Meyver Perez Leon
Tampa,FL
Summary
Foreign Medical Doctor. Accomplished Risk Adjustment Coder with seven years of HCC coding expertise. Highly experienced in HCC coding, with an extensive background in medical coding, auditing, and regulatory compliance. Strong understanding of ICD-10-CM guidelines and Risk Adjustment models. Demonstrated ability to perform accurate code assignments while maintaining high productivity rates. Noteworthy impact made by improving accuracy of coded data and reducing billing errors in previous roles.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Risk Adjustment Specialist
Highmark Health
10.2024 - Current
- Clinical Quality Management Analyst/ Risk Adjustment Accuracy Management.
- HCC coding, projects with different MA, ESRD, and ACA models.
- NLP Coding.
- Experience with the V28 HCC Model.
HCC- Risk Adjustment Coder
Maxim Health Care/ Amergis Health Care
10.2022 - 12.2024
- Reveleer Project - IVA Coder.
HHS - HCC Projects
BCBSMI HCC Validation Project - MA/HCC Models Categ. V24/ V28
Experience using the Validation Reason Code (VRC).
Experience as an Overread coder using EVE (Evidence Validation Engine).
- Episource - HCC coder for HHS/CMS projects.
HCC- Risk Adjustment Coder
GeBBS Healthcare Solutions
Culver City, CA
04.2023 - 10.2024
- HCC Validation/ Neoplasms Validation using Integrated Auditing Workbench (IAW)/ for CMS/HHS-MA/ACA
- CMS-HCC Risk Adjustment Data Validation.
HCC-Risk Adjustment Coder
Change Health Care
09.2022 - 10.2023
- United Health Care - Optum Services
Risk Adjustment HCC: Seasonal Project.
HCC Coder
Bayside Clinical Research/ Bayside Medical Group
03.2021 - 12.2022
- HCC coder.
Quality assessment ensures that clinical documentation accurately portrays patient health status, and that all clinically documented diagnoses are reported correctly before submitting any claim.
HCC – Risk Adjustment Medical Coder
CSI Companies- Optum
04.2018 - 07.2020
- Risk Adjustment Coder.
Medical Doctor and Traumatology Assistant
Santa Fe Clinic
, Ecuador
03.2013 - 03.2016
- Company Overview: Ecuador
- Ecuador
Medical Auditor
Salud SA Company
, Ecuador
04.2014 - 09.2015
- Company Overview: Ecuador
- Ecuador
Medical Doctor
Carlos J.Finlay Hospital General
, Cuba
01.2012 - 01.2013
- Company Overview: Havana- Cuba
- Havana- Cuba
Education
Certificate - Certified Professional Coder (CPC)
American Association of Professional Coders (AAPC)
Salt Lake City, Utah12-2017
Medical Doctor -
University of Medical Sciences
Havana, Cuba07-2012
Skills
- Strong and advanced understanding of medical terminology, medical abbreviations, clinical knowledge related to acute and chronic illness diagnosis, treatment, management, pathophysiology, pharmacology, anatomy, body systems, and concepts of disease processes
- Confidentiality and knowledge of HIPAA requirements
- RA-HCC coding experience, 7 years
- Extensive knowledge working with different models of risk adjustment ( CMS HCC/HHS ACA)
- Experience in RADV/IVA (data validation)
- Strong experience working with different EMR systems and coding platforms, eg, CAO, Optum M360, Edifecs, ICS (Intelligent Coding Solution), iOS, eClinicalW, Epic/iCRA, Salesforce/Episource, NextGen, WAVE Health Technologies/CodelogixPlus, Practice Fusion, IAW - Auditing Neoplasm Projects, and Spectrum - Highmark
- Outpatient/ Inpatient guidelines
- E/M codes, CPT and HCPCS
- Team collaboration
- Professionalism and integrity
- Self-motivated, with attention to detail
- Problem solving, decision making, empathy
- Responsibility, discipline, remote work
- Deadline-driven environment
- Efficiency under pressure
- Written and oral communication
- Ability to accept and develop new projects
- Computer proficiency (MS Windows, MS Office, Internet, Outlook, meeting platforms)
- Clinical Quality Management Analyst
- Ability to apply complete and consistent coding practices for the production of high-quality healthcare data
- Maintain quality (>95% quality standards), daily goals and productivity in any project assigned
- Ensure diagnosis codes are supported by the documentation, and ensure adherence to ICD-10-CM Guidelines for Coding and Reporting, updated
- HCC coding on projects for MA, ACA, and ESRD Ability to quickly flex between coding projects, including retrospective and prospective coding, with different MA, ESRD, and ACA HCC models
- Audit assigned coded charts for quality assessment, and ensure clinical documentation accurately portrays patient health status, and ensure all clinically documented diagnoses are reported correctly before submitting any claim
- Ensures compliance with all applicable federal laws and regulations related to coding and documentation guidelines
Certification
AAPC, 01485052
Languages
- English
- Spanish
References
- Jessica Prokop, Supervisor Strategic RA coding Highmark, 716-887-8573
- Robert Leon, Site Director -Bayside Medical Group, 813-368-5738
- Hannah Morrison, Manager of Coding Operations-Optum, 859-629-1279
Academic Data
- American Association of Professional Coders (AAPC), 01/01/17, Present, Salt Lake City, UT, Certified Professional Coder (CPC)
- University of Medical Sciences, 01/01/06, 01/01/12, Havana, Cuba, Medical Doctor
Summary/Roles Responsibilities
- Maintain quality standards and productivity in projects
- Review medical records for diagnosis codes accuracy
- Audit assigned coded charts for quality assessment
- Perform medical record review for relevant diagnosis codes
- Determine valid encounters and ensure documentation compliance
- Ensure adherence to coding and reporting guidelines
Languages
English
Professional
Spanish
Professional
Timeline
Risk Adjustment Specialist
Highmark Health
10.2024 - Current
HCC- Risk Adjustment Coder
GeBBS Healthcare Solutions
04.2023 - 10.2024
HCC- Risk Adjustment Coder
Maxim Health Care/ Amergis Health Care
10.2022 - 12.2024
HCC-Risk Adjustment Coder
Change Health Care
09.2022 - 10.2023
HCC Coder
Bayside Clinical Research/ Bayside Medical Group
03.2021 - 12.2022
HCC – Risk Adjustment Medical Coder
CSI Companies- Optum
04.2018 - 07.2020
Medical Auditor
Salud SA Company
04.2014 - 09.2015
Medical Doctor and Traumatology Assistant
Santa Fe Clinic
03.2013 - 03.2016
Medical Doctor
Carlos J.Finlay Hospital General
01.2012 - 01.2013
Certificate - Certified Professional Coder (CPC)
American Association of Professional Coders (AAPC)
Medical Doctor -
University of Medical Sciences
Similar Profiles
Michael HavensMichael Havens
Customer Service Representative at Highmark HealthCustomer Service Representative at Highmark Health
Dawn Melissa FindlingDawn Melissa Findling
Procurement Specialist/Vender Relations at Highmark HealthProcurement Specialist/Vender Relations at Highmark Health
Yamini SuguruYamini Suguru
Sr. Application Developer at Highmark HealthSr. Application Developer at Highmark Health
Nicholas RhoadesNicholas Rhoades
Shift Supervisor at OG SubsShift Supervisor at OG Subs
KARTIK PUNEKARKARTIK PUNEKAR
SENIOR SOFTWARE DEVELOPMENT ENGINEER IN TEST at VONAGESENIOR SOFTWARE DEVELOPMENT ENGINEER IN TEST at VONAGE