Ana Laura Bacallao Martinez
Miami,Fl
Summary
Logical and efficient medical coding professional with exceptional skills in abstracting information and assigning codes related to medicine, surgery, diagnosis, pathology and HCC Risk Adjustment models. Working knowledge of official coding conventions and rules established by AMA and AAPC. A meticulous individual who has demonstrated ability to liaise with insurance companies. Highly motivated to work in team-oriented and collaborative environment.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Risk Adjustment Coding Specialist
Baptist Health South Florida
12.2020 - Current
- Perform medical record reviews prior to and following annual wellness visits and other identified visits to determine appropriate ICD-10-CM coding and billing and compliance with Medicare Risk Adjustment metrics.
- Support continuation of patient care by identifying patients with gaps in care or in need of MRI metrics reporting prior to each qualified visit.
- Document detailed chart audit findings including documentation errors, diagnosis errors as well as missed HCC opportunities in applicable audit tools on a daily basis.
- Identify and communicate documentation deficiencies to providers to improve documentations for accurate risk adjustment coding.
- Identify and document coding observations or discrepancies and provide information to management team to further enhance quality and/or provider education.
- Assist coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes.
- Facilitate and obtain appropriate physician documentation for any clinical condition or procedure to support the appropriate severity of illness diagnoses.
- Provide measurable, actionable, solutions to providers that will result in improved accuracy for documentation and coding practices.
Risk Adjustment Lead Coder Specialist Lead
Guidewell Sanitas
08.2017 - 12.2020
- Perform Quarterly audits to Commercial and Medicare Risk Adjustment Coder.
- Review HEDIS codes pertaining to each encounter and ensure closing Gaps.
- Assisting Billing Department to resolve denied/rejected claims issues and improve workflow in both departments.
- Provide Coding training sessions to educate according to National Coding Guidelines and Risk Adjustment Model.
- Attend meetings with the Health Plan for feedback on Risk Projects and Stars/Gaps.
- Analyze coder’s productivity and monitor Risk Project progress.
- Codify specialist’s notes, such as Cardiology, GYN/OB, Nephrology, Pulmonology, Urology, Podiatry, Dermatology, General Surgeon, Pain Management, and Sport Medicine.
- Codify Urgent Care
Medical Coder
Conviva Care Center
Miami, Fl
12.2013 - 08.2017
- Review medical records documentation for primary care and specialist’s outpatient encounters and assigned appropriate diagnoses, E/M codes and modifiers.
- Collaborate with physicians to identify and clarify missing, conflicting or non-specific documentation related to diagnoses and procedures.
- Performed Post audit chart reviews improving the overall completeness of clinical documentation and evaluation of HEDIS measures, MRA and Hierarchical Conditions Category (HCC) for Commercial Insurance and Medicare population.
- Verify and ensure the accuracy and appropriate coding based on CMS HCC categories.
- Key involved in HER, EMR, and the HIPPA process and office personnel training for compliance purpose.
- Validate HCCs query from insurance and coding recommendation
Education
Pharmacist Degree - undefined
Miami Dade College
Miami, Fl07.2025
Philology
University of Havana
La Habana01.2010
High School Graduate - undefined
IPVCE Felix Varela Morales
La Habana04.2009
Skills
- Good multi-tasking abilities with determination of completing assigned tasks
- Strong understanding of ICD-9/ICD-10-CM and CPT requirements and procedures, HCC RAF models
- Good interpersonal skills and the ability to function as a team member
- Experience with fast-paced medical care environments
- Worked in a fast-paced medical office with multiple physicians specializing in geriatrics
- Utilized knowledge of CPT and ICD-9/10-CM to properly translate performed services into numerical code for insurance company reimbursements
- Routinely communicated with insurance providers regarding submitted invoices
- Worked as a vital member of the medical office support staff team
- CPT
- ICD-9/10, HPCC, CPC
- Risk Adjustment
- Medical Terminology
- Payment Methodologies
- HIPPA Compliance
- Anatomy
- Surgery and Modifiers
- HCPCS Level II
Certification
Certified Professional Coder-AAPC 2014
Languages
Spanish
Native or Bilingual
English
Full Professional
Timeline
Risk Adjustment Coding Specialist
Baptist Health South Florida
12.2020 - Current
Risk Adjustment Lead Coder Specialist Lead
Guidewell Sanitas
08.2017 - 12.2020
Medical Coder
Conviva Care Center
12.2013 - 08.2017
Pharmacist Degree - undefined
Miami Dade College
High School Graduate - undefined
IPVCE Felix Varela Morales
Philology
University of Havana