Stacy Rae Moleno
Jacksonville,FL
Summary
Detail-oriented Certified Professional Coder specializing in risk adjustment and outpatient coding. Analyzes audit findings to identify process improvements, driving compliance and elevating quality standards.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Senior Quality Auditor - Risk Adjustment Coding
Optum Global Solutions
Taguig City, Philippines
08.2024 - 09.2025
- Created detailed reports on audit findings with actionable recommendations, facilitating targeted improvements in risk adjustment coding processes.
- Maintained comprehensive records of audit findings, implementing corrective actions to enhance compliance and accuracy.
- Analyzed audit results to identify key areas for process enhancements.
- Participated in team meetings to discuss quality metrics and strategies, contributing insights that shaped quality improvement initiatives.
Quality Auditor - Risk Adjustment Coding
Optum Global Solutions
Taguig City, Philippines
08.2019 - 08.2024
- Conducted comprehensive audits on Medicare Advantage Risk Adjustment coding, reinforcing compliance with quality standards and enhancing accuracy.
- Executed seasonal Medicaid Risk Adjustment Coding audits for UnitedHealth Care and Centene, ensuring adherence to regulatory standards.
- Collaborated with cross-functional teams to pinpoint process improvement opportunities, enhancing overall audit effectiveness.
- Trained staff on quality assurance procedures and best practices.
Subject Matter Expert - Risk Adjustment Coding
Optum Global Solutions
Taguig City, Philippines
08.2018 - 08.2019
- Facilitated training sessions for staff on HCC coding compliance and regulatory standards, enhancing team knowledge and adherence.
- Supported external auditors during annual audits by supplying accurate information to ensure compliance.
- Compiled detailed reports on audit findings and recommendations for management, providing insights for strategic decision-making.
Medical Coding Specialist - Risk Adjustment Coding
Optum Global Solutions
Taguig City, Philippines
06.2013 - 08.2018
- Reviewed medical records to ensure accurate ICD-10-CM coding and compliance with regulatory standards.
- Utilized coding software to assign correct codes for diagnoses and procedures. (Medical Record Manager, HCC Coder Tool)
- Maintained current knowledge of medical terminology and coding updates to support accurate and compliant coding practices.
- Abstracted HQPAF data and contributed to seasonal HEDIS programs to enhance quality of care.
- Maintained strict confidentiality with adherence to HIPAA guidelines and regulations.
Medical Coding Specialist - OP and SDS Coding
NCO Philippines
Quezon City, Philippines
02.2012 - 05.2013
- Reviewed outpatient and inpatient medical records to ensure coding accuracy and compliance with standards.
- Maintained current knowledge of CPT and ICD-9-CM coding principles and regulations, enhancing coding accuracy and compliance.
- Analyzed patient health data and physician diagnoses to assign billing codes, ensuring accuracy and compliance.
- Completed coding accurately and timely, adhering to facility standards and improving billing processes.
Education
Bachelor of Science - Nursing
Philippine College of Health Sciences, Inc.
Manila, Philippines11-2006
Skills
- CPC certification
- Risk adjustment coding
- Outpatient and Same Day Surgery Coding
- Quality assurance
- Proficient Computer skills
- Flexible and adaptable
Certification
- Certified Professional Coder - AAPC, June 2013 to present
References
References available upon request.
Education and Training
other
Timeline
Senior Quality Auditor - Risk Adjustment Coding
Optum Global Solutions
08.2024 - 09.2025
Quality Auditor - Risk Adjustment Coding
Optum Global Solutions
08.2019 - 08.2024
Subject Matter Expert - Risk Adjustment Coding
Optum Global Solutions
08.2018 - 08.2019
Medical Coding Specialist - Risk Adjustment Coding
Optum Global Solutions
06.2013 - 08.2018
Medical Coding Specialist - OP and SDS Coding
NCO Philippines
02.2012 - 05.2013
Bachelor of Science - Nursing
Philippine College of Health Sciences, Inc.