Ketty Pradera Navarro
Tampa,USA
Summary
Experienced and certified Risk Adjusting Coder (CRC, CPC) with strong proficiency in ICD-10-CM coding, HCC mapping, and prospective and retrospective chart review. Skilled in querying providers, collaborating with clinical teams, and maintaining strict compliance with CMS/HHS regulations. Proven track record of 98% accuracy. Highly adaptable in a remote environment and deadline-driven setting.
Overview
2
2
years of professional experience
1
1
Certification
Work History
HCC Specialist
Optum
Remote
06.2023 - Current
- Conducted a detailed retrospective and prospective chart review to capture missed HCC codes.
- Mapped diagnosis accurately to CMS-HCC categories, ensuring proper risk adjustment.
- Issued queries to providers to obtain clinical documentation that meets coding standards.
- Consistently maintained 98% accuracy and met productivity metrics.
Medical Biller
TopMD
Tampa, FL
02.2023 - 06.2023
- Prepare, review, and submit claims using billing software, including paper and electronic claims processing.
- Verification of eligibility and verification of benefits for treatments, hospitalizations, and procedures.
- Review patient bills for accuracy and completeness, and obtain missing information.
Education
Certificate Technical Program - Medical Billing and Coding
Ana G Mendez University
Tampa, FL, USA08.2021
Skills
- ICD-10-CM coding and HCC mapping
- CMS-HCC and HHS-HCC risk models
- Retrospective/prospective chart review
- Providers, queries, and documentation clarification
- Compliance with HIPAA, CMS, and AAPC guidelines
- Team collaboration and clinical support
- Microsoft Office Suite
Certification
- Certified Risk Adjustment Coder (CRC)- AAPC 08/2024
- Certified Professional Coder (CPC)- AAPC 08/2021
ID 01881504
Timeline
HCC Specialist
Optum
06.2023 - Current
Medical Biller
TopMD
02.2023 - 06.2023
Certificate Technical Program - Medical Billing and Coding
Ana G Mendez University
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