Daniel Rivera
Miami,FL
Summary
Certified Professional Coder. Working knowledge of CPT, ICD-9 and ICD-10. Knowledge and understanding of several different coding systems. Knowledge and understanding of authorizations and pre-certifications. Knowledge of medical billing/collection practices. Proficient in the full Microsoft Office Suite
Overview
18
18
years of professional experience
1
1
Certification
Work History
Coding Specialist
Signify Health
03.2024 - Current
- Achieved 98% accuracy in coding 120 to 130 medical charts daily, enhancing patient data integrity.
- Specialized in Hierarchical Condition Category (HCC) captures to optimize reimbursement processes.
- Consistently met daily coding targets, contributing to efficient departmental operations and workflow management.
- Reviewed and validated medical documentation to ensure compliance with coding standards and regulations.
- Collaborated with healthcare providers to clarify documentation requirements for accurate coding practices.
- Maintained up-to-date knowledge of coding guidelines and regulations to ensure compliance.
- Participated in ongoing training sessions to improve coding skills and knowledge in medical terminology.
Senior Operation Warehouse Associate
Go Puff
06.2021 - 12.2024
- Coordinated order fulfillment processes, ensuring timely dispatch of customer deliveries.
- Maintained accurate inventory records using warehouse management systems (WMS).
- Oversaw daily workflows, managing staff schedules to optimize resource allocation.
- Monitored equipment functionality and coordinated maintenance to minimize downtime risks.
- Prepared orders for shipment by picking, packing, and labeling merchandise.
- Collaborated with team members to achieve daily targets and complete tasks efficiently.
- Performed inventory control, such as counting, and stocking merchandise.
- Consistently met or exceeded productivity targets while maintaining high standards for quality and safety.
- Assisted in receiving, stocking and distribution of merchandise.
- Operated forklifts and pallet jacks to efficiently move inventory throughout warehouse.
- Implemented process improvements that reduced picking errors and increased productivity.
Medical Risk Adjustment Coder
Advantasure/UST Health proof
04.2023 - 02.2024
- Coding HCC Coding Charts to the best of my ability while maintaining 100% Accuracy and meeting QA Requirements
- Collaborated with clinical teams to enhance documentation accuracy and improve coding practices.
- Conducted comprehensive risk adjustment coding reviews to ensure compliance with regulatory standards.
- Analyzed patient data to identify coding discrepancies, driving improvements in overall data integrity.
- Evaluated coding audits and provided actionable feedback to minimize errors and optimize reimbursement processes.
- Improved revenue cycle management by accurately assigning HCC codes to maximize reimbursement potential.
- Achieved high levels of coder productivity by consistently meeting or exceeding established benchmarks for daily coding volume and accuracy rates.
- Enhanced data accuracy by meticulously reviewing and validating medical records for risk adjustment coding.
- Reduced coding errors through rigorous attention to detail, thorough knowledge of ICD-10-CM guidelines, and continuous professional development.
- Maintained accuracy, completeness, and security for medical records and health information.
Remote Risk Adjustment Coder
CSI Companies/UHG
04.2022 - 04.2023
- Coding HCC Medical Charts with the highest attention to detail, following Official Coding Outpatient and Inpatient Guidelines, while maintaining accuracy 95% or higher
- Reviewed and analyzed medical records for accurate documentation and coding integrity.
- Collaborated with healthcare providers to clarify documentation discrepancies.
- Achieved high levels of coder productivity by consistently meeting or exceeding established benchmarks for daily coding volume and accuracy rates.
- Reduced coding errors through rigorous attention to detail, thorough knowledge of ICD-10-CM guidelines, and continuous professional development.
- Maintained accuracy, completeness, and security for medical records and health information.
Personal Shopper
Instacart
10.2017 - 06.2021
- Monitor checkout stations to ensure that they have adequate cash available and that they are staffed appropriately.
- Compute and record totals transactions
- Issue receipts, refunds, credits, or change due to customers
- Maintain clean and orderly checkout areas.
- Answering customers questions and provide information on procedures or policies
Remote Coding Review Consultant
Inovalon
03.2016 - 07.2017
- Responsible for conducting chart reviews for purposes of identifying, confirming, and/or documenting appropriate medical coding; perform quality control over-read reviews of previously completed record reviews to ensure accuracy, completeness, and overall high-quality of the record review processes
- Knowledge of coding guidelines and regulations as they relate to Risk Management.
- Abide by all HIPAA and associated patient confidentiality requirements.
- Coding CRG, HCC Charts and E-Pass Charts following proper Outpatient and Inpatient Coding Guidelines
HCC Coder
OS2 Healthcare Solutions
10.2015 - 11.2015
- Handle information about patient treatment, diagnosis, and related procedures to ensure proper coding
- Review medical procedures as documented by service providers
- Translate medical treatment into codes that can be interpreted by payers, other medical coders, and other medical facilities
- Submit claims to insurance companies and other third-party payers
- Receiving patient treatment codes to use in assembling reimbursement claims
Medical Biller
Managed Care Consortium Group
08.2012 - 09.2015
- Coding Daily Claims for assigned provider Groups
- Entering Claims for assigned provider Groups.
- Generating Clean Claims.
- Provide practices with accurate responses to inquires regarding ICD-9, CPT and HCPCS request
Cashier/ Customer Service Representative
Staples
Miami, FL
01.2008 - 06.2009
- Ensured adequate cash and staffing at checkout stations for efficiency.
- Accurately computed and recorded transaction totals for customer purchases.
- Issued receipts, refunds, and change promptly to maintain customer satisfaction.
- Maintained clean, organized checkout areas to enhance customer experience.
- Answered customer inquiries and provided clear information on policies and procedures.
Education
High School -
Smart Horizon High School
Miami, FloridaRisk Adjustment/HCC Coding
AAPC
Remote04.2015
Certified Professional Coder Program -
Excelsior Technical Institute
Doral, FL10.2013
Skills
- ICD-10 proficiency
- HIPAA compliance
- Medical abbreviations
- Procedural coding accuracy
- Diagnostic coding accuracy
- Professional ethics
- CPT coding
- Code validation
- HCPCS level II coding
Certification
- CPC - Certified Professional Coder
- CRC - Certified Risk Adjustment Coder
Timeline
Coding Specialist
Signify Health
03.2024 - Current
Medical Risk Adjustment Coder
Advantasure/UST Health proof
04.2023 - 02.2024
Remote Risk Adjustment Coder
CSI Companies/UHG
04.2022 - 04.2023
Senior Operation Warehouse Associate
Go Puff
06.2021 - 12.2024
Personal Shopper
Instacart
10.2017 - 06.2021
Remote Coding Review Consultant
Inovalon
03.2016 - 07.2017
HCC Coder
OS2 Healthcare Solutions
10.2015 - 11.2015
Medical Biller
Managed Care Consortium Group
08.2012 - 09.2015
Cashier/ Customer Service Representative
Staples
01.2008 - 06.2009
High School -
Smart Horizon High School
Risk Adjustment/HCC Coding
AAPC
Certified Professional Coder Program -
Excelsior Technical Institute