This document provides a summary of a medical billing and coding professional's qualifications. It includes 3 sentences summarizing her objective, education, and current role as a medical risk adjustment field auditor reviewing medical records to ensure accurate risk adjustment coding.

1. 1808 NW 20th
Place
Cape Coral, FL 33993-4984
AIDA PROENZA, CPC, CPC-P, CPMA, CPC-I, CRC Cell: (239) 438-2061
aproenza01@hotmail.com
OBJECTIVE
To obtain a challenging opportunity with a company in the medical field that would utilize my abilities,
training, and experience to boost the organizations bottom line via compliance and auditing, ultimately
benefiting the company, and therefore enhancing my career goals and expertise.
EDUCATION
Florida SouthWestern State College Fort Myers, FL
Program of Study - AS in Health Information Technology (HIT) 1/2015 to present
Seeking RHIT and CCS Certifications through AHIMA
Certified Risk Adjustment Coder (CRC) 12/12/2015
ICD-10-CM Proficient via AAPC Exam 12/29/2014
Certified Professional Medical Auditor (CPMA) 6/1/2013
Certified Professional Coder – Payer (CPC-P) 9/12/2009
Certified Professional Coder – Instructor (CPC-I) 5/14/2007
Certified Professional Coder (CPC) 6/24/2006
Cape Coral Institute of Technology, formerly
Lee County High Tech Center North Cape Coral, FL
1000hr Medical Coder/Biller program 8/1999 –11/2000
Rutgers, the State University New Brunswick, NJ
Liberal Arts/Accounting 9/1980 – 5/1982
WORK RELATED SKILLS AND ACCOMPLISHMENTS
 Specialties: Medicare Risk Adjustment (MRA), Hierarchical Condition Coding (HCC), Critical
Care/Pulmonary, Cardiology, Emergency Department, Internal/Family/Geriatric Medicine
 Medical Software: EPIC: Resolute and Epicare, 3M, Optika, Clinix, Medical Manager/Managed Care,
Intergy by Sage, Medic, Athena, Centricity, PowerChart by Cerner
 Knowledge of Windows, Word, Access, Excel, and Medical Office Procedures.
 Knowledge of medical terminology, diseases & conditions, anatomy & physiology.
 Ability to code diagnoses and procedures proficiently.
 Capability of conducting proactive coder reviews with the ability to abstract/audit a medical record.
 Extensive working knowledge of CPT and ICD-9-CM coding principles, governmental regulations,
protocols, and third-party payer requirements regarding coding and billing documentation.
 Exceptional communication and interpersonal skills.
 Excellent organizational techniques that ensure accurate and timely processing of job functions.
 Bilingual in both English/Spanish.

2. EMPLOYMENT HISTORY
Global TPA – Freedom Health 8/18/2014 to present
MRA Field Auditor – Principle duties include but are not limited to ensuring compliance with all applicable
Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk
Adjustment. Review medical records, patient medical history and physical exams, physician orders, progress
notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries in
order to verify whether: the diagnosis codes are supported by the documentation and ensure with ICD-9-CM
Guidelines for Coding and Reporting. The diagnosis codes for each chronic or major medical condition have
been captured and submitted within the permitted timeframe. Decide if any diagnosis code is unsubstantiated by
the record and should be eliminated. Review for clinical indicators and query providers to capture the severity
of illness of the patient. Review all medical record documentation using the Healthcare Effectiveness Data and
Information Set (HEDIS) to: Measure Providers' performance on important aspects of care and service. Provide
feedback that will assist Health Plan with reporting valid HEDIS measures with the goal of ensuring accurate,
reliable, and publicly reportable data.
NCH Physician Group 8/9/2010 to 8/12/2014
Manager of Internal Medicine 5/19/2013 to present
Principle duties included but were not limited to overall responsibility for personnel and staffing of the Marco
Island Internal Medicine office which included interviewing and hiring staff following established procedures.
My staff consisted of two physicians, two nurses and two front office personnel. I coordinated orientation of all
new employees and completed their 90 day evaluations. Oversaw and participated in staff training and
development. Ultimately assuming responsibility for ensuring staff was performing their job duties in an
exemplary fashion while at the same time addressing instances of staff performance that fell below the
established departmental and NCH standards. Ensured staff members remained in compliance with continuing
education requirements. Oversaw the staffs work time-management and payroll needs. Analyzed and oversaw
all operations, procedures and processes applicable to assigned practices/departments so as to achieve an
exceptionally high degree of efficiency and standardization. Such procedures and processes included but were
not limited to: check-in; check-out; patient registration; patient appointment scheduling; telephone
management; medical records management; ancillary/specialty referral/appointment management; patient flow;
front-desk operations; forms management; equipment management; supply and inventory management.
Develop, oversee and manage the practice/departmental budget.
Internal Audit/Coding Reviewer – 10/1/2012 to 5/16/2013
Principal duties included but were not limited to conducting monthly and quarterly record reviews in order to
accomplish the compliance review goals as set forth annually by compliance and revenue cycle departments.
Responsible for physician/provider coding and billing reviews; coding staff record reviews; education to
professionals and staff on appropriate coding and medical record documentation based on coding guidelines and
regulations; in addition to assisting with other compliance issues. Ensure accuracy and reliability of data while
promoting documentation efficiencies. Identify areas of risk, in addition to assisting as needed with coding and
follow-up overflow. Share data with directors, managers, physicians/providers, and coders in a timely manner
as appropriate, sharing compiled educational materials pertinent to the discovered areas of compliance risk to
physician/provider and coding staff. Seek out direct understanding of physician/provider work related to any of
the respective specialties either by personal research, or by following or shadowing in clinic periodically.
Assist coding team with research of difficult coding and documentation issues, as well as assist coding and
billing teams with coding and follow-up assistance when necessary. Know principles and practices of medical

3. record keeping; advanced medical terminology, anatomy and physiology, as well as the sequence, progression
and description of diseases as they apply to medical record coding and abstraction.
Certified Coding/Billing Specialist – 8/9/2010 to 10/1/2012
Principal duties include but are not limited to appropriately linking the correct evaluation and management
(E/M) codes and current CPT procedure codes to the assigned and/or appropriately designated ICD-9-CM
codes. Perform Inpatient/Outpatient Billing and Coding, Charge-entry and Payment-posting, Claims appeals
and denials. I began my career with NCH when they acquired Anchor Health Centers in October of 2010. I
was a Coder for the Pulmonary Department and then transferred to the Cardiology Department which was
newly acquired by NCH Healthcare Group in October of 2011. I organized physician interaction/education
sessions and coding projects which required accuracy, efficiency and the ability to multitask.
AVICA Billing Solutions 1/1/2010 to 8/7/2010
Coder/Billing Specialist – Principal duties included but were not limited to Inpatient/Outpatient Billing and
Coding, Charge-entry and Payment-posting, Claims appeals and denials. Verified account balances and
refunded appropriate outstanding balances. Entered notes in patient accounts of refund check amount and check
date. Forwarded refund requests to Controller for check processing. I monitored all insurance edit reports,
making any necessary corrections and re-filing corrected charges promptly. I generated requests for review
from the insurance pending/AR status claims and balances over 60 days old.
Jose R. Marquina, MD, FCCP 3/12/2005 to 1/26/2010
Administrative Director of Finance – Principal duties included but were not limited to Human Resources
Administrator/Payroll-processor, Physician Credentialing, Inpatient/Outpatient Billing and Coding, Charge-
entry and Payment-posting, Registrations, Claims appeals and denials. Planned, directed and coordinated
professional fee revenue cycle operations from point of entry to accurate adjudication of patient’s accounts.
Implemented specific performance measures and monitored tools that quickly and proactively responded to
revenue cycle issues. Communicated policy, procedure and standard changes to providers and staff effectively.
Responsible for ensuring the accuracy and integrity of the practice management system with compliance
relative to regulatory requirements such as Medicare Fraud Initiatives specific to bundling and unbundling
codes, billing un-chargeable items, and billing non-covered services. Claims transmissions, failed edits,
monthly A/R reports, month and year end closes. Developed and administered annual operating budget,
identified resources needed to accomplish performance objectives, and exercised cost control to stay within
budget. Identified variances and developed action plans to address budgetary impact issues. Responsible for
managing the day to day operations of two (2) physicians, two (2) mid-levels, a Nurse, a Respiratory Therapist,
three (3) front office staff and a biller. Other responsibilities included the recruitment, selection, training, and
performance evaluation of the office staff. I worked directly with the Physicians/Mid-levels and assisted them
in finding ways to improve on efficiency and time saving techniques for the Physicians and the staff on a day to
day basis. I also provided Physician education when necessary. I worked closely with patients and vendors to
help ensure all expectations were met. In 2005, when I began working for this office their revenue increased
from $900,000 annually to $2,250,000 by the end of 2009. The A/R was also worked and was dramatically
decreased from an outstanding amount of $650,000 to just under $150,000.
PROFESSIONAL ACTIVITIES, INTERESTS AND RECOGNITIONS
 Current Member of the American Academy of Professional Coders (AAPC) since 2001
 Certified Professional Coder (CPC) since 10/2001
 President-Elect of the City of Palm Chapter AAPC in 2001, 2015, 2016
 President of the City of Palms Professional Coders in 2002, 2003, 2008 and 2012
 Founder and President of the Weston Professional Coders in 2004

4.  Member of the American Health Informational Management Association (AHIMA) both National and
Local Florida Chapter (FHIMA) since 2002
 Advisory Board Committee High Tech Center North from 2007 to present