Work experience

• Medical Auditor / Trainer

  laredo technical services inc. - hybrid

  2025.06-Current

  (a year)

  • Review and assign ICD-10-CM, CPT, HCPCS, modifiers, and E/M codes for facility and professional fee coding . · Conduct coding audits and documentation reviews to identify and correct inaccuracies, reducing claim denials. · Submit provider queries for documentation clarification and respond to provider feedback. · Deliver coding guidance and education to providers and clinical staff, improving provider documentation quality and compliance. · Develop and facilitate monthly and annual coding education programs, increasing team coding accuracy.
• Medical Coder / Auditor

  SRS, Inc.

  2023.07-2024.12

  (a year)

  · Audited and coded outpatient E/M encounters across Family Medicine, Pediatrics and Orthopedics, and OB/GYN adhering to professional fee coding metrics. · Researched and corrected denied or rejected claims, ensuring accurate reimbursement and improved claim resolution timelines. · Collaborated with billing operations to streamline claims review and invoice submission processes, maintaining compliance with CMS regulations. · Reviewed and corrected pre-bill edits, applied Correct Coding Initiative (CCI) guidelines for clean claim submission.
• PROFESSIONAL SABBATICAL

  N/A

  2019.06-2023.06

  (4 years)

  · Maintained CPC and CPMA credentials through continuing education, coding conferences, webinars, and regulatory training. · Continued professional development focused on ICD-10-CM, CPT, compliance regulations, risk adjustment methodologies, and 2021 E/M Guideline implementation.
• Risk Adjustment Auditor

  Visual Connections

  2019.01-2019.05

  (5 months)

  · Part of CMS massive operational overhaul of RADV audits, validating ICD-10- diagnosis coding and HCC mappings in alignment with CMS requirements. · Reviewed medical records for coding accuracy, documentation support and CMS compliance. · Evaluated provider documentation to ensure complete capture of chronic conditions and risk-adjusted diagnoses. · Identified documentation deficiencies and coding opportunities to improve audit outcomes.
• Inpatient Auditor

  Hybrid

  2016.07-2018.12

  (2 years)

  · Audited inpatient and outpatient encounters for DRG assignment, procedure coding, and E/M coding accuracy using 1995 and 1997 guidelines. · Produced summary of findings which included scope and methodology, objectives and overall error rate or findings. · Served as interim Project Manager, overseeing coding workflow, audit quality, and new hire interviews. · Was used as a consultant for new contract bids for DOD as a SME. Additional Contract & Remote Coding Roles · Remote HCC Coder | Inovalon · Outpatient Coder | Diamond Solutions Inc. · Medical Coder | Complex Care Solutions · Contract Coder | Maxim Healthcare | Coding IQ | KForce | Altegra Health | Wright Solutions Inc. | DOD | Kaiser Permanente · Medical Biller | Capital Home Healthcare Responsibilities included: Reviewed and coded complex outpatient and professional fee encounters while maintaining 98% + coding accuracy. Analyzed coding trends and audit findings to identify revenue opportunities and support process improvement initiatives. Supported revenue integrity initiatives through accurate charge capture, coding validation, and documentation improvement efforts. Utilized Epic, Cerner, 3M, Optum and CAC technologies to streamline coding workflows and maintain productivity targets.
• Coder II

  Fresenius Medical Care

  2018.07-2018.10

  (4 months)

  · Assigned ICD-10-CM, CPT, HCPCS, and E/M codes for nephrology and dialysis services. · Applied coding guidelines to support compliant reimbursement and accurate claim submission. · Queried providers for documentation clarification to ensure accurate code assignment. · Resolved billing edits and coding issues impacting Medicare, Medicaid, and commercial claims.
• HEDIS Reviewer

  Equity Staffing

  2018.01-2018.05

  (5 months)

  · Performed HEDIS medical record abstraction and quality reviews. · Validated documentation against HEDIS specifications and quality reporting requirements. · Collaborated with provider offices to improve documentation completeness and reporting accuracy. · Leveraged Clinical Documentation Improvement (CDI) principles to review medical records.

Educational experience

• Prince George's Community College

  General Studies

  2009.09-2015.05

  (6 years)

  Associate

Certificates