Belissa Cipreni
Summary
Polished professional manages multiple tasks, utilizes electronic medical record systems, and provides excellent customer service to patients and staff. Adheres to medical records policies and procedures to comply with HIPAA regulations. Track record of effectively troubleshooting issues and maintaining patient confidentiality.
Fully Bilingual (Spanish), CPC and CRC Certification, Proficient with Electronic Medical Records (EMR) and Power Point, Microsoft Office® (Word®, Excel®, Outlook®).
Overview
19
19
years of professional experience
Work History
Clinical Risk Adjustment Coder
SecondWave Data System
10.2022 - 02.2024
- Reviews medical records, consultations notes, progress notes, patient medical history, physical exam, review of system, discharge summary, diagnostic and operation reports to determine if specific disease or conditions were correctly reported and the codes supported based on documentation and following ICD-10-CM Guidelines for coding and reporting.
- Demonstrated flexibility and adaptability in response to changes in coding guidelines, software systems, or departmental priorities.
- Streamlined workflow efficiency by collaborating with interdisciplinary teams, addressing documentation gaps and inaccuracies.
- Performed electronic medical record review to capture all HCC diagnosis codes based on cos Hierarchical Condition Categories conditions that are applicable to Medicare Risk Adjustment and Commercial reimbursement.
- Retrospective CDI alerts and queries
- Maintained a minimum of 95% accuracy on HCC and CDI quality audits.
- Improved HEDIS measures trough the review and audit records to confirm compliance with HEDIS and NCQA standards.
- Close HEDIS gaps.
- Assisted the QA team whenever is needed.
Risk Adjustment Coder II
Advantasure/Blue Cross Blue Shield Of Michigan
07.2016 - 09.2022
- Performed code abstraction and/or coding quality audits of medical records to ensure ICD-9-CM/ICD-10-CM codes are accurately assigned and supported by clinical documentation.
- Review medical records to ensures complete capture of relevant HCC diagnosis.
- Retrospective CDI alerts.
- knowledge of ICD-9-CM/ICD-10-CM codes, CMS documentation requirements, and state and federal regulations.
- Maintained a minimum 95% accuracy on coding quality audits.
- Contributed to ongoing process improvements within the department by identifying inefficiencies or inconsistencies in current workflows and suggesting practical solutions.
- Ensured compliance with CMS regulations and guidelines by staying up-to-date on industry standards and best practices.
- Maintained strict confidentiality of patient information in accordance with HIPAA regulations while managing sensitive data.
Case Management Coordinator
PayerFusion
09.2015 - 06.2016
- Collaborated with interdisciplinary teams to develop comprehensive care plans tailored to post discharged individual needs.
- Collaborated with multidisciplinary teams to facilitate client care and reduce case management barriers.
- Streamlined, standardized and implemented case management processes and techniques to maximize revenue cycle.
- Concurrent monitoring of inpatient and outpatients treatment plans.
- Coordination of hospital admissions and appointments.
- Coordination of referrals.
Appeals and Grievance Analyst
MMM & PMC Holdings
04.2013 - 08.2015
- Collaborated with cross-functional teams to identify opportunities for process improvement and increased efficiency.
- Improved internal knowledge sharing by developing comprehensive documentation outlining standard operating procedures for various tasks.
- Provided expertise or general support in processing, reviewing, evaluating, investigating, negotiating and resolving all claim appeals through resubmission to healthcare providers and/or members with complete and accurate supporting documentation.
- Track and log all open appeals and follow up to ensure their timely resolution established by CMS.
- Experience with National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and Outpatient coding guidelines for coding and reporting.
- Conduct pertinent research in order to evaluate, respond and close appeals in accordance with all established regulatory guidelines.
- Identify and analyze trends for claim appeals and develop methods to prevent negative outcomes and also identify methods to improve internal processes to minimize denials.
- DRG audits for claim denials resolutions.
- Maintained complete confidentiality of patient information and HIPPA regulations.
Provider Specialist
MMM & PMC Holdings
01.2012 - 04.2013
- Monitored contractual compliance within the network by conducting thorough reviews periodically.
- Streamlined provider onboarding processes for increased efficiency and timely completion.
- Developed strong relationships with providers, fostering trust and collaboration.
- Educate providers regarding policies and procedures related to referrals and claims, web site education, and problem solving.
- Respond to a variety of technical issues from the Provider Portal and issues with billing, authorizations and other inquiries such as contracting issues or credentials, coverage, appeals status and coding related issues.
- Excellent service skills and demonstrated call control with high level of courtesy and professionalism.
Customer and Provider Specialist
Humana Health Insurance
02.2009 - 01.2012
- Developed strong relationships with providers, fostering trust and collaboration.
- Managed a portfolio of providers while effectively handling multiple priorities and deadlines.
- Handled escalated or complex inquiries from providers by applying problem-solving skills leading to satisfactory resolutions.
- Assisted in contract negotiations, ensuring mutually beneficial agreements between providers and the organization.
- Provided outstanding and on-demand service to Commercial members, Medicare, Medicaid and healthcare providers.
- Provided Portal technical support for members, providers, pharmacies and third parties.
- Medical and dental claims analyzing in order to provide billing and denial solutions.
Professional Bank Teller
Bank Of America
06.2005 - 06.2007
- Managed high-volume transactions during peak hours while maintaining attention to detail, ensuring seamless customer experience.
- Balanced cash drawers accurately at the end of each shift, minimizing discrepancies in financial records.
- Answered customer inquiries regarding account balances, transaction history, services charges, and interest rates.
- Established trust with clients by maintaining confidentiality and protecting sensitive financial information.
- Managing customer inquiries and ensuring accurate and compliant operations within the Service Department and Relationships Bankers division.
- Explained and promote products and services and follow banking policies and procedures.
Education
Certification - Medical Coding
Excelsior Technical Institute
Doral, FL06.2016
No Degree - Psychology
Metropolitan University
San Juan, Puerto Rico01.2013
Bachelor of Arts - Advertising
University of Puerto Rico - Carolina
Carolina, PR06.2001
Skills
- Self-motivation and discipline
- ICD-10 Proficiency
- Leadership Qualities
- HIPAA Compliance
- Clinical Documentation Review
- Continuous Learning Attitude
- Diagnostic Coding Accuracy
- Training and Mentoring Abilities
- Deadline Oriented Approach
Affiliations
- AAPC
Timeline
Clinical Risk Adjustment Coder
SecondWave Data System
10.2022 - 02.2024
Risk Adjustment Coder II
Advantasure/Blue Cross Blue Shield Of Michigan
07.2016 - 09.2022
Case Management Coordinator
PayerFusion
09.2015 - 06.2016
Appeals and Grievance Analyst
MMM & PMC Holdings
04.2013 - 08.2015
Provider Specialist
MMM & PMC Holdings
01.2012 - 04.2013
Customer and Provider Specialist
Humana Health Insurance
02.2009 - 01.2012
Professional Bank Teller
Bank Of America
06.2005 - 06.2007
Certification - Medical Coding
Excelsior Technical Institute
No Degree - Psychology
Metropolitan University
Bachelor of Arts - Advertising
University of Puerto Rico - Carolina
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