Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Yolanda Casiano

Labelle,USA

Summary

Detail-oriented certified HCC Risk Adjustment coder with nearly 3 years of experience in accurately reviewing and abstracting medical records for ICD-10-CM coding in compliance with CMS risk adjustment guidelines. Adept at using various EMR systems, maintaining HIPAA compliance, and working independently to meet productivity and quality standards. Strong analytical skills and a commitment to continuous learning in a fast-evolving healthcare environment.

Overview

9
9
years of professional experience
1
1
Certification

Work History

PRN HCC Risk Adjustment Coder

Datavant
, FL
08.2024 - Current
  • Managed multiple clients with diverse coding requirements while ensuring high accuracy and adherence to client guidelines.
  • Reviewed and coded medical records, identifying Hierarchical Condition Categories (HCCs) in compliance with CMS guidelines.
  • Maintain a minimum of 95% coding accuracy to meet performance expectations and ensure compliance
  • Maintained up-to-date knowledge of coding standards and CMS regulatory changes for optimal coding practices.

HCC Risk Adjustment Coder

Physicians' Primary Care
Fort Myers, FL
08.2022 - 09.2024
  • Reviewed problem lists for HCC diagnosis codes, transferring details for provider evaluation.
  • Analyzed multiple external medical records to identify potential HHC codes and notified providers.
  • Updated diagnosis codes, ensuring compliance with required levels of specificity.
  • Completed daily Attestation for assigned providers, maintaining accurate record-keeping.
  • Code E/M as needed.

Billing Specialist

Urological Supplies Inc
Fort Myers, FL
07.2021 - 08.2022
  • Monitored accounts receivable activity to ensure timely payment of invoices.
  • Generated periodic reports summarizing account balances and collection activities.
  • Reviewed medical records to ensure accuracy of billing information and patient data.
  • Implemented new policies related to billing processes when required.
  • Maintained accurate records of collections, adjustments and denials in the system.
  • Monitored Medicare policies to remain compliant with changes in Urological supplies.
  • Answered customer inquiries regarding billings, payments, account status.

A/R Specialist

Orthopaedic Specialist of Austin
Austin, TX
07.2020 - 07.2021
  • Reconciled accounts receivable balances with payers when necessary.
  • Resolved billing disputes between providers and third party payers in a timely manner.
  • Identified any discrepancies in patient information, provider information, or coding accuracy as part of the denial process.
  • Investigated and documented payment errors resulting from incorrect processing of claims.
  • Ensured compliance with healthcare regulations and insurance policies during the denial management process.
  • Reviewed and analyzed denied claims to determine reasons for denial and identified corrective actions.
  • Checked documentation for appropriate coding, catching errors and making revisions.
  • Retained strong medical terminology understanding in effort to better comprehend procedures.

Charge Entry Specialist

Primer Family Physicians
Austin, TX
12.2019 - 04.2020
  • Performed quality assurance checks on all charge entries before submission to payers.
  • Submitted clean claims electronically via various clearinghouses or direct-to-payer connections.
  • Reviewed account information to confirm patient and insurance information is accurate and complete.
  • Reviewed clinical data from medical records to assign ICD, CPT, and HCPCS codes.
  • Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.

HIM/Billing Department

Pain Care Physicians
Austin, Texas
09.2017 - 12.2019
  • Superuser of company's EMR system which is eMDs.
  • Review coding provided on patient superbills.
  • A liaison to law firms to discuss and settle our LOP's (Letter of Protection).
  • Deposit patient, insurance, and other 3rd party checks to various bank accounts.
  • Update patient charts using eMDs.
  • Assisted with maintaining Accounts Receivables.
  • Worked denials as questions arose.
  • Assisted patients to resolve outstanding balances.
  • Make appropriate financial arrangements for payment of patient accounts.
  • Prepared various medical records for our different customers.
  • Work on various daily duties as assigned.

Patient Access

Southeast Orthopedic Specialist
Jacksonville, FL
12.2016 - 08.2017
  • Used Nextgen software to update patient's charts.
  • Answer incoming telephone calls to schedule appointments, take messages, route calls and messages to the appropriate department.
  • Update demographics and insurance information to register patients in computer system.
  • Verification of insurance.
  • Getting into the task box receiving referrals and calling patients to schedule.

Education

Certification of Completion - Medical Billing And Coding

Immokalee Technical College
Immokalee, FL
06.2016

Skills

  • Medical terminology
  • HIPAA regulations
  • Detail-oriented
  • Adaptive
  • CPT coding
  • HCC coding
  • Anatomy and physiology
  • Continuous learning attitude
  • Medical record review

Certification

  • Certified Professional Coder

Timeline

PRN HCC Risk Adjustment Coder

Datavant
08.2024 - Current

HCC Risk Adjustment Coder

Physicians' Primary Care
08.2022 - 09.2024

Billing Specialist

Urological Supplies Inc
07.2021 - 08.2022

A/R Specialist

Orthopaedic Specialist of Austin
07.2020 - 07.2021

Charge Entry Specialist

Primer Family Physicians
12.2019 - 04.2020

HIM/Billing Department

Pain Care Physicians
09.2017 - 12.2019

Patient Access

Southeast Orthopedic Specialist
12.2016 - 08.2017

Certification of Completion - Medical Billing And Coding

Immokalee Technical College

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