Summary
Overview
Work History
Education
Skills
Certification
Accomplishments
Timeline
Disclaimer
Generic

Paresh I. Muliya

Botad

Summary

Dynamic Senior Quality Auditor, as well as Medical Coding Specialist, with extensive experience, excelling in data analysis, innovative problem-solving, and HCC/HHS coding. Proven track record in mentoring and training, enhancing coding accuracy, and driving team performance. Adaptable and hardworking, I thrive in multicultural environments, consistently delivering high-quality results in risk adjustment coding and HEDIS projects.

Overview

11
11
years of professional experience
1
1
Certificate

Work History

Senior Quality Auditor - HCC

Cliffcraft
Ahmedabad
11.2024 - Current
  • Worked as a trainer to train the newcomers (coders).
  • Helped to set up HCC coding software.
  • Prepared HEDIS measures and their guideline materials for upcoming projects.
  • RCA of risk adjustment error was performed, and an analysis was provided to overcome or minimize such future coding errors.
  • Conducted IJP assessment to promote coders to higher posts, such as quality analyst, quality team leaders, and senior medical coders.
  • Prepared ICD-10-CM chapter-wise coding guidelines.
  • Conducting an audit of coded medical records by coders.

Medical Coding Specialist

Freelance
Botad
04.2023 - 11.2024
  • Working in the risk adjustment coding domain.
  • Specialized in ICD-10-CM coding, HCC, and HHS coding.

Senior Quality Auditor

Advantmed LLP
Ahmedabad
01.2016 - 04.2023
  • Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information.
  • Monitor coding changes to ensure that the most current information is available.
  • Keep current on ICD-10 guidelines, and maintain CRC certification.
  • Working experience in segments of HCC, HHS commercial, Medicaid projects, data validation, and HEDIS (abstraction).
  • 8 years of experience as a quality auditor.
  • Mentoring of the freshers' batch to achieve good output during live work and meet the organization’s goals.
  • Vast experience in coding, data analysis, through which a further plan of action could be decided for the improvement of work.
  • Lead a medical coding professional, assigning workflow and coaching to improve performance.

Medical Coder

Advantmed LLP
Ahmedabad
08.2014 - 01.2016
  • Identified, collected, assessed, monitored, and documented claims, and encountered coding information as it pertained to Clinical Condition Categories.
  • Verified and ensured the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered.
  • Reviewed medical record information to identify all appropriate coding based on CMS HCC categories. Completed appropriate paperwork, documentation, and system entry regarding claim and encounter information.
  • Performed coding and abstracting with an accuracy rate higher than 95%.
  • Provided support, education, and training related to documentation quality, level of service, and diagnosis coding, consistent with established coding guidelines and standards.
  • Monitored coding changes to ensure that the most current information was available.
  • Demonstrated analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information.

Education

Advanced Post Graduate Diploma - Clinical Research and Pharmacovigilance

Cliniminds

Bachelor of Pharmacy -

Skills

  • MS Office
  • Data analysis
  • Medical coding software

Certification

  • CRC, AAPC ID: 01404599
  • LSSGB, Lean Six Sigma
  • CAIMC (AAPC)
  • CPMB

Accomplishments

  • Achieved CRC certification (Certified Risk Adjustment Coder from AAPC)
  • Awarded for the best Quality Auditor of Year 2017, 2018, 2019, 2020
  • Awarded for the best Medical Coder for big client project
  • Achieved Certification in Lean Six Sigma Green belt

Timeline

Senior Quality Auditor - HCC

Cliffcraft
11.2024 - Current

Medical Coding Specialist

Freelance
04.2023 - 11.2024

Senior Quality Auditor

Advantmed LLP
01.2016 - 04.2023

Medical Coder

Advantmed LLP
08.2014 - 01.2016

Advanced Post Graduate Diploma - Clinical Research and Pharmacovigilance

Cliniminds

Bachelor of Pharmacy -

Disclaimer

I hereby declare that the information given above is genuine to the best of my knowledge & if you give an opportunity to work in your organization, I will put my best efforts.

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Paresh I. Muliya