Naga Lakshmi Vadavelli
Lisle,IL
Summary
Dedicated and detail-oriented Clinical Documentation Improvement (CDI) Specialist with over 14+ years of experience in CDI, inpatient coding and risk adjustment quality & review analyst (HCC coding). Proficient in Epic, 3M, and other EHR systems, with expertise in DRG assignment, severity of illness, risk of mortality, HCC coding, and enhancing the quality and completeness of provider-based clinical documentation within both inpatient and outpatient settings. Skilled in medical record auditing, provider education, and compliance with federal and state regulations. Adept at conducting detailed chart reviews, identifying documentation gaps, and facilitating effective communication between providers and coding teams to optimize reimbursement and patient care.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Senior Outpatient Clinical Documentation Improvement Specialist
Gebbs Healthcare Solutions
, United States Of America
07.2024 - 12.2024
- Review of medical record charts in a variety of outpatient settings to identify diagnoses that meet risk adjustment criteria for CMS HCC (Medicare Advantage, ACOs, and Alternative Payment Models) and HHS-HCC for ACA Marketplace Exchange, identifying documentation opportunities and coding compliance issues related to HCC/Risk Adjustment
- Maintained accurate documentation reflecting rendered care, illness severity, and mortality risk.
- Executed clear query implementation adhering to Query Practice Brief standards.
- Stay current with HCC documentation requirements, ICD-10-CM coding guidelines, conventions.
- Performing clinical validation of diagnoses documented in medical record charts to identify additional clinical documentation opportunities (query opportunities) to ensure clinical documentation accuracy for coding outcomes, including reviewing provider and other clinical documentation, chart disease processes, medications and their indications, diagnostic information, and treatment plans.
- Analyzed and implemented query recommendations for optimized workflow processes.
- Compiled review observations and audit data within specified repository.
Outpatient Clinical Documentation Specialist (CDS)
Enjoin.
, United States of America
09.2023 - 06.2024
- Conduct comprehensive chart reviews of both pre-encounter and post encounter records to identify opportunities for documentation improvement, collaborating with providers to address gaps and ensure accurate coding
- Collaborate with providers and staff to identify primary diagnoses, secondary diagnoses, pertinent HCCs, outpatient procedures, and ensure complete documentation in the outpatient/ambulatory setting
- Reviewed and validated medical records to ensure accurate reflection of patient conditions, aligning with coding standards and regulatory requirements
- Facilitate the improvement of clinical documentation to support the appropriate assignment of CPT and ICD-10-CM codes
- Analyze patient clinical status, treatment plans, and medical history to identify potential gaps in provider documentation; communicate with providers to validate observations and, when necessary, query for more specific documentation
- Actively participate in the identification, management, and development of Epic enhancements, aligning clinical documentation with coding guidelines
- Utilize Epic systems to monitor and review clinical documentation, ensuring compliance with healthcare regulations and organizational guidelines
- Maintain up-to-date knowledge of Epic systems, supporting the implementation of necessary changes to documentation processes
- Formulate clinical documentation clarifications to improve documentation of principal diagnoses, co-morbidities, and HCC diagnoses
- Utilize software systems for data collection, tracking, and reporting outcomes, ensuring data integrity through proficient abstracting and data entry
Senior Clinical Documentation Integrity and Coding Specialist
HCL Technologies Ltd.
Hyderabad, India
04.2020 - 06.2023
- Assigned appropriate DRGs, ensuring compliance with severity of illness and risk of mortality indicators
- Reviewed inpatient medical records for coding accuracy and documentation completeness
- Assisted in provider education to enhance coding and documentation practices
- Lead clinical and coding-focused tasks during the assessment, implementation, and monitoring phases of projects, ensuring alignment with organizational goals and standards
- Collaborate with clinical documentation improvement (CDI) teams to ensure that medical records accurately reflect the clinical conditions and services provided
- Analyzed medical records and claims data to identify and assess potential coding errors, documentation deficiencies, and other factors affecting risk adjustment
- Identifying and advocating for documentation improvements to better capture patient acuity and complexity, enhancing the quality of care and coding accuracy
- Participating in team-based peer chart and claims reviews, contributing insights to improve documentation practices and coding accuracy
- Writing, editing, and finalizing chart review findings, ensuring clear and effective communication with clients regarding documentation and coding outcomes
- Providing comprehensive training and education on clinical documentation, coding, and charging guidelines through virtual and in-person presentations and department discussions
- Collaborating closely with team members to achieve specificity, accuracy, and completeness in clinical documentation, supporting the highest level of medical record integrity
- Involved in training/mentoring of freshers
- Awards: Received 'Knowledge Champion' two times in 2022 for best performance and 'HCL Achiever’s League Award' in 2023 for exceptional performance
Senior Medical Coding Auditor
Optum Global Solutions (United Health Group)
Hyderabad, India
03.2016 - 03.2020
- Conduct comprehensive audits of medical records to ensure accurate coding of diagnoses in accordance with ICD-10-CM guidelines
- Identify coding errors and discrepancies, providing detailed feedback and corrective actions to coding staff to enhance compliance and accuracy
- Managed complex medical record reviews and coding audits, identifying trends and areas for improvement in coding practices and data accuracy
- Provide ongoing training and education to coding staff, focusing on areas of improvement identified through audit findings
- Prepare detailed audit reports and present findings to management, recommending process improvements and compliance strategies
- Collaborated with cross-functional teams to develop and deliver training programs focused on risk adjustment and HCC coding, enhancing the knowledge and compliance of internal and external partners
Medical Coder
Optum Global Solutions (United Health Group)
Hyderabad, India
09.2014 - 02.2016
- Apply clinical knowledge to optimize the identification of patient conditions in medical records, ensuring accurate documentation for appropriate reimbursement and outcome reporting
- Reviewing patient electronic medical records and assigning ICD-10 CM codes to the highest specificity ensuring accurate diagnostic and documentation for visit encounter
- Utilize the HHS Risk Adjustment Model to validate Hierarchical Condition Categories (HCC) derived from ICD-10-CM diagnosis codes, ensuring accuracy for the appropriate Benefit Year
- Evaluate the accuracy and completeness of diagnostic codes assigned to patient records, ensuring compliance with coding guidelines and regulations such as ICD-10-CM
- Stay up-to-date with changes in risk adjustment policies, regulations, and guidelines at the state and federal levels, ensuring compliance and adapting practices accordingly
- Maintained confidentiality and protected sensitive data to comply with HIPPA
- Deep understanding of medical terminology, anatomy, and physiology
- Demonstrated proficiency in adhering to coding guidelines of ICD-10-CM
- Received Edge award consecutively five times for consistent top performance
- Qualified for Enterprise level test for Six Sigma training
Quality Control Analyst
Mars Therapeutics & Chemicals Ltd
Hyderabad, India
08.2010 - 09.2014
- Operating analytical instrumentation in particular Gas Chromatography (GC)
- Instruments handled: Instrument Make: shimadzu; Software: GC solution; Model: GC2014 & Model: GC2010
- Instrument Make: PerkinElmer; Software: PC Navigator; Model: Head space model & Autosampler
- Checking, Cleaning, and operating of both systems
- Performing analytical chemistry assays based on new and existing methodologies
- Writing technical reports and log books to document analytical methods and transferring documented analytical methods to the QA department
- Collection of in-process samples from the production facility
- Experience in handling KF autotitrator
- Coordinate with senior members of the team to discuss and resolve any issues related to the process and to generate new ideas to improve the process
- To undertake any other reasonable duties as requested by our line manager/director on a permanent or temporary basis
Education
Master of Pharmacy - Pharmaceutical Analysis & Quality Assurance
Vishwa Bharathi College of Pharmaceutical Sciences
India06.2010
Bachelor of Pharmacy - Licensed pharmacist from Pharmacy Council of India
KVSR Siddhartha College of Pharmaceutical Sciences
India05.2008
Intermediate - Board of Intermediate Education
Aditya Junior College
India06.2004
Secondary School of Education -
India04.2002
Skills
- Clinical Documentation Improvement (CDI)
- Query Writing (AHIMA/ACDIS Guidelines)
- HCC Coding, ICD 10 CM, CPT coding and HCPCS
- Risk Adjustment, CDPS & HHS HCC Models
- Familiarity with Medicare, Medicaid, and ACA Regulations
- Medical Billing
- Outpatient/Physician Fee Service Auditing
- Medical Terminology
- Knowledge of Disease Conditions and Manifestations
- Attention to Detail
- Collaboration skills
- Ability to Stay Updated with Industry Changes
- Experience in Working Remotely
- Epic, 3M, Cerner, and EHR
- Coding Software: EncoderPro and TruCode
- Microsoft Office Suite: Word, Excel, and PowerPoint
Certification
- Certified Professional Coder (CPC), American Academy of Professional Coders, 2014
- Certified Risk Adjustment Coder (CRC), AAPC, 2024, 01336916
Accomplishments
- Involved in training/mentoring of freshers.
- Received 'Knowledge Champion' two times in 2022 for best performance.
- Received 'HCL Achiever’s League Award' in 2023 for exceptional performance.
- Received Edge award consecutively five times for consistent top performance.
- Qualified for Enterprise level test for Six Sigma training.
Timeline
Senior Outpatient Clinical Documentation Improvement Specialist
Gebbs Healthcare Solutions
07.2024 - 12.2024
Outpatient Clinical Documentation Specialist (CDS)
Enjoin.
09.2023 - 06.2024
Senior Clinical Documentation Integrity and Coding Specialist
HCL Technologies Ltd.
04.2020 - 06.2023
Senior Medical Coding Auditor
Optum Global Solutions (United Health Group)
03.2016 - 03.2020
Medical Coder
Optum Global Solutions (United Health Group)
09.2014 - 02.2016
Quality Control Analyst
Mars Therapeutics & Chemicals Ltd
08.2010 - 09.2014
Master of Pharmacy - Pharmaceutical Analysis & Quality Assurance
Vishwa Bharathi College of Pharmaceutical Sciences
Bachelor of Pharmacy - Licensed pharmacist from Pharmacy Council of India
KVSR Siddhartha College of Pharmaceutical Sciences
Intermediate - Board of Intermediate Education
Aditya Junior College
Secondary School of Education -
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