1 of 28 team members for a high-impact chart abstraction project due to maintaining 100% accuracy across all cases; identified and corrected duplicated or missing diagnoses, surgeries, medications, and other critical data, resulting in a 40% reduction in rework and significantly streamlining the abstraction process.
- Consistently exceeded risk adjustment coding standards by maintaining a 95%+ accuracy rate while meeting and often surpassing the productivity benchmark of coding 2 charts per hour, applying both HCC and RxHCC coding models to ensure accurate risk score capture and compliance with regulatory requirements.
Timeline
Risk Adjustment Coder
CSI Companies - Apixio
09.2024 - 07.2025
AML/BSA Analyst
Robert Half - TD Bank
12.2023 - 06.2024
Data Entry Specialist
CSI Companies - Munson Healthcare
09.2023 - 11.2023
Patient Support Specialist
University of South Carolina Upstate
06.2023 - 08.2023
EMR Abstractor
CSI Companies - Prisma Health
02.2021 - 04.2023
EMR Abstractor
SB Administrative Services, LLC
04.2019 - 06.2020
Data Analyst
Lehigh Technical and Professional
08.2018 - 12.2018
RN Chart Abstractor
MaxiReturn
03.2018 - 08.2018
Registered Nurse
Suffolk County Department of Health Services
10.2017 - 02.2018
Registered Nurse
Hudson River Healthcare
03.2015 - 03.2017
Licensed Practical Nurse
Seafield Center
10.2011 - 01.2012
Bachelor of Science - Information Systems, Healthcare Informatics
Saratoga Springs, NY
Associate of Applied Science - Registered Nurse
Selden, NY
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