Feb 2025 – Jan 2026 · 11 mos · El Paso County, Texas, United States · Remote

• Fraud Prevention & Corrective Action Support
• Performed preventive Program Integrity audits for the Keiser account, supporting corrective action initiatives, reducing
• fraud, waste, and abuse (FWA) exposure, and strengthening CMS audit readiness.
• Reviewed 80–110 charts per day while maintaining ≥98% QA accuracy across high-risk Medicare claims.
• Conducted targeted claim and documentation audits to ensure compliance with CMS and Medicare regulations.

Sep 2024 – Mar 2025 · 6 mos · Remote

• Review inpatient and outpatient Medicare claims for fraud in departments such as Behavioral Health, DME, Planned Parenthood, and ER visits.

Jan 2024 – Apr 2025 · 1 yr 3 mos · REMOTE · Remote

• Performed backlogged inpatient/outpatient HCC coding using ICD-10, DataRAP, and Salesforce.
• Audited home visits and provided provider education.
• Reviewed documentation for completeness and accuracy in accordance with CMS and ICD-10-CM guidelines.
• Conducted retrospective chart reviews and maintained coding databases.

Nov 2023 – Jan 2024 · 2 mos · REMOTE · Remote

• Assigned accurate ICD-10-CM codes for Medicare, Medicaid, and Commercial plans.
• Audited physician records and inpatient discharge summaries.
• Ensured coding compliance aligned with CMS risk adjustment models.
• Tools used: Excel, MS Word, Adobe Acrobat.

Mar 2023 – Jan 2024 · 10 mos · United States · Remote

• Audited inpatient/outpatient records and reviewed charts coded by Coder I and II for accuracy.
• Attended continuing education sessions on ICD-10-CM and HCC updates.
• Tools used: Excel, MS Word, Adobe Acrobat.

Feb 2021 – Oct 2024 · 3 yrs 8 mos · Las Cruces, New Mexico, United States · Remote

• Coded risk-adjusting diagnoses and audited physician documentation for ICD-10 compliance.
• Queried physicians for documentation clarification and tracked training and queries in EMR.
• Collaborated with clinical staff and administrators on risk adjustment outcomes.
• Conducted provider education and coding performance analysis.

Mar 2020 – Dec 2020 · 9 mos · El Paso, Texas, United States · On-site

• As a scheduler we register, and pre-registers patients in a courteous, professional and timely manner. Conducts patients/guarantor interviews, explains hospital policies, collects and assists patients with their financial responsibilities, and informs patients on bill of rights. Ensures all necessary demographic and financial data is obtained, and accurately documented into the manual or Experian system. Verifies insurance via the electronic verification system or contacts the insurance payers for verification of eligibility and benefits.

Mar 2017 – Feb 2020 · 2 yrs 11 mos · El Paso, Texas, United States · On-site

• Coded in the Health Information Department for Revenue Management.
• Interpreted clinical and pharmacological data for accurate code assignment and analysis.