Michael Gonzales

• Reviewed medical claims to verify accuracy of codes and documentation in records.
• Identified coding errors or discrepancies, collaborating with coding teams and healthcare providers for documentation enhancement.
• Analyzed provider documentation and chart formats to detect trends and areas needing improvement.

• Executed comprehensive medical record reviews for HEDIS compliance.
• Collaborated with healthcare teams to enhance data collection accuracy.
• Educated providers on HEDIS standards and quality improvement practices.
• Facilitated quality audits to assess adherence to HEDIS guidelines across departments.

• Executed comprehensive medical record reviews for HEDIS compliance.
• Collaborated with healthcare teams to enhance data collection accuracy.
• Educated providers on HEDIS standards and quality improvement practices.
• Facilitated quality audits to assess adherence to HEDIS guidelines across departments.

• Executed comprehensive medical record reviews for HEDIS compliance.
• Collaborated with healthcare teams to enhance data collection accuracy.
• Educated providers on HEDIS standards and quality improvement practices.
• Facilitated quality audits to assess adherence to HEDIS guidelines across departments.

• Administered medications while monitoring patient responses in a fast-paced healthcare environment.
• Collaborated with healthcare teams to create and execute comprehensive patient care plans.
• Educated patients and families regarding health management strategies and treatment options.
• Conducted physical assessments and accurately documented findings in electronic health records.
• Coordinated patient schedules and managed appointments for efficient care delivery.

• Reviewed medical claims to verify accuracy of codes and documentation in records.
• Identified coding errors or discrepancies, collaborating with coding teams and healthcare providers for documentation enhancement.
• Analyzed provider documentation and chart formats to detect trends and areas needing improvement.

• Managed day-to-day operations of healthcare BPO accounts, overseeing 70+ FTEs across various functions.
• Supervised workflow while implementing process improvement initiatives to enhance efficiency.
• Executed financial management tasks including P&L analysis, forecasting, and presales for new projects.
• Ensured compliance through thorough audit preparation and delivery processes.
• Facilitated weekly and monthly meetings with team leads to promote alignment and progress.
• Maintained client relationships and prepared for visits to identify new business opportunities.
• Led diverse operational areas: Risk Adjustment, HCC Coding, chart retrieval, HEDIS, claims processing, utilization management, and provider credentialing.

• Day-to-day management of Healthcare BPO Accounts (Risk Adjustment / HCC Coding, Chart Retrieval Operations / Data Collection Specialist, HEDIS Abstraction / HEDIS Intake, Claims Adjudication/Processing, Provider Credentialing and Re-credentialing, Provider Credentialing Intake Process, Utilization Review Intake Specialist, Utilization Review Appeals

• Oversee and delegate workflow between members to achieve maximum efficiency.

• Provide first level assistance to staff by answering questions, reviewing guidelines/procedures, participating in client calls, addressing escalation issues, researching client complaints and/or providing feedback.

• Run weekly and daily performance metrics by team member and by client to ensure maximum efficiencies are obtained.

• Conduct weekly staff meeting and daily coaching.

• Ensured compliance with federal and state regulations by adhering to coding guidelines.
• Conducted audits and reviews of coding to guarantee accuracy of documentation.
• Performed comprehensive reviews of records to verify presence of all required components.
• Analyzed provider documentation to confirm correct assignment of ICD 9-CM and ICD 10-CM codes.
• Maintained confidentiality and security of patient information throughout processes.
• Validated final diagnoses and procedures reported by physicians and other healthcare providers.

• Addressed coding inquiries from team members efficiently across the floor.
• Escalated complex coding questions to Training Manager for resolution.
• Audited HEDIS charts for precise data measurement and reporting accuracy.
• Facilitated bootcamp training sessions for new hire certification program.

• Reviewed medical records for accurate risk adjustment coding compliance.
• Collaborated with healthcare providers to clarify documentation and coding issues.
• Conducted regular audits of coded data for quality assurance and accuracy.
• Utilized coding software to ensure thorough and precise documentation processes.
• Conducted comprehensive HEDIS reviews to ensure accuracy and compliance.
• Analyzed medical records for adherence to quality measures and guidelines.
• Assisted in identifying areas for improvement in care delivery processes.

• Provides training and certification to students, healthcare, and non-healthcare personnel on basic life support, first aid-CPR, and disaster risk management.
• Responds to emergency situations/accidents, coordinates with healthcare facilities for emergency transfers.

• Administered medications and treatments according to physician prescriptions.
• Monitored patient vital signs, reporting significant changes to medical team.
• Collaborated with healthcare professionals to develop comprehensive patient care plans.
• Educated patients and families on effective post-operative care and rehabilitation strategies.