Aleisha Ortiz
Gretna,Nebraska
Summary
Goal driven, Reputable and Skilled Account Manager -focused on providing expert advice to improve business operations, help Identify areas of improvement, develop strategies, and implement solutions to help achieve goals. Proficient in relationship management and forecasting client needs. Repeated success in maintaining large books of business, improving efficiency, time management, enhancing performance, and cost-effective solutions to operational challenges.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Operations Consultant / Account Manager / Affiliate Success Coordinator
FocusOne / Medical Solutions
09.2019 - 10.2023
- Acted as single point of contact for all clinical and non-clinical staffing needs
- Assisted in improving efficiency, saving time, enhancing performance, and helped gain control over staffing spend
- Streamlined hundreds of staffing companies and was tailored to each of our client hospitals
- Relationship management with client hospitals, managing all aspects of the day-to-day staffing needs (both travel and permanent)
- Absorb the calls, manage relationships with staffing agencies, and source candidates with a priority on quality, ensuring one consistent credentialing process
- Skilled in Contact Centers, Management, Insurance, Account Management, and Leadership
- Determining the scope of operational improvement initiatives via consultation and evaluation
- Single Point of contact for Client
- Developing operational improvement strategies
- Recommending cost-effective solutions to operational challenges
- Restructuring departments and defining employee roles.
Account Manager / Customer Service Specialist
Payflex/ Aetna/ CVS
11.2010 - 08.2019
- Accountable for the retention of National and Key accounts and Select book of business by delivering superior service
- Responsible for coordinating with AMs to grow existing client revenue through several approaches
- Introducing and selling additional products and grow existing product membership
- Open enrollment support
- Increase revenue using applicable renewal guidelines
- Direct all aspects of customer benefit plan implementation for new and existing customers
- Identify critical implementation issues ensuring customer expectations are consistently satisfied or exceeded
- Provide guidance to develop and implement strategic plans
- Responsible for managing and cultivating positive, collaborative relationships with clients
- Act as the single point-of-contact for benefit plan implementation
- Mediate and coordinates resolution of all project deliverables and implementation related issues
- Create, manage and track detailed project plan(s
- Identify problems and establish procedures to ensure that they do not recur
- Maintain strong in-depth knowledge of PayFlex products, services and system capabilities, including HSA, FSA, HRA, Commuter, COBRA and Direct Billing administration
- Conduct standard quality reviews /audits to measure compliance
- Assist with the day-to-day maintenance and operations of assigned functional unit
- Perform analysis of data to identify and communicate trends during day-to-day work
- Execute resolution for escalated member and company issues
- Perform or assist with special projects/reviews
- Provide technical or subject matter expertise concerning policies, procedures, and function-related applications/systems tools.
Affiliate Success Coordinator
FocusOne / Medical Solutions
- Managing and maintaining relationships with the company’s affiliates
- Ensure affiliates are meeting goals and objectives
- Provide support to the affiliates, including training, marketing materials, and other resources to help them succeed in their roles
- Monitored affiliate performance and provided feedback to help them improve their performance
- Manage Payroll, compliance, and billing services
- Provide Market material as well as gain feedback
- Screen candidate profiles to ensure they are qualified for the client assignments
- Train agencies on client portal as far as timekeeping and viewing of open assignments
- Act as single point of contact for any day-to-day email communication to and from client and in relation to the contractors
- Timely post and marketing for client needs and assignments.
Customer Service Specialist/ Web Support/ Escalations and Claim processing
Payflex/ Aetna/ CVS
- Answer questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors
- Triages resulting rework to appropriate staff
- Documents and tracks contacts with members, providers and plan sponsors
- Explains member's rights and responsibilities in accordance with contracts and IRS Guidelines
- Processes claim referrals, new claim handoffs, claims support, nurse reviews, complaints
- Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues
- Responds to requests received from Aetna's Law Document Center regarding litigation; lawsuits
- Handles extensive file review requests
- Assists in preparation of complaint trend reports
- Assists in compiling claim data for customer audits
- Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals
- Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible
- Performs financial data maintenance as necessary
- Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.
Education
Some College Coursework Completed, Metro Community College
College of Saint Mary
Skills
- Account Acquisition & Management
- Business Planning
- Presentations and Evaluations
- Compliance Regulations
- Strategic Account Development
- Cold Calling & Prospecting
- Strong Interpersonal Skills
- Product Training and Placement
- Customer Service Oriented
- Analyzing Market material and feedback
- Billing and Invoicing
- Implementations on New Business
- Benefits Knowledge
- Quality Analyst/ Escalation resolutions
- Leadership Skills
- Analysis of data
- Data Entry
- Claims Analysist
- Sales and Service
- Problem Solving
- Detail Oriented
- Time Management
- Strong Work Ethic
- Team Player
- Account and Relationship Management
Certification
Professional Development 1, 01/2023, Omaha, NE
Software Proficiencies
- Microsoft Office
- Health Direct
- Power point
- ADP
- Word, Excel, Outlook
- Macro Templates
- Connect
- Payroll Systems
- Remi
- Share point
- CBAS & SFTP sites
Personal Information
Specialization: Account and Relationship Management
Timeline
Operations Consultant / Account Manager / Affiliate Success Coordinator
FocusOne / Medical Solutions
09.2019 - 10.2023
Account Manager / Customer Service Specialist
Payflex/ Aetna/ CVS
11.2010 - 08.2019
Affiliate Success Coordinator
FocusOne / Medical Solutions
Customer Service Specialist/ Web Support/ Escalations and Claim processing
Payflex/ Aetna/ CVS
Some College Coursework Completed, Metro Community College
College of Saint Mary