Summary
Overview
Work History
Education
Skills
Affiliations
Certification
Accountability
Languages
Timeline
Generic

Raymond Rios

Tampa,FL

Summary

Meticulous Clinical Fraud Investigator with expertise in medical terminology and coding. Proven ability to conduct thorough audits and educate providers, ensuring compliance with CPT and HCPCS guidelines.

Overview

18
18
years of professional experience
1
1
Certification

Work History

Clinical Fraud Investigator II

Elevance Health
Tampa, FL
08.2008 - Current
  • Providers Onsite Audit - Medical record review to identify documentation that supports the billed CPT and HCPCS codes.
  • Use reference such as : Medicare claims processing manuals, Local Coverage Determination and CMS Guidelines.
  • Refers cases with findings to the appropriate federal agencies or internal departments.
  • Providers education - Provide references that support the audit findings.

Education

Certification - Health

American Academy of Professional Coders
San Juan, PR
11-2019

Associate of Science - Science

National College
San Juan, PR
05-1997

Skills

    Medical terminology

    Coding CPT and HCPCS

    Medical documentation review

Affiliations

Member of American Academy of Professional Coders

Certification

  • Coding - CPC
  • Pharmacy Tech

Accountability

Recognition from my employer

Languages

Spanish
Native or Bilingual
English
Professional Working

Timeline

Clinical Fraud Investigator II

Elevance Health
08.2008 - Current

Certification - Health

American Academy of Professional Coders

Associate of Science - Science

National College
Raymond Rios