Jose F Rodriguez Ramos
Medical Record Reviewer
Summary
Highly experienced medical case coordinator with emphasis clinical data extraction. Worked with medical records in different areas such as quality, auditing, coding, and billing for the past 15 years. Strong problem solving skills, troubleshooting, and technical skills. Well knowledge with HIPAA regulations, Information Governance, and Data Governance.
Overview
13
13
years of professional experience
10
10
years of post-secondary education
1
1
Language
Work History
Medical Record Reviewer
OPTUM
San Juan
11.2022 - Current
- Handled sensitive and confidential patient data following strict HIPAA law guidelines.
- Built cases for review for determining proper patient status for hospitalization.
- Responsible for abstracting necessary clinical information to determine patient status based on clinical data.
- Determined if a case was supposed to be built as an admission, procedure, post discharge, follow up or denial reviews.
- Correct any defects on the case prior to final case determination.
- Processed on average 35 cases daily.
- Maintained over 95% productivity in average with daily productivity sometimes reaching over 110%
- Maintained an average quality of 100%
- Maintained current knowledge of, but not limited to, EPIC, CERNER, Meditech Expanse, Powerchart EMR/EHR.
- Communicated any problems, discrepancies, or incidental findings to upper management.
- Problem solved any technical issues regarding portal access issues, password issues, or workarounds needed to complete tasks.
Patient Care Coordinator
Kangaroo Health
Caguas
12.2021 - 10.2022
- Call patients in the program to remind them of blood pressure or weight monitoring.
- Made over 40 calls daily to patients in the program
- Made sure patient's vitals were received in the system correctly.
- Helped patients setup or calibrate their blood pressure machines or weight scales.
- Troubleshoot any problems with the monitoring devices over the phone.
- Monitored patients whose vitals where above or below the determined threshold and report back to the physician a report with the symptoms.
- Worked closely with patients to deliver excellent and direct individualized patient care.
- Upheld confidentiality requirements and regulatory compliance guidelines.
- Maintained confidentiality of patient data and condition to safeguard health information.
- Delivered excellent patient experiences and direct care.
Medical Office Administrator
MEDINT
Humacao
08.2010 - 11.2021
- Verified benefits and worked with insurance companies to obtain payments.
- Entered procedure codes and diagnosis codes into medical billing software.
- Scheduled, rescheduled, and cancelled appointments for dental patients.
- Aided with prescription refill requests.
- Managed appointments, registrations and patient relations in busy multi specialty office.
- Maintained patient databases and updated information in alignment with HIPAA protocols.
- Trained all new employees on records management system.
- Oversaw office records and maintained strict document control.
- Reviewed and sent medical records to other physicians upon request.
- Audited customer files to verify medical necessity and satisfaction of coverage criteria.
- Designed and introduced leadership development, coaching and team management model, resulting in promotion of employees into increased levels of responsibility.
Education
Bachelor of Science - Health Information Management
Western Governor's University
Salt Lake City, UT 07.2018 - 08.2021
Master of Science - Master in General Public Health
University of Puerto Rico- Medical Science Campus
San Juan, PR 08.2011 - 07.2013
Bachelor of Science - Biology
University of Puerto Rico - Cayey
Cayey, PR 08.2006 - 06.2011
Skills
Medical terminology understanding
undefinedTimeline
Medical Record Reviewer
OPTUM
11.2022 - Current
Patient Care Coordinator
Kangaroo Health
12.2021 - 10.2022
Bachelor of Science - Health Information Management
Western Governor's University
07.2018 - 08.2021
Master of Science - Master in General Public Health
University of Puerto Rico- Medical Science Campus
08.2011 - 07.2013
Medical Office Administrator
MEDINT
08.2010 - 11.2021
Bachelor of Science - Biology
University of Puerto Rico - Cayey
08.2006 - 06.2011
Similar Profiles
Tracey McAllisterTracey McAllister
Sr UX UI Engineer - Product Manager at OptumSr UX UI Engineer - Product Manager at Optum
MANJUNATH HUNACHIKATTIMANJUNATH HUNACHIKATTI
Associate Medical Coder at OptumAssociate Medical Coder at Optum
MRIDHULA KALLIVALAPPILMRIDHULA KALLIVALAPPIL
Medical Coding Analyst at OptumMedical Coding Analyst at Optum