Mayra Liz Rivera
Toa Baja
Summary
AAPC Certified Risk Adjustment Coder with extensive experience in healthcare administration and EHR management. Proficient in ICD-10-CM coding and documentation review, focusing on quality measures and compliance. Committed to enhancing risk adjustment coding through meticulous attention to detail and ongoing professional development.
Overview
1
1
Certification
23
23
years of professional experience
Work History
EHR Management / Medical Records & Coding Support
CSM Levittown
Toa Baja
07.2003 - Current
- Coding & Documentation Review | 2025 – Present; Medical Records / EHR Responsibilities
- Review medical documentation and assigned ICD-10-CM codes for consistency and documentation support.
- Apply MEAT principles when reviewing documented medical conditions to determine whether diagnoses are adequately supported within the medical record.
- Review patient charts for documented conditions that may potentially support HCC capture.
- Identify possible discrepancies between medical documentation and diagnosis coding for additional review or correction.
- Assisted with internal review of medical records, enhancing coding and documentation accuracy.
- Review relevant portions of the medical record, including assessments, problem lists, treatment information, and supporting clinical documentation.
- Continue developing knowledge of risk adjustment, HCC concepts, ICD-10-CM guidelines, and documentation requirements through hands-on review and ongoing learning.
- Maintain strict patient and physician confidentiality while handling protected health information.
- Manage and maintain electronic patient health records and supporting documentation.
- Process medical-record requests while maintaining confidentiality and HIPAA compliance.
- Review patient information and documentation for completeness and accuracy.
- Verify insurance eligibility and claims information with insurance carriers.
- Maintained organized electronic and paper filing systems, facilitating efficient retrieval of patient information.
- Assist with medical coding, records management, data entry, and healthcare administrative functions.
- Communicated professionally with providers, insurance representatives, patients, and other healthcare personnel to ensure clarity and understanding.
- Adapt to changing healthcare systems, documentation requirements, and office procedures.
Administrative & Medicare Advantage Quality Support
William Grassette Medical Office
Toa Baja
06.2014 - Current
- Reviewed Star Quality measures, identifying outstanding documentation and requirements needing attention for improved quality outcomes.
- Review Medicare Advantage reports and medical records for completeness and assist with quality-related follow-up.
- Supported Medicare Advantage quality initiatives and ensured compliance with annual physical requirements.
- Monitored completion of annual physicals and quality requirements. of annual physical and quality requirements and maintain organized documentation for reporting purposes.
- Work with CHRA requirements for MCS Classicare annual physicals and AHA requirements for Medicare y Mucho Más (MMM).
- Assist with physician credentialing and recredentialing, including preparation, organization, and submission of required documentation.
- Communicate with health plans regarding quality initiatives, documentation requests, credentialing, and administrative requirements.
- Maintain accurate records and confidentiality of patient and provider information.
Education
CRC Coder Program -
Advance Learning Center Inc.
09-2024
Medical Office Assistant Diploma -
Bayamón Community College
Bayamón, Puerto Rico10-2023
Medical Billing and Coding -
YCA Billing
Toa Baja, Puerto Rico01-2003
High School Diploma -
María T. Piñero
Toa Baja, Puerto Rico01-1998
Skills
- AAPC Certified Risk Adjustment Coder (CRC)
- ICD-10-CM Coding
- Medical Record & Documentation Review
- Coding & Documentation Discrepancy Review
- MEAT Documentation Principles
- Developing Knowledge of HCC Coding
- Medicare Advantage Quality Support
- Star Quality Measures
- Electronic Health Records (EHR)
- Medical Records Management
- Medical Terminology
- HIPAA & Patient Confidentiality
- Insurance Eligibility & Claims Review
- Physician Credentialing Support
- Microsoft Office
- Data Entry & Document Management
- Attention to Detail
- Adaptability & Fast Learning
- Bilingual — English & Spanish
Certification
Certified Risk Adjustment Coder (CRC) — AAPC (Active Certification)
LANGUAGES
Spanish: Fluent English: Fluent
Timeline
Administrative & Medicare Advantage Quality Support
William Grassette Medical Office
06.2014 - Current
EHR Management / Medical Records & Coding Support
CSM Levittown
07.2003 - Current
CRC Coder Program -
Advance Learning Center Inc.
Medical Office Assistant Diploma -
Bayamón Community College
Medical Billing and Coding -
YCA Billing
High School Diploma -
María T. Piñero