Risk Adjustment Medical Records

CLAUDIA ROLDOS

Miami, FL 305-***-**** ******.*******@*****.***

Licensed professional coder by AAPC with more than 4 years of experience in the Coding and Billing branch of Administrative Healthcare.

EXPERIENCE

MAY 2025- DECEMBER 2021

CERTIFIED RISK ADJUSTMENT PROFESSIONAL CODER – SANITAS MEDICAL CENTER

Accurately assign the ICD-10 and CPT codes for 60 to 80 patient chats daily, reviewing documentation from both primary and urgent care settings.

Apply in-depth knowledge of Hierarchical Condition Categories (HCC) and risk adjustment models (CMS, HHS) to ensure precise coding and optimize patient risk scores.

Identify documentation deficiencies in provider notes; proactively collaborate with physicians to improve documentation quality and ensure compliance with risk adjustment requirements.

Utilize advanced understanding of medical terminology, anatomy and physiology to support accurate and compliant coding.

Contribute to improved quality reporting and reimbursements outcomes through coding accuracy and risk score optimization.

NOVEMBER 2021- FEBRUARY 2018

HEALTH INFORMATION MANAGEMENT- SANITAS MEDICAL CENTER

Managed high volume inbox processing, handling and routing 100-150 incoming faxes daily to the appropriate staff and accurately assigning them to corresponding patient charts.

Processed medical records requests from patients, external providers, specialists’ offices and subpoenas in compliance with HIPAA and organizational protocols.

Maintained detailed logs of all medical records and fax related requests to ensure accuracy, compliance and follow up tracking.

Supported smooth clinical operations by ensuring timely communication and record-sharing between departments and external healthcare entities.

SKILLS AND EDUCATION

ICD-10, CPT, HCPCS coding HCC Coding and Risk Adjustment (CMS, HHS models) Time Management and Multitasking Provider Communication Medical Record Review Documentation Improvement Medical Terminology and Anatomy eClinicalWorks (eCW) High Volume Fax and Record Processing HIPAA Compliance EHR Navigation Fluent in English and Spanish Tech-savvy; proficient with healthcare software and digital tools.

Graduated with a high school diploma in 2013. Attended Miami Dade College for two years.

Assisted Excelsior Technical Institute in North Miami Beach where I received courses to obtain both CPC and CRC certifications.