Maria Madelin Maceiro Lazo
Miami,FL
Summary
MRA Coding Analyst with over 8 years of expertise in medical coding and compliance, adept at ensuring precise CMS payments and advancing quality care through provider education on risk adjustment. Proficient in HEDIS, ICD-10, and HIPAA, with a robust background in data entry and pharmacy coordination, leveraging analytical skills to enhance coding precision and regulatory adherence. Committed to pioneering improvements in coding accuracy and fostering a culture of compliance within healthcare organizations.
Overview
8
8
years of professional experience
Work History
Coding Auditor
Pasteur/ Wellmax Medical Center
05.2021 - Current
- Verifying that diagnosis and procedure codes are correct and up-to-date according to current coding guidelines (such as ICD-10, CPT, HCPCS)
- Ensuring the codes accurately reflect the services provided to the patient
- Ensuring that coding complies with local, national, and international regulations, including reimbursement and insurance billing rules (e.g., Medicare, Medicaid, private insurance)
- Ensuring adherence to privacy and patient data protection regulations, such as HIPAA (Health Insurance Portability and Accountability Act)
- Reviewing medical documentation and clinical records to ensure they are complete, accurate, and consistent with the codes used
- Identifying and correcting discrepancies between medical records and coding
- Detecting potential fraud or errors in coding, such as incorrect or inappropriate codes for the treatment received, to prevent fraudulent or excessive claims
- Developing and implementing procedures to reduce coding errors and minimize fraud risks
- Providing ongoing training to physicians, nurses, and administrative staff on best coding practices
- Offering support in resolving coding and billing-related issues
- Generating detailed reports on audits performed, highlighting findings, necessary corrections, and actions taken
- Evaluating and continuously improving coding processes within the organization to increase accuracy and efficiency
- Working closely with other departments, such as billing, accounting, and administration, to ensure proper billing and payment compliance
- Collaborating with internal and external auditors in conducting periodic audits and implementing improvements
Coding Specialist
DD Medical Group – MSO
02.2018 - 05.2021
- Company Overview: Simply Healthcare
- As an MRA Coder Analyst I Perform on site and remote clinical validation audits and interpretation of medical documentation to capture of all relevant coding in coordination with the physician
- Verify and ensure the accuracy, completeness, specificity and appropriate coding based on CMS HCC Categories
- Analyze and translate medical and clinical diagnoses, procedures, injuries, and illnesses with designated ICD codes
- Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative reports and pathology reports and discharge summaries
- Perform ongoing analysis of medical charts for appropriate coding compliance
- Ensure compliance with all applicable Federal, State laws regulations according to the documentation guidelines
- Provide support and compliance with each HEDIS specification
- Facilitate education and/or educate providers and office staff on proper CMS Risk Adjustment Coding
- Participate in departmental and organizational quality management activities
- Simply Healthcare
Pharmacy Coordinator
Wellmax Medical Center
09.2016 - 02.2018
- Verifies member information and inputs data for the Pharmacist
- Educates members on pharmacy-based rules related to prescriptions and medication resources or assistance programs
- Processes prior authorization request form physician offices and ensure compliance with Medicare requirement
- Responds to inquiries form physician, sales team, and members related to formulary and prescription benefits
- Keep the pharmacy inventory by checking pharmaceutical stock to determine inventory level, anticipating needed medications supplies, ordering, verifying, receive, remove and update drugs
Education
CDEO Certified Documentation Expert Outpatient -
10.2023
CPMA Certified Professional Medical Auditor -
12.2020
CRC Certified Risk Adjustment Coder -
Hialeah05.2019
CPC Certified Professional Coder -
05.2018
Registered Pharmacist Intern -
02.2014
Bachelor’s Degree - Pharmacy
University of Havana
08.1996
Skills
- Extensive knowledge of medical terminology
- Excellent data entry skills
- Good interpersonal relationships
- Ability to function as a team member
- Ability to perform excellently under pressure
- Ability to listen and understand different points of view
- Good multi-tasking abilities
- Compliance standards
- Balance sheets
- Excel & Word like Software
References
- Dr. Alfredo Dally, DD Medical, 305-269-8099
- Dr. Aniano Cabrera Garcia, Wellmax Medical Center, 305-631-8080
- Dr. Rafael Chiong, Pasteur Medical Partner
Timeline
Coding Auditor
Pasteur/ Wellmax Medical Center
05.2021 - Current
Coding Specialist
DD Medical Group – MSO
02.2018 - 05.2021
Pharmacy Coordinator
Wellmax Medical Center
09.2016 - 02.2018
CDEO Certified Documentation Expert Outpatient -
CPMA Certified Professional Medical Auditor -
CRC Certified Risk Adjustment Coder -
CPC Certified Professional Coder -
Registered Pharmacist Intern -
Bachelor’s Degree - Pharmacy
University of Havana
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