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Lorena Rodriguez

@lorenarodriguez1

Clinical documentation and authorization reviewer with experience validating medical necessity, inpatient criteria, and DRG documentation.

United States

Message

I've reviewed clinical documentation for outpatient and inpatient medical-necessity requirements, including diagnoses, procedures, and payer authorization criteria. My experience includes work associated with Northwestern Medicine, Midwest Physicians Alliance, Family Eye Physicians, and UI @ Chicago.

I evaluate inpatient admission criteria using InterQual/MCG, physician orders, and clinical indicators, and conduct post-review validation of billed diagnoses, procedures, DRG assignment, and length-of-stay justification. I also identify documentation gaps and prepare summaries to support denial appeals.

I apply CMS LCD/NCD criteria and payer policies across commercial and government plans. My background includes Epic, Cerner, Availity, payer portals, and CPC-A coursework in coding and clinical subjects.

Experience

Work history, roles, and key accomplishments

Clinical Documentation Specialist

Northwestern Medicine

Evaluated clinical documentation to ensure diagnoses and procedures meet payer medical-necessity criteria for outpatient and inpatient services.

ICD 10 CM CPT HCPCS E&M HCC Coding InterQual MCG DRG LCDs NCDs Epic Cerner Availity

Clinical Documentation Specialist

UI @ Chicago

Reviewed clinical documentation to support medical necessity and coding accuracy for inpatient and outpatient services.

ICD 10 CM CPT HCPCS E&M HCC Coding InterQual MCG DRG LCDs NCDs Epic Cerner Availity

Clinical Documentation Specialist

Family Eye Physicians

Assessed clinical documentation for medical necessity and coding accuracy in an ophthalmology practice.

ICD 10 CM CPT HCPCS E&M HCC Coding InterQual MCG DRG LCDs NCDs Epic Cerner Availity

Clinical Documentation Specialist

Midwest Physicians Alliance

Reviewed clinical documentation for medical necessity and coding accuracy, supporting authorization and reimbursement.

ICD 10 CM CPT HCPCS E&M HCC Coding InterQual MCG DRG LCDs NCDs Epic Cerner Availity

Education

Degrees, certifications, and relevant coursework

AAPC

CPC-A Apprentice Level Coding Certification, Medical Coding

Completed coursework in Medical Terminology, Anatomy & Physiology, Pathophysiology, ICD-10-CM, CPT/HCPCS, and E/M Concepts, and earned the CPC-A Apprentice Level Coding Certification.