Adeline Rivera Email & Phone Number

Identify opportunities to improve provider documentation/coding/billing and create education plans tailored to each assigned provider by following correct coding practices according to CMS guidelines.Review internal medical data reports/claims and arrange educational sessions (face-to-face, Zoom or Teams) with providers and staff aimed at quality of care and documentation improvements as well as identify missed opportunities and interpret various courses of action to implement correct practices.Create PowerPoint presentations to show and outline various reports and spreadsheets used to calculate provider trends, risks scores, patient population and outreach, redocumentation rates, inferred conditions, unreported chronic conditions and educational opportunities.Complete appropriate paperwork/documentation/system entry and tracking of all completed educations to demonstrate receptiveness of providers and staff or MSO representatives.Follow up quarterly with providers to ensure education is being implemented appropriately to show improvements.Support and participate in process and quality improvement initiatives and educational forums, obtain CEU credits.

Tampa, Florida, United States

Review medical record (including inpatient) information to identify all appropriate coding based on CMS HCC categories, Corporate Coder II Level.Complete appropriate system entry regarding claim/encounter information through Cotiviti, CAS, EStar, Crosswalk, Speedweb.Support and participate in process and quality improvement initiatives. Forward corrections or inquiries to proper departments in order to obtain accurate diagnosis and provider/patient information.Continue coding education by participating in associate development, obtain CEU's and volunteer on special projects in helping other departments meet goals.

Conducted in-person chart reviews at provider offices within the Tampa Bay area.Review patient records for proper MRA/HCC coding and documentation, identified educational opportunities for providers.Abstracted chronic conditions from medical records (provider assessments, SOAP notes, past medical history, medication list, treatment plans, provider credentials/signatures).Educated providers and staff on best practices, coding, documentation, claims/billing and coding guidelines.Collected medical records for special projects – MRA, HEDIS, PDV, RADV.Follow all CMS guidelines and compliance, associate development, obtain CEU credits.