Summary
Overview
Work History
Skills
Certification
Accomplishments
Affiliations
Languages
Timeline
Generic

Diana Morales Morales

Marion,IA

Summary

I have extensive experience in the healthcare industry and am particularly well-versed in HEDIS/Stars, CPT II coding, ICD-10, and the importance of thorough clinical documentation. Healthcare, auditing, data analysis, leadership, communication, risk management, and quality management are just a few of the areas where my analytical abilities have been helpful. As a Certified Professional Coder and Risk Coder, my utmost concern is enhancing healthcare system efficiency and improving results. I will devote myself to providing education and therapy based on values to accomplish these aims.

Overview

9
9
years of professional experience
1
1
Certification

Work History

Value-Based Care Manager

Oasis Health Partners
Cedar Rapids, NE
05.2023 - Current
  • Coordinated healthcare projects with stakeholders.
  • Monitored program effectiveness and improvement.
  • Developed educational materials for practitioners.
  • Maintained effective communication for high-quality patient care.

Practice Performance Manager, Medicare Consultant

Optum
Cedar Rapids, IA
06.2020 - 05.2023
  • Provided customized analyses and insights for growth and led continuous improvement initiatives across 22 clinics.
  • Manage programs and provide healthcare providers with HEDIS and coding knowledge.
  • Supported CMS audits, RADV, and IVA with data-driven feedback and analytics.
  • Led teams, monitored KPIs, and executed quality and continuous improvement initiatives.
  • Managed quality control process to drive accuracy of performance inputs.
  • Leveraged analytical tools to provide insight and enhance performance.

Medicare Consultant

Optum
Cedar Rapids, IA
06.2018 - 06.2020
  • Developed work plans, managed deadlines, and prepared presentations for process improvements.
  • Collaborated with leadership to optimize recapture rates and ensure compliance with CMS and risk adjustment coding.
  • Conducted quarterly medical documentation evaluations for 28 clinics, CMS audits, and RADVs and provided documentation, billing, and coding training.
  • Utilized analytics for targeted Medicare risk adjustment training and supported clients with business analysis, documentation, and data modeling.
  • Delivered outstanding service to clients to maintain and extend relationships for future business opportunities.
  • Organized and analyzed research to understand industry, market, and company trends. Collaborate with leadership to optimize recapture rates.

Documentation Analyst

UnityPoint
Cedar Rapids, IA
05.2017 - 06.2018
  • Managed and reviewed medical records and extracted relevant information for coding in 18 clinics.
  • Analyze physician notes, laboratory results, and diagnostic reports.
  • Update training material, operation manuals, and technical guides to current standards.
  • Identify audit parameters to comply with quality standards.
  • Provide staff training and mentorship in preparing communication content for different media outlets.

Clinical Auditor

UnityPoint Health - Des Moines
Cedar Rapids, IA
11.2014 - 05.2017
  • Ensure accuracy and compliance of medical records for 18 clinics.
  • Identified fraud and abuse areas.
  • Educated providers on record integrity.
  • Identified control gaps and suggested methods for improvement.
  • Planned and executed audits; analyzed data and findings to prepare reports.

Skills

  • Advanced ICD-10 coding knowledge
  • Expertise in risk adjustment coding
  • Strong leadership and management skills
  • Ability to analyze complex data
  • Excellent communication and interpersonal skills
  • Proficiency in EHR and healthcare IT systems
  • Familiarity with regulatory requirements and compliance standards
  • Proven track record of process improvement
  • Strong problem-solving and decision-making skills
  • Commitment to quality and accuracy

Certification

Certified Risk Adjustment Coder (CRC) - AAPC Certified Professional Coder (CPC) - AAPC

Accomplishments

  • Awarded United Hero plaque at UHC by delivering exceptional support to providers in Stars incentive program

Affiliations

  • AAPC

Languages

Spanish
Native or Bilingual

Timeline

Value-Based Care Manager

Oasis Health Partners
05.2023 - Current

Practice Performance Manager, Medicare Consultant

Optum
06.2020 - 05.2023

Medicare Consultant

Optum
06.2018 - 06.2020

Documentation Analyst

UnityPoint
05.2017 - 06.2018

Clinical Auditor

UnityPoint Health - Des Moines
11.2014 - 05.2017
Certified Risk Adjustment Coder (CRC) - AAPC Certified Professional Coder (CPC) - AAPC

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Diana Morales Morales