YAINELIS PEREZ
Homestead,FL
Summary
Certified Professional Medical Coder with over 10 years experience in medical office facilities. Accurate and detail-oriented with knowledge of multiple record types and specialties
Overview
10
10
years of professional experience
Work History
Validation Program Coder - Risk Adjustment (Remote
Well Sense Health Plan
09.2023 - Current
- Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation.
- Ability to code government and state models. This includes code everything projects.
- Assist coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes.
- Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations.
- Ability to maintain 95% accuracy rate on all coding projects.
- Handle other related duties as required or assigned.
- Coders assist with code abstraction and coding quality audits using Official Coding Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and procedures.
Documentation Support Specialist (On Site)
Cano Health Inc
04.2023 - 07.2023
- Shadow physician to document in EHR System events in history and physical exam, and document accurately Subjective, Objective, Assessment and Plan (SOAP) progress note.
- Guide clinician in crafting and documenting detailed disease specific assessment as well as detailed disease specific treatment plan.
- List all relevant symptoms and diagnosis including laboratory test, medication orders, treatment, etc.
- Document all procedures performed by physician.
- Verifies patient information by interviewing patient; recording medical history; confirming purpose of visit.
- Maintain and demonstrate understanding of team approach to patient care and documentation.
- Pursue continuing education through clinical experiences to enhance skills and knowledge in promotion of quality documentation.
- Demonstrate ability to maintain confidentiality and privacy in accordance with governing HIPAA regulations.
- Ability to multi-task efficiently and effectively.
- Communicate effectively by phone, in person and in writing.
- Adheres to all policies and procedures, including but not limited to standards for safety, attendance, punctuality, and personal appearance
- Participation on medical reviews, EMR updates and any additional training in regards medical documentation
- Performing post treatment physical tests: taking blood pressure, body temperature; recording patient history summary.
- Inform and review for clinician appropriate workflows for orders, order sets, referrals, task resolutions, structure data, etc.
- Secures patient information and maintains patient confidence by completing and safeguarding medical records.
- Maintains safe, secure, and healthy work environment by establishing and following standards and procedures, complying with legal regulations.
- Serves and protects practice by adhering to professional standards, policies and procedures, federal, state, and local requirements.
- Identifies opportunities for clinician improvement through evaluation of progress notes, pending tasks reports, and time management.
- Improve clinicians' understanding of EHR platform to increase documentation efficiency.
- Support clinicians in documentation process in compliance with CMS guidelines and HEDIS measures in outpatient exam room setting.
CDI Auditor Educator (Remote)
Devoted Medical Services INC
07.2020 - 12.2022
- Perform Clinical Documentation Improvement medical record reviews based on organizational priorities
- Utilize compliant query process to ensure accurate severity of illness of Devoted members is reported
- Ensure RAF score and payment accuracy through provider engagement
- Ability to work independently with providers to present on condition focused clinical indicators
- Ability to analyze needs and trends to ensure solutions are meeting practice needs and expectations
- Interaction with various team to develop and improve suspect logic and technology solutions
- Develop and lead provider education regarding trends and areas of opportunity regarding compliant documentation and coding practices
- Support CDI Manager by making recommendations for process improvements to further enhance documentation and coding quality goals and outcomes
- Handle other related risk adjustment and documentation duties as required or assigned
- Remain current on ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and CMS Risk Adjustment guidance.
MRA Coder (On Site)
Amicus Medical Centers
10.2018 - 10.2019
- Performs on-site and remote clinical validation audits and interpretation of medical documentation to ensure capture of all relevant coding in coordination with physician.
- Verifies and ensures accuracy, completeness, specificity and appropriate coding based on CMS HCC categories.
- Analyses and translates medical and clinical diagnoses, procedures, injuries, and illnesses into designated numerical codes.
- Reviews medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries.
- Performs ongoing analysis of medical charts for appropriate coding compliance.
- Ensures compliance with all applicable Federal, State, and/or County laws and regulations related to coding and documentation guidelines.
- Communicates with co-workers, management and clinic staff regarding reimbursement issues.
- Provides support and compliance with each HEDIS specification through effective communication and training/education.
- Maintains established departmental policies and procedures, objectives, safety, environmental, and infection control standards.
- Participates in departmental and organizational quality management activities.
- Cooperates with other personnel to achieve department objectives and maintain good employee relations, and interdepartmental objectives.
- Attends departmental meetings as required.
- Effectively manage special projects and other tasks as assigned.
- Performs other duties as required.
MRA Coder (On Site)
Caremax Medical Center
06.2018 - 10.2018
- Performs ongoing analysis of medical charts for appropriate coding compliance
- Ensures compliance with all applicable Federal, State, and/or County laws and regulations related to coding and documentation guidelines
- Communicates with co-workers, management and clinic staff regarding reimbursement issues
- Provides support and compliance with each HEDIS specification through effective communication and training/education
- Maintains established departmental policies and procedures, objectives, safety, environmental, and infection control standards
- Participates in departmental and organizational quality management activities
- Cooperates with other personnel to achieve department objectives and maintain good employee relations, and interdepartmental objectives
- Attends departmental meetings as required
- Effectively manage special projects and other tasks as assigned
- Performs other duties as required.
Remote Senior Coder Specialist (Remote)
CSI (Optum)
01.2017 - 06.2018
- Performs on-site and remote clinical validation audits and interpretation of medical documentation to ensure capture of all relevant coding in coordination with physicians.
- Verifies and ensures accuracy, completeness, specificity and appropriate coding based on CMS HCC categories.
- Analyses and translates medical and clinical diagnoses, procedures, injuries, and illnesses into designated numerical codes.
- Reviews medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries.
- Performs ongoing analysis of medical charts for appropriate coding compliance.
- Ensures compliance with all applicable Federal, State, and/or County laws and regulations related to coding and documentation guidelines.
- Communicates with co-workers, management and clinic staff regarding reimbursement issues.
- Provides support and compliance with each HEDIS specification through effective communication and training/education.
- Maintains established departmental policies and procedures, objectives, safety, environmental, and infection control standards.
- Participates in departmental and organizational quality management activities.
- Cooperates with other personnel to achieve department objectives and maintain good employee relations, and interdepartmental objectives.
- Attends departmental meetings as required.
- Effectively manage special projects and other tasks as assigned.
- Performs other duties as required.
MRA Coder (On Site)
Continucare Medical Group (Humana)
03.2015 - 12.2017
- Performs on-site and remote clinical validation audits and interpretation of medical documentation to ensure capture of all relevant coding in coordination with physician.
- Verifies and ensures accuracy, completeness, specificity and appropriate coding based on CMS HCC categories.
- Analyses and translates medical and clinical diagnoses, procedures, injuries, and illnesses into designated numerical codes.
- Reviews medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries.
- Performs ongoing analysis of medical charts for appropriate coding compliance. Ensures compliance with all applicable Federal, State, and/or County laws and regulations related to coding and documentation guidelines. Communicates with co-workers, management and clinic staff regarding reimbursement issues.
- Provides support and compliance with each HEDIS specification through effective communication and training/education.
- Maintains established departmental policies and procedures, objectives, safety, environmental, and infection control standards.
- Participates in departmental and organizational quality management activities.
- Cooperates with other personnel to achieve department objectives and maintain good employee relations, and interdepartmental objectives.
- Attends departmental meetings as required.
Effectively manage special projects and other tasks as assigned. - Performs other duties as required.
Risk Adjustment Coder (On Site)
Chenmed Medical Center
06.2014 - 03.2015
- Ensures compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment.
- Reviews of medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries to verify whether: Diagnosis codes are supported by documentation and ensure with ICD-10-CM Guidelines for Coding and Reporting diagnosis codes for each chronic or major medical condition have been captured correctly.
- Any diagnosis code that is unsubstantiated by record should be queried to provider and assess to accuracy. Reviews for clinical indicators and query providers to capture severity of illness of patients.
- Conducts medical charts to identifying opportunities for improving individual member risk adjustment score accuracy.
- Provides feedback to internal clients on: Examples of documentation and physician self-coding that do not meet quality standards. Examples of missed operations missed opportunities. Examples of clinical that ensure quality and timely care of our members as well as correct reimbursement. Identifies clinical coding and documentation trends and training needs to improve quality of documentation to reflect our patients' health data
- Attends all meetings as required.
- Other duties as assigned and modified at manager's discretion.
Education
Certified Risk Adjustment (CRC) -
AAPC
Miami, FL01.2018
Certified Professional Medical Auditor (CPMA) -
AAPC
Miami, FL01.2017
Certified Professional Coder (CPC) -
AAPC
Miami, FL01.2014
Vocational - Medical Billing & Coding
The English Center - Miami-Dade County Public Schools
Miami, FL01.2014
High School Equivalency Diploma - Technician in Accounting
Institute Lazaro Peña Gonzalez
Cuba 01.2002
Skills
- Extensive Knowledge Medical Terminology
- Extensive/Physiology Knowledge ICD-10/CPT/HCPCS Coding HIPPA Compliance Maintains Strict Confidentiality
- Deadline-driven Team player-with positive attitude
- Exercises good judgment Good written communication Strong work ethic
- Ability to work independently in fast-paced remote environment with minimal supervision and guidance
- Ability to interact with management personnel
- Possess strong organizational skills and attention to detail
- Ability to adapt to changing priorities while managing wide range of projects
- Adaptive and flexible to new ideas and change
- Advanced knowledge of medical terminology, anatomy, and pharmacology
- Advanced skills utilizing official coding resources for research and problem solving
- Advanced skills and knowledge of computers, use of required software to perform job functions
- Excellent written and communication skills and ability to explain complex Information
Languages
English
Full Professional
Timeline
Validation Program Coder - Risk Adjustment (Remote
Well Sense Health Plan
09.2023 - Current
Documentation Support Specialist (On Site)
Cano Health Inc
04.2023 - 07.2023
CDI Auditor Educator (Remote)
Devoted Medical Services INC
07.2020 - 12.2022
MRA Coder (On Site)
Amicus Medical Centers
10.2018 - 10.2019
MRA Coder (On Site)
Caremax Medical Center
06.2018 - 10.2018
Remote Senior Coder Specialist (Remote)
CSI (Optum)
01.2017 - 06.2018
MRA Coder (On Site)
Continucare Medical Group (Humana)
03.2015 - 12.2017
Risk Adjustment Coder (On Site)
Chenmed Medical Center
06.2014 - 03.2015
Certified Risk Adjustment (CRC) -
AAPC
Certified Professional Medical Auditor (CPMA) -
AAPC
Certified Professional Coder (CPC) -
AAPC
Vocational - Medical Billing & Coding
The English Center - Miami-Dade County Public Schools
High School Equivalency Diploma - Technician in Accounting
Institute Lazaro Peña Gonzalez
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