Ailen Valdes
Miami,USA
Summary
Health Care Professional with over 17 years of experience. Detailed-oriented and enthusiastic, with excellent communication and collaboration skills within teams. Proven ability to adapt to challenges, work effectively under pressure, and deliver high-quality results. Certified Professional Auditor and Coder dedicated to maintaining compliance with regulations and optimizing healthcare operations.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Medical Auditor
Claremedica
Miami, FL
05.2025 - 04.2026
- Conducted internal pre-audits of medicare patient medical records to ensure documentation accuracy and CMS compliance.
- Reviewed provider documentation to validate ICD-10-CM coding, HCC capture, and risk adjustment accuracy.
- Identified documentation gaps, unsupported diagnoses, and coding discrepancies prior to submissions.
- Ensured compliance with CMS Risk Adjustment guidelines and Medicare Advantage requirements.
- Provided feedback and education to providers to improve documentation specificity and RAF accuracy.
Medical Coder Level 3
CareMax
Miami, FL
11.2022 - 02.2025
- Code and review patient records with a focus in accuracy using ICD-10 CM, CPT and HCPCS Level II codes
- Ensure compliance with HCC and CMS guidelines to optimize reimbursement and enhance the accuracy of risk adjustment scores
- Collaborate with physicians and staff to resolve documentation queries and provide training on proper coding practices
- Conduct detailed audits and analyses to identify opportunities for improvement in clinical documentation
- Maintain patient confidentiality while working with sensitive medical data in line with HIPPA standards
- Utilize expertise in Microsoft Office, NextGen, Practice Fusion, MDFlow, Harris CareTracker and Athena for efficient documentation and workflow management
Office Manager, Referral and Medical Records
Rafael Chiong, MD PA Office
Miami, FL
04.2008 - 11.2022
- Obtained necessary signatures on information release forms to obtain medical and treatment records from other service providers
- Analyzing daily administrative operations and utilization of resources
- Managing liaison with insurance providers on behalf of patients
- Ensuring office policy and procedure and followed
- Scanning all signed result documents in the patient's chart daily
- Pre-Authorizations of medication and processing referral for Specialist
- Managing patient's health records and history helping conduct audits, gathering and refilling patient information
Medical Assistant
Pasteur Medical Center
Miami, Florida
01.2007 - 11.2022
- Directed patients to exam rooms, fielded questions and prepared for physician examinations
- Obtained client medical history, medication information, symptoms and allergies
- Completed clinical procedures and gathered patient data for interpretation by physician
- Promoted office efficiency, coordinating charts, completing insurance forms and helping patients with diverse needs
- Performed clerical duties, such as word processing, data entry, answering phones and refilling
- Ensuring compliance with all HEIDIS, HIPPA, OSHA and other federal, state or local regulations
Education
CPC - Certified Professional Coder
Excelsior Technical Institute
Doral, FL08-2021
NRCMA - Certified Medical Assistant
Compu-Med Vocational Careers
Miami, FL05-2009
CNA - Certified Nursing Assistant
Florida Education Institute
Miami, FL09-2006
Skills
- ICD-10 CM
- CPT
- HCPCS level II codes
- Medical Terminology
- Patient Data Coding
- Excellent Communication
- Multitasking Abilities
- Decision-Making
- Analytical and Critical Thinking
- Procedural Codes
- Patient Data Management Systems
- Health Care Systems
- Microsoft Office
- NextGen
- Practice Fusion
- Harris CareTracker
- Athena
- MDFlow
Certification
- CNA - Certified Nursing Assistant
- NRCMA - Nationally Registered Certified Medical Assistant
- CPC - Certified Professional Coder
- CPR and AED
- OSHA Safety Risk Management Program
- CPMA - Certified Professional Auditor
- CDEO - Certified Documentation Expert Outpatient
- CRC - Certified Risk Adjustment Coder
Languages
English
Full Professional
Spanish
Native/ Bilingual
Additionalinformation - References
Available upon request
Timeline
Medical Auditor
Claremedica
05.2025 - 04.2026
Medical Coder Level 3
CareMax
11.2022 - 02.2025
Office Manager, Referral and Medical Records
Rafael Chiong, MD PA Office
04.2008 - 11.2022
Medical Assistant
Pasteur Medical Center
01.2007 - 11.2022
NRCMA - Certified Medical Assistant
Compu-Med Vocational Careers
CNA - Certified Nursing Assistant
Florida Education Institute
CPC - Certified Professional Coder
Excelsior Technical Institute