Gerald Lazarte
La Canada,CA
Summary
My goal is to become a Compliance Coding Auditor. I have ten years of experience as a medical coder specializing in HCC and E&M compliance coding. I have perfected my aptitude in auditing electronic records and data abstraction. I apply attention to details in reviewing medical records and ways to improve operational processes effectively.
Overview
17
17
years of professional experience
Work History
Senior Certified Professional Coder
Providence Health & Service, MediRevv, Tegria
10.2014 - 01.2023
- Review edits and rejections and resubmit it with proper coding base on approved diagnosis codes from LCD and NCD, LMRP, and CCI edits
- Reviews of proper modifiers and elimination of codes in a bundled procedure for Medicare and Medi-Cal / CalOptima standard management documentation
- Review revenues according to its highest approved services.
- Medicare documentation review on members annual wellness visit.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Reviewed outpatient records and interpreted documentation to identify diagnoses, Evaluation and Management, and procedures.
- Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Resourcefully used various coding books, procedure manuals and on-line encoders.
- Reviewed patient charts to better understand health histories, diagnoses and treatments.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Accurately selected proper descriptive code when more than one anatomical location was indicated.
- Verified signatures and checked medical charts for accuracy and completion.
- Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
- Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
Temp Medical Coder for Providence Health Services
Kelly’s Services, Inc
07.2014 - 10.2014
- Abstract, review, and audit code from medical records to ensure procedures, E&M services, and diagnoses meet all ICD-9, ICD-10, HCC, CPT, CCI edits, AMA, CMS coding guidelines, and OIG rules and regulations
- To assigned appropriate E&M level, based on utilization of 95 or 97 audit worksheet for office and hospital care services including all related outpatient hospital procedures
- Perform physician queries as needed to validate outpatient procedure codes based on the medical reports in established physician query protocol.
HCC Remote Audit Coder
Altegra Health, PVT Int'l, LLC & MAWI Consultancy,
11.2013 - 07.2014
- Remotely assigned to capture all Risk Adjustment/HCC diagnoses in patients' medical records provided by the primary physician and all other consultations from medical specialty doctors
- Responsible for the accuracy of diagnoses submitted with its higher level of specificity.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Resourcefully used various coding books, procedure manuals and on-line encoders.
- Verified signatures and checked medical charts for accuracy and completion.
HCC Coder
Altegra Health
01.2010 - 07.2014
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Reviewed outpatient records and interpreted documentation to identify diagnoses.
- Reviewed, analyzed and managed coding of diagnostic contained in outpatient medical records.
- Resourcefully used various coding books, procedure manuals and on-line encoders.
HCC & EM Compliance Audit Contract Coder
The Coding Source, AE & Assoc., Jobal Healthcare
06.2006 - 01.2010
- Assigned to review patients’ medical records on-site in their EHR and paper charts to abstract diagnoses codes submitted to CMS
- To assure that the documentation is fully supported based on the CMS HCC conditions that apply to Medicare Risk Adjustment Reimbursement Initiative and ICD-9-CM coding guidelines
- Assigned to identify appropriate information from medical records according to NCQA HEDIS Technical Specifications data based on the documentation provided
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Verified signatures and checked medical charts for accuracy and completion.
- Assigned ICD-9 codes to the highest level of specificity based on the documentation that applies to Medicare Risk Adjustment Reimbursement Initiative with the applications of HCC coding guidelines
- To capture services, and other procedure charges provided by the HOV Charge Trigger system
- To review charges from medical records and transfer charges to Epic Health Connect system with updated and valid CPT codes.
- Client: Traveled to Kaiser Permanente, Scan, Methodist Healthcare Texas, Prospect Medical, etc.
Education
AAPC Learning– Certification for Outpatient Ambulatory Coding (COC) - in progress The Coding Source, LLC / PMCC – Medical Coding Certification - Medical Insurance Coding
The Coding Source, LLC
Los Angeles, CA12.2005
Associate of Science - Computer Programming
System Technology Institute
Philippines03.1997
Bachelor of Arts - Architecture
University of Santo Thomas
Philippines03.1993
High School Diploma -
Philippine Christian University
Philippines03.1983
Skills
- Data Verification
- Records Management
- Medical Terminology
- Procedural Codes
- Sequence Selection
- Diagnostic Codes
- CPT Code Modifiers
- Account Information Review
- ICD-10 Requirements
- Medical Claims Coding
- Medical Records Security
- ICD-10 (International Classification of Disease Systems)
- Demographics Information
- Coverage Determination
- 3M Encoder
- Medical Billing and Collections
- Data Abstraction
- Protected Health Information
Accomplishments
- Providence Saint Joseph Medical Center: Emergency Department Staff Volunteer August 2017 – February 2018 Minimum four hour every Sunday
- Credential & Certification
- Certified Professional Coder (CPC) – certified by: American Academy of Professional Coders (AAPC)
Bible class fellowships, Basketball, Trail walking
I joined the weekly Bible class with interactions and discussions for over a year. It helps to know my path and direction to make good life decisions. Playing basketball helps me to have full-body workouts. Walking on the trails relaxes me.
Timeline
Senior Certified Professional Coder
Providence Health & Service, MediRevv, Tegria
10.2014 - 01.2023
Temp Medical Coder for Providence Health Services
Kelly’s Services, Inc
07.2014 - 10.2014
HCC Remote Audit Coder
Altegra Health, PVT Int'l, LLC & MAWI Consultancy,
11.2013 - 07.2014
HCC Coder
Altegra Health
01.2010 - 07.2014
HCC & EM Compliance Audit Contract Coder
The Coding Source, AE & Assoc., Jobal Healthcare
06.2006 - 01.2010
AAPC Learning– Certification for Outpatient Ambulatory Coding (COC) - in progress The Coding Source, LLC / PMCC – Medical Coding Certification - Medical Insurance Coding
The Coding Source, LLC
Associate of Science - Computer Programming
System Technology Institute
Bachelor of Arts - Architecture
University of Santo Thomas
High School Diploma -
Philippine Christian University
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