Paulito Pelicano
Summary
Results-driven coding and HCC Auditor expert with a deep understanding of medical coding standards and procedures. Proven track record of ensuring precise code assignment, leading to improved billing efficiency and maximized reimbursement. Recognized for exceptional teamwork and adaptability in dynamic environments, complemented by strong analytical and communication skills that facilitate effective collaboration and problem-solving. Committed to continuous improvement and excellence in healthcare auditing and coding practices.
Overview
9
9
years of professional experience
1
1
Certification
Work History
HIM Coding Auditor
Samstaff for Kaiser Permanente
02.2025 - Current
- Conduct quality audits on coder-reviewed charts, maintaining a minimum 95% quality threshold.
- Address coding inquiries, provide clarifications, and recommend corrective actions to ensure compliance.
- Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
HCC Quality Coding Specialist
Corrohealth
10.2024 - Current
- Audit and validate ICD-10-CM codes for HCC, RxHCC, and ESRD models, ensuring compliance with Medicare, ICD-10-CM, and client-specific guidelines.
- Provide clear, detailed feedback to coders to enhance accuracy and reduce repeat errors.
- Act as a coding subject matter expert, offering guidance on project requirements and coding standards.
Risk Adjustment Auditor
Wellerhit
02.2022 - 01.2025
- Audited coder work for ICD-10 and project guideline adherence, providing detailed performance feedback.
- Achieved ≥95% accuracy while consistently meeting 100% productivity benchmarks.
- Served as a resource for coding questions, resolving discrepancies promptly.
- Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
HCC Auditor I
Regal Medical Group
09.2022 - 10.2024
- Audit and validate ICD-10-CM codes for HCC, RxHCC, and ESRD models, ensuring compliance with Medicare, ICD-10-CM, and client-specific guidelines.
- Improved coding documentation integrity within medical records and HCC databases.
- Generated QA reports to track coder accuracy, trends, and adherence to established guidelines.
- Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
Eligibility / Claims Specialist
TeamHealth
10.2018 - 09.2022
- Resolved claim denials by verifying eligibility via payer websites and insurer calls.
- Analyzed denial reasons and submitted corrected claims to appropriate payers.
- Consistently exceeded departmental standards for productivity and quality.
Risk Adjustment Coder
AE & Associates, LLC
11.2019 - 05.2022
- Reviewed and coded medical records for risk adjustment using ICD-10-CM in compliance with client guidelines.
- Verified documentation completeness before coding to ensure audit readiness.
- Maintained ≥95% accuracy and consistently achieved 100% productivity.
- Reduced coding errors through rigorous attention to detail, thorough knowledge of ICD-10-CM guidelines, and continuous professional development.
Coder I
Valley Medical Coding
04.2019 - 10.2019
- Assigned ICD-10-CM, CPT, and PCS codes based on project-specific guidelines.
- Validated chart completeness prior to coding to ensure compliance and accuracy.
- Achieved high performance in both accuracy and productivity metrics.
Medical Records Specialist II
IPC / TeamHealth
11.2017 - 10.2018
- Abstracted medical records from multiple EMR/EHR systems for internal department requests.
- Processed manual record requests via fax and telephone.
- Maintained accuracy and exceeded productivity goals.
Release of Information Specialist (ROI)
Sharecare HDS
01.2017 - 11.2017
- Managed secure medical record systems by scanning, indexing, and uploading documentation.
- Processed Patient, Provider, Insurer, and Government record requests in strict compliance with HIPAA and hospital policies.
- Reduced errors in released records by thoroughly reviewing documentation before submission.
- Decreased turnaround time for record requests by prioritizing tasks and utilizing organizational skills.
Education
Medical Coding - CCS
Valley Medical Coding Institute
Los Angeles, CAMed Office Specialist - Billing/Coding
National Career College
Panorama City, CABachelor of Science - Medical Technology
FEU Institute of Medicine
Skills
- ICD-10-CM expertise
- CPT
- PCS
- Healthcare vocabulary expertise
- Medical record documentation
- HIPAA compliance knowledge
- Medical claims processing
- Claims processing
- Experience with electronic health records - Epic, Eclinical, Cerner, etc
- Proficient in using different encoders such as HCC coder, 3M Optum, Find-a-code,etc
Certification
- AHIMA (CCS), 03/01/19 - 03/01/27, #226264
- AAPC (CRC), 03/01/23 - 03/01/26, #01824565
Timeline
HIM Coding Auditor
Samstaff for Kaiser Permanente
02.2025 - Current
HCC Quality Coding Specialist
Corrohealth
10.2024 - Current
HCC Auditor I
Regal Medical Group
09.2022 - 10.2024
Risk Adjustment Auditor
Wellerhit
02.2022 - 01.2025
Risk Adjustment Coder
AE & Associates, LLC
11.2019 - 05.2022
Coder I
Valley Medical Coding
04.2019 - 10.2019
Eligibility / Claims Specialist
TeamHealth
10.2018 - 09.2022
Medical Records Specialist II
IPC / TeamHealth
11.2017 - 10.2018
Release of Information Specialist (ROI)
Sharecare HDS
01.2017 - 11.2017
Medical Coding - CCS
Valley Medical Coding Institute
Med Office Specialist - Billing/Coding
National Career College
Bachelor of Science - Medical Technology
FEU Institute of Medicine
Similar Profiles
Marie A. StevensonMarie A. Stevenson
Patient at Patient FinancialAdvisor, Kaiser Permanente Eligibility and FinancialServices, FinancialAdvisor, Kaiser PermanentePatient at Patient FinancialAdvisor, Kaiser Permanente Eligibility and FinancialServices, FinancialAdvisor, Kaiser Permanente
Karina MaheyKarina Mahey
Teleservice Representative at Kaiser Permanente - The Permanente Medical GroupTeleservice Representative at Kaiser Permanente - The Permanente Medical Group
MICHAEL NAVAMICHAEL NAVA
Area Director at Kaiser Permanente – The Permanente Medical GroupArea Director at Kaiser Permanente – The Permanente Medical Group
Maria FuentesMaria Fuentes
OASIS & Coding Auditor, Quality Assurance, Coding/ at Bee Well Home Health CareOASIS & Coding Auditor, Quality Assurance, Coding/ at Bee Well Home Health Care
JAUNITA DISASIJAUNITA DISASI
Medical Coding Auditor Specialist at Personalized Health PartnersMedical Coding Auditor Specialist at Personalized Health Partners