Raven X. Calvio, CPC, CPC-I

• Banner Health | Level 1 Trauma Facility | Teaching Hospital
• Allegheny Health Network | Level 1 Trauma Facility | Teaching Hospital
• Systems used: Epic, 3M
• Verified proper coding, sequencing of diagnoses and accuracy of Cardiovascular, Interventional Radiology procedures, & inpatient encounters.
• Analyzed physician documentation for completeness, accuracy, and compliance with coding guidelines.
• Coded diagnoses and procedures from patient medical records using ICD-10-CM, HCPCS/CPT4, PCS, & DRG.
• Researched discrepancies between documentation and billing information in order to resolve any issues prior to submission.
• Maintained up-to-date knowledge of coding changes, updates, and new rules.
• Validated accuracy of diagnosis codes as well as modifiers used on claims before final submission to payer and insurance companies.
• Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD codes for diagnoses and procedures. (60%)
• Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. (15%)
• Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. (5%)
• Keeps informed of the changes/updates in ICD guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these updates in daily work. (5%)
• Acts as a mentor and subject matter expert to others. (5%)
• Engages in process improvement with coding team and management. (5%)

• Conducted audits of medical facilities to evaluate their performance in accordance with regulatory requirements.
• Collaborated with department managers, staff members, and other stakeholders to develop audit strategies and corrective action plans.
• Performed data analysis using software tools such as Microsoft Excel to identify trends in provider payments.
• Developed reports summarizing audit findings and recommendations for management review.
• Provided feedback to providers regarding coding errors or deficiencies identified during the audit process.
• Maintained detailed records of all auditing activities including observations, interviews, meetings.
• Participated in training sessions designed to keep abreast of new regulations and changes in the healthcare industry.
• Researched and implemented best practices to improve audit results.
• Cross-trained employees, enabling completion of priority tasks during personnel absences.
• Assisted with coding to ensure 3 day turn around time.
• Systems used: Nextgen, Optum 360 Encoder

• Jackson Heart Clinic

Verified proper coding, sequencing of diagnoses and accuracy of Cardiovascular and Interventional Radiology procedures for eighteen Cardiologists associated with St. Dominic Hospital.

Systems used: Epic, 3M

• Richland Primary Clinic

Verified proper coding, sequencing of diagnoses and accuracy for three primary care physicians and two nurse practitioners.

Systems used: Eclinical Works, Optum 360 encoder

• Plastic & Hand Surgery Associates

Verified proper coding, sequencing of diagnoses and accuracy of dermatology, cosmetic, plastic & reconstructive Surgery, and Orthopedic hand surgery for ten providers/surgeons associated with Merit Health & Women’s Hospital.

Acute care facility

Systems used: Epic, 3M

• Verified proper coding, sequencing of diagnoses and accuracy of Hepatology/GI procedures for fifteen providers and seven nurse practitioners associated with Baylor Scott & White Hospital.
• Coded 10 charts at rate of 5 per hour while maintaining 97% accuracy rate.
• Level 1 Trauma and Teaching facility
• Systems used: Cerner/Epic and 3M
• Assisted with Cerner to Epic transition as an Epic Superuser.