Lester Ramos
Haines City,FL
Summary
Dedicated Family Nurse Practitioner with over 10 years of diverse experience in clinical care, documentation, and Medicare Advantage. Proven expertise in chronic disease management, preventive care, and delivering high-quality, patient-centered primary care. Specialized knowledge in HCC coding, RAF optimization, and compliant documentation, supported by extensive involvement in Medicare audits and provider education. Committed to enhancing outcomes through hybrid care delivery and interdisciplinary collaboration within value-based care settings.
Overview
12
12
years of professional experience
1
1
Certification
Work History
APRN – Family Nurse Practitioner
Family First Medical Center
Haines City, FL
08.2025 - Current
- Provide comprehensive primary care for adult and geriatric populations, including chronic disease management (HTN, DM2, COPD, CHF, obesity).
- Conduct preventive care visits including AWVs, screenings, immunizations, and wellness counseling.
- Manage acute visits, triage patient needs, and coordinate care with specialists.
- Ensure accurate and compliant documentation aligned with Medicare Advantage, HCC coding, and RAF scoring requirements.
- Utilize EMRs (Athena, eClinicalWorks, EPIC) to document encounters, close quality gaps, and support value-based care performance.
- Collaborate with interdisciplinary teams to improve patient outcomes and streamline clinic workflows.
- Deliver culturally competent care to diverse patient populations, leveraging bilingual fluency in English and Spanish.
- Evaluated patient progress regularly, adjusting care plans based on clinical findings and feedback.
- Provided comprehensive patient assessments and developed individualized care plans.
- Improved patient outcomes by utilizing evidence-based practice and collaborating with multidisciplinary healthcare teams.
- Diagnosed and responded to illnesses and physical conditions through prescription of medication and health counseling and education.
- Established and implemented developmental screening initiatives to detect delays in young children.
Fraud Nurse III – Medical Records Analyst
Peraton
Remote
10.2023 - Current
- Conduct Medicare audits to ensure compliant documentation of chronic conditions and preventive services.
- Support integrity in care reporting across CMS-aligned providers and risk-based contracts.
- Collaborate with analysts and medical directors to improve documentation accuracy and outcomes in value-based care.
- “Perform Medicare audit reviews to validate documentation of chronic and preventive services.”
- Evaluated patient progress and adjusted care plans in collaboration with healthcare professionals.
- Performed accurate documentation of patient assessments, interventions, and outcomes in compliance with regulatory standards.
Medical Records Auditor & Provider Educator (Medicare Risk Adjustment)
Elevance Health (Anthem)
Remote
10.2016 - 10.2023
- Performed HCC audits and educated providers on compliant documentation, AWVs, SOAP structure, and risk coding optimization.
- Developed standardized training for primary care teams to improve diagnosis accuracy and RAF capture.
- Partnered with cross-functional teams to support accurate reporting in Medicare Advantage populations.
- “Conducted chart audits and coached providers on compliant documentation for chronic conditions.”
- Conducted comprehensive audits of medical records for accuracy and compliance with regulations.
- Collaborated with healthcare teams to streamline documentation processes and improve workflow efficiency.
- Mentored junior auditors on best practices in record management and auditing standards.
- Ensured adherence to HIPAA regulations during audits, safeguarding patient confidentiality at all times.
Certified Medical Assistant – Outpatient Family Medicine
AdventHealth
Haines City, FL
07.2014 - 10.2016
- Supported patient care workflows including vitals, patient education, and encounter documentation.
- Ensured regulatory compliance and contributed to improved patient experience scores.
- “Assisted in direct patient care for acute visits and chronic follow-ups.”
Education
Master of Science in Nursing - Family Nurse Practitioner
Miami Regional University
Miami, FL04-2024
Master of Science in Nursing -
Miami Regional University
Miami, FL12-2022
Doctor of Medicine (MD Equivalent) - Family Medicine Focus
Medical Faculty of Santiago De Cuba
BAYAMO, CUBA01-2008
Skills
- EMRs: eClinicalWorks, Athena, Tebra
- Coding: ICD-10, CPT, HCC, CMS Risk Adjustment
- Platforms: Doximity, Zoom for Healthcare, eVisit
- Tools: SOAP templates, AWV workflows, RAF dashboards
- Effective written and verbal communication
- Interprofessional collaboration
- Clinical judgment
- Adult health management
- Medical documentation
- Diagnosis and treatment
- Preventive care
- Quality improvement
- Geriatric care
- Diagnostic test interpretation
- Emergency care
- Diagnostics
- Preventive medicine
- Teamwork and collaboration
- Problem-solving
- Reliability
Certification
- APRN – Florida (Active)
- RN – Florida (Active)
- FNP-C – AANP Certified
- CPC, CRC, CDEO – AAPC
LANGUAGES
English – Fluent
Spanish – Fluent
CORE COMPETENCIES
- Primary Care: Adult & geriatric care, acute & chronic disease management
- Preventive Care: AWVs, screenings, immunizations, wellness planning
- Medicare Advantage: HCC coding, RAF scoring, quality gap closure
- Documentation Integrity: ICD-10, CPT, HCC, CMS risk adjustment
- Care Delivery: Telehealth, hybrid care, culturally competent communication
- EMRs: eClinicalWorks, Athena, EPIC, Tebra
- Team Collaboration: MDs, MAs, care coordinators, health coaches
Timeline
APRN – Family Nurse Practitioner
Family First Medical Center
08.2025 - Current
Fraud Nurse III – Medical Records Analyst
Peraton
10.2023 - Current
Medical Records Auditor & Provider Educator (Medicare Risk Adjustment)
Elevance Health (Anthem)
10.2016 - 10.2023
Certified Medical Assistant – Outpatient Family Medicine
AdventHealth
07.2014 - 10.2016
Master of Science in Nursing - Family Nurse Practitioner
Miami Regional University
Master of Science in Nursing -
Miami Regional University
Doctor of Medicine (MD Equivalent) - Family Medicine Focus
Medical Faculty of Santiago De Cuba