Yanett B. Gala
Tulsa
Summary
Detail-oriented Risk Adjustment Coding Auditor with over 8 years of experience in prospective, retrospective, and concurrent audits. Expertise in ICD-10-CM coding accuracy, regulatory compliance, and provider education. Certified CPC, CRC, CDEO, COBGC, and CCDS-O, with strong analytical and operational skills.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Risk Adjustment Auditor Sr.
Centers Plan for Healthy Living / Elevance Health
01.2025 - Current
- Validated clinical documentation for HCC accuracy across multiple LOBS using V24/V28 Models, ensuring compliance with diagnosis reporting criteria.
- Conducted comprehensive prospective and retrospective reviews, focusing on II-III pass auditing to ensure compliance and accuracy.
- Executed coding for health plan home visits, ensuring accurate documentation of services provided during patient visits.
- Led special projects focused on Medicaid, ensuring complete code capture for ACA and chronic condition coding, including various health issues.
- Joined the Elevance team, contributing to streamlined operations and collaborative efforts starting January 1, 2025.
Risk Adjustment Consultant
Stoddard Group
07.2024 - 11.2024
- Conducted pre-visit and concurrent documentation reviews to identify clinical indicators for high-risk conditions, enhancing accuracy of patient risk assessments.
- Generate compliant CDI queries to clarify documentation deficiencies.
- Collaborated with risk adjustment team to gather and complete code capture in Epic, identifying coding discrepancies and improvement opportunities.
- Contributed to development and execution of risk adjustment strategies, optimizing compliance and documentation accuracy.
Remote Senior Risk Adjustment Coder
Centene Corporation -WellCare Division after acquisition
12.2018 - 07.2023
- Elevated to senior coder position to leverage advanced coding expertise
- Conducted audits for prospective risk adjustment reviews to ensure compliance and accuracy
- Achieved 98% chart accuracy in adherence to company policies and procedures
Risk Adjustment Auditor (PT Independent Contractor)
Cavo Health - Humanizing Technologies
Indianapolis
10.2019 - 08.2022
- Consulted on risk adjustment auditing and coding processes to enhance compliance and accuracy.
- Validated clinical data through medical records analysis, offering actionable improvement recommendations.
Medical Coder/Biller
Billing Source of Houston
Houston
04.2016 - 08.2018
- Audited multispecialty surgical coding using ICD10CM-CPT coding books to ensure compliance and accuracy.
- Utilized EPIC-3M encoder for efficient coding and reimbursement processes.
- Managed coding denials through verbal and written appeals to secure rightful reimbursements.
Education
Health Information Technology - Associate's degree
Rasmussen University
Tampa, FL06-2022
Medical Biller & Coder Specialist - Vocational Certificate
Florida Technical College
Bay, Florida, US03-2016
Skills
- Risk adjustment coding
- ICD coding
- CPT coding
- HCC coding
- Clinical documentation
- Clinical Data
- EHR management
- EHR systems
- Coding
- 3M coding software
- Find-a-Code software
- EncoderPro
- Medicaid
- Medicare
- Managed care
- Revenue cycle management
- Chart Review
- Medical billing
- Chart accuracy
- Data validation
- healthcare auditing
- Documentation review
- compliant documentation queries
- Clinical indicators identification
- Analysis skills
- Natural language processing
- Retrospective & Prospective
- DRG
- Improvement
- ICD 9/10 CM
- Outpatient
- Inpatient
- Patient interaction
- Attention to detail
- Microsoft Excel
- Microsoft Word
- Microsoft Office
- Microsoft Outlook
- Microsoft PowerPoint
- Spreadsheets
- Auditing
- Bilingual
- Epic
- LCD guidelines
- ACA knowledge
- HCPCS
- HIPAA
- chart review
- Data analysis skills
- medical record analysis
- clinics (AHA)
- Validation
- Chart Review
- Microsoft PowerPoint
- Auditing
- Coding Clinics (AHA)
- Bilingual
- Compliance auditing
- Healthcare operations
- Data analysis
- EClinicalWorks
Certification
• Certified Clinical Documentation Specialist-Outpatient (CCDS-O), 07/01/21, 07/30/27
• Certified Documentation Expert Outpatient (CDEO), 08/01/19, 05/31/26
• Certified Obstetrics Gynecology Coder (COBGC), 11/01/18, 05/31/26
• Certified Risk Adjustment Coder (CRC), 03/01/18, 05/31/26
• Certified Professional Coder (CPC), 09/01/17, 05/31/26
• Certified Documentation Expert Outpatient (CDEO), 08/01/19, 05/31/26
• Certified Obstetrics Gynecology Coder (COBGC), 11/01/18, 05/31/26
• Certified Risk Adjustment Coder (CRC), 03/01/18, 05/31/26
• Certified Professional Coder (CPC), 09/01/17, 05/31/26
Personal Information
Title: Medical Coding | Risk Adjustment Auditing | Clinical Data Validation & CDI
Languages
- English, Fluent
- Spanish, Expert
Additional Information - Areas Of Expertise
- CPT Coding/ ICD-10-CM/HCPCS
- Risk Adjustment Coding & Auditing (Complete Code Capture/MRA)
Languages
English
Full Professional
Spanish
Native/ Bilingual
Timeline
Risk Adjustment Auditor Sr.
Centers Plan for Healthy Living / Elevance Health
01.2025 - Current
Risk Adjustment Consultant
Stoddard Group
07.2024 - 11.2024
Risk Adjustment Auditor (PT Independent Contractor)
Cavo Health - Humanizing Technologies
10.2019 - 08.2022
Remote Senior Risk Adjustment Coder
Centene Corporation -WellCare Division after acquisition
12.2018 - 07.2023
Medical Coder/Biller
Billing Source of Houston
04.2016 - 08.2018
Health Information Technology - Associate's degree
Rasmussen University
Medical Biller & Coder Specialist - Vocational Certificate
Florida Technical College