GABRIEL MOJICA BERRIOS
BAYAMON
Summary
Analytical and detail-oriented Risk Adjustment & Coding Analyst with experience in medical record review, risk adjustment validation, CMS compliance, data quality auditing, and healthcare process optimization. Strong background in cross-functional coordination with hospitals, VA systems, and provider networks. Skilled in data analytics, Excel-based reporting, and identification of documentation gaps that impact HCC capture, RAF accuracy, and medical integrity. Certified in CPC, CRC & CVBA, with experience supporting internal and external audits, improving workflows, and driving documentation accuracy through structured reviews and feedback loops. Known for exceptional attention to detail, high accountability, and the ability to translate clinical documentation into accurate and compliant data.
Hardworking professional applies official coding conventions and rules established by American Medical Association and Centers for Medicare and Medicaid Services. Confident Medical Coder adheres to data confidentiality and privacy rules in all workflows and promotes dynamic interpersonal skills.
Overview
7
7
years of professional experience
3
3
Certification
Work History
MEDICAL CODING ANALYST
TRIPLE S
01.2025 - Current
- Evaluate and analyze medical records to ensure accurate ICD-10-CM coding in accordance with CMS guidelines, HCC risk adjustment requirements, and internal audit standards.
- Identify documentation gaps, patterns, and trends impacting RAF accuracy, HCC capture, and medical integrity, escalating issues when indicated.
- Conduct quality reviews of vendor-submitted cases, validating MEAT/TAMPER criteria, provider documentation, and coding accuracy.
- Prepare Excel-based summaries, audit reports, and action plans to support Coding, Compliance, and Provider Education teams.
- Support audits requested by CMS, OIG, Compliance, or Internal Audit, ensuring proper documentation retrieval and coding accuracy.
- Collaborate with providers to request records, clarify documentation discrepancies, and reinforce compliant clinical documentation.
- Maintain updated knowledge of ICD-10-CM, CPT, HCPCS, CMS Risk Adjustment rules, and federal regulatory updates.
- Contribute to departmental KPIs through metric tracking, quality assurance, and consistent adherence to compliance standards.
- Full Time: over 45hrs per week
REGIONAL SUPPORT SPECIALIST
HEALTHMAP SOLUTIONS
11.2023 - 01.2025
- Reviewed and validated clinical documentation and member data to ensure coding accuracy, completeness, and compliance with CMS, NCQA, and internal standards.
- Performed quality checks and reconciliations to correct discrepancies, improve data integrity, and support accurate reporting for operational and clinical programs.
- Supported regional teams with medical record coordination, EMR navigation, and clarification of missing or inconsistent information.
- Prepared clear summaries, error reports, and trend analyses to highlight gaps in documentation and recommend corrective actions.
- Collaborated with cross-functional partners to improve workflows, standardize data processes, and reinforce accurate, compliant documentation practices.
- Ensured secure handling of PHI and strict adherence to HIPAA and data governance requirements.
- Full Time: over 50hrs per week
CLINICAL DATA & DOCUMENTATION COORDINATOR
PRECISION HEALTH CENTERS
11.2021 - 09.2023
- Conducted in-depth reviews of clinical documentation to ensure compliance with CMS and VA standards.
- Identified coding discrepancies and communicated directly with providers to improve documentation accuracy.
- Served as liaison with VA Hospital San Juan, coordinating record requests, documentation workflows, and cross-team communication.
- Contributed to increased billing accuracy and reduction of documentation-related denials.
- Full Time: over 50hrs per week
TRAUMA REGISTRAR
ASEM- CONTINIUM CARE SOLUTIONS
08.2020 - 11.2021
- Maintained trauma registry data integrity through accurate abstraction and data entry.
- Conducted QA checks to ensure alignment with national trauma reporting standards.
- Partnered with clinical teams to reconcile missing documentation and validate case completeness.
- Full Time: 40hrs per week
EMERGENCY ROOM CLERK
BAYAMON HEALTH CENTER
02.2019 - 10.2020
- Provided administrative and clerical support for emergency department operations.
- Ensured accurate patient intake, record creation, and coordination with clinical staff.
- Managed sensitive patient information following HIPAA and organizational privacy standards.
- Full Time: 40hrs per week
Education
BACHELOR’S - HEALTH CARE ADMINISTRATION
NUC
01.2023
ASSOCIATE - INSURANCE SPECIALIST/MEDICAL BILLER
NUC
01.2020
Skills
- ICD-10-CM Coding Accuracy
- HCC/Risk Adjustment
- MEAT/TAMPER Validation
- Documentation Integrity
- Data Quality & Validation
- Error Identification & Reconciliation
- Record Review & Audit Support
- Healthcare Compliance
- CMS Guidelines
- HIPAA
- VA/EMR Documentation Standards
- Clinical Data Review
- Gap Analysis
- Trend Identification
- Provider Documentation Support
- Operational Efficiency
- Workflow Optimization
- QA Processes
- Cross-Functional Coordination
- Analytical Skills
- Excel (Advanced), PivotTables, Lookups
- Reporting & Summary Preparation
- Communication & Collaboration
- Clear Documentation Feedback
- Provider & Team Support
Certification
- NOVEMBER 2025 CVBA, AAPC
- AUGUST 2024 CRC, AAPC
- AUGUST 2023 CPC, AAPC
Volunteering
AAPC San Juan Puerto Rico Local Chapter Treasurer (Elected Officer) 2024-2026
Timeline
MEDICAL CODING ANALYST
TRIPLE S
01.2025 - Current
REGIONAL SUPPORT SPECIALIST
HEALTHMAP SOLUTIONS
11.2023 - 01.2025
CLINICAL DATA & DOCUMENTATION COORDINATOR
PRECISION HEALTH CENTERS
11.2021 - 09.2023
TRAUMA REGISTRAR
ASEM- CONTINIUM CARE SOLUTIONS
08.2020 - 11.2021
EMERGENCY ROOM CLERK
BAYAMON HEALTH CENTER
02.2019 - 10.2020
ASSOCIATE - INSURANCE SPECIALIST/MEDICAL BILLER
NUC
BACHELOR’S - HEALTH CARE ADMINISTRATION
NUC