Dairet Rivera Reyes
@dairetriverareyes
Senior CDI Specialist and medical coder improving documentation accuracy for compliance and accurate reimbursement.
United StatesWhat I'm looking for
I’m a highly accomplished Clinical Documentation Improvement (CDI) Specialist and Medical Coding Professional with over 7 years of progressive experience in inpatient and outpatient clinical documentation review, medical record auditing, ICD-10-CM/PCS coding, and Medicare Risk Adjustment (HCC). I conduct concurrent and retrospective reviews to identify documentation gaps, validate diagnoses, and collaborate with providers to ensure clinical severity, quality metrics, and reimbursement are accurately reflected.
I’ve built strong expertise auditing inpatient records for MS-DRG, APR-DRG, and HCC capture accuracy aligned with CMS, AHIMA, and NCOA guidelines. I’m currently pursuing the Certified Documentation Integrity Practitioner (CDIP) credential through AHIMA to advance clinical documentation integrity, inpatient reimbursement methodologies, and regulatory compliance—bringing exceptional analytical skills, attention to detail, and high-quality independent productivity in fast-paced environments.
Experience
Work history, roles, and key accomplishments
CDI Specialist
Advantasure Coding Department
Apr 2021 - Present (5 years 3 months)
Perform concurrent and retrospective inpatient and outpatient clinical documentation reviews to support accurate capture of conditions and procedures for proper coding and reimbursement. Validate diagnoses for HCC capture, identify documentation gaps, and query providers to ensure documentation integrity and regulatory adherence.
MRA / HCC Auditor
Common Health
Nov 2022 - Feb 2024 (1 year 3 months)
Conduct retrospective medical record audits to validate documentation and support accurate capture of HCC conditions in line with CMS and client-specific guidelines. Perform vendor quality audits, provide feedback, and analyze audit trends to identify documentation and coding improvement opportunities.
Review inpatient and outpatient medical records to assign accurate ICD-10-CM codes and HCCs, performing retrospective reviews to ensure complete and accurate documentation capture for risk adjustment.
HCC Risk Adjustment Coder
Change Healthcare
Jan 2019 - Jun 2020 (1 year 5 months)
Abstract and report diagnostic data from electronic and handwritten medical records to support Risk Adjustment scoring in compliance with TAMPER, MRA, and client guidelines. Ensure documentation supports accurate Risk Adjustment scores per NCQA and CMS guidance while maintaining PHI confidentiality under HIPAA and company policy.
Education
Degrees, certifications, and relevant coursework
Excelsior Technical Institute
Medical Coder (Diploma), Medical Coding
2016 - 2017
Completed a Medical Coder diploma program at Excelsior Technical Institute from 2016 to 2017.
Valencia University
Bachelor’s Degree in Communication, Communication
2012 -
Earned a Bachelor’s degree in Communication in 2012 from Valencia University in Valencia, Spain.
Availability
Location
United StatesAuthorized to work in
Job categories
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