Yaremis Bormey
Pembroke Pines
Summary
- Experienced and highly capable Risk Adjustment Medical Coder and Auditor, strong organizational and excellent analytical skills, focused on improving business compliance, workflow and processes through detailed audits and optimization recommendations. Successful track records of fully evaluating information, structures and procedures and initiating corrective actions. Strong communication with problem-solving, time management and advanced software skills.
- 14 + Years of coding experience and outpatient Risk Adjustment coding.
- Experience in Health plans Risk Adjustment Data Validation Audit (RADV).
- Current Coding Certifications (CPC, CPMA, and CRC) trough AAPC.
- Ability and experience in different types of EMRs, (NextGen, Apollo, eClinicalWorks, MdFlow, Practice Fusion).
- Proficient with standard industry coding systems such as CPT, HCPCS, ICD-10, Revenue Codes and extensive knowledge of medical coding guidelines.
- Excellent interpersonal and strong time management skills.
- Bilingual: Fluid Spanish and English.
- Mastery and understanding of medical terminology, physiology, body system/anatomy, concept of disease process and pharmacology.
- Advanced technical skills using MS Office (Excel, Word, Outlook and PowerPoint) and organization skills.
- Strong Data entry and excellent problem-solving skills.
Overview
16
16
years of professional experience
Work History
Medical Coder III and Medical Auditor
IMC Health (Caremax)
01.2012 - Current
- Educate providers on HCC coding and clinical documentation requirements relate to Risk Adjustment
- Query providers for HCC conditions to ensure that appropriate documentation and strong support in in patient medical records compliance with Medicare guidelines
- Review Pre-Audit patient medical documents, deep chart review (Labs, Diagnostic reports and specialist records) to create educational strategies to ensure correct quality in the coding process a day before to the scheduled patient appointment
- Post Audit Evaluation and complete with Accuracy the patient progress note including all appropriate MRA/HCC codes no later than 72 hrs
- Maximum 10 days after the date of patient service
- Maintain performance and quality conducting ongoing of physicians and mid-level providers medical records to ensure ICD-10- CM codes are fully supported by the provider clinical documentation
- Confirm all progress note are coded accurately and to highest level of specificity following established coding guidelines
- Ability to abstract valid codes from hospital data and outpatient providers
- Work on Prospectives and Retrospectives projects by plans.
Medical Coder
Interamerican Medical Center
01.2010 - 01.2012
- Identify documentation shortcomings for appropriate corrections
- Assess the medical records content and identify documentation shortcomings to the doctor for appropriate correction
- Responsible for addressing with the Doctor all (GAP) Diagnoses listed on the MRA Dx List and certify all Dx are captured in the year through the patient visit
- Work wit Revenue Max’s “MRA Diagnosis List” for all Medicare members in the center
- Review all medical records documentation and accurately code all appropriate diagnoses and procedure using ICD-9 ad CPT coding conventions
- Confirm encounter data was correctly entered into MD2000 daily, accepted by the carrier and identify rejected claims to avoid delays in the workflow process for payers.
Medical Records / Referral Coordinator
Care Solution Healthcare
01.2008 - 01.2010
- Responsible for the organization and security of electronic data, entering and retrieving data, scanning documents and creating data backup
- Filling all medical records received, personal information like their medical history and demographics
- Safeguarding patient records and ensuring that everyone complies with the HIPAA standards
- Transferring data into the facility’s main system database
- Preparing Invoices and creating digital copies of paperwork and storing the records electronically
- Organizing patient information, ensuring complete and accurate registration and providing appropriate clinical data to specialists
- Responsible for referral operations at assigned clinics, establishing and standardizing systems and procedures for the distribution and use of heath information throughout the organization
- Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety
- Faxing and sending medical records to our various departments for processing and expediting patient referrals to specialty office.
Education
CRC -
Excelsior Technical Institute
Doral, FL05.2019
CPC CPMA -
Excelsior Technical Institute And America Academy
Doral, FL06.2010
QuickBooks -
Computer Plus USA
03.2008
English Level VI -
Miami Dade Collage
North Campus06.2006
Skills
- Medical Terminology
- Anatomy knowledge
- HIPAA Compliance
- HCPCS Coding
- Medical Billing
- Teamwork capabilities
- Regulatory guidelines
- Diagnostic Coding
- Coding Error Resolution
- ICD-10 Coding
- EMR Systems
- Certified Professional Coder (CPC)
- Records Review
References
Available upon request.
Timeline
Medical Coder III and Medical Auditor
IMC Health (Caremax)
01.2012 - Current
Medical Coder
Interamerican Medical Center
01.2010 - 01.2012
Medical Records / Referral Coordinator
Care Solution Healthcare
01.2008 - 01.2010
CRC -
Excelsior Technical Institute
CPC CPMA -
Excelsior Technical Institute And America Academy
QuickBooks -
Computer Plus USA
English Level VI -
Miami Dade Collage
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