Bertha De La Torre
Lake Mary,FL
Summary
Dedicated and adaptable professional with a proactive attitude and the ability to learn quickly. Strong work ethic and effective communication skills. Eager to contribute to a dynamic team and support organizational goals.
Overview
2025
2025
years of professional experience
Work History
Network Management Specialist
AdventHealth
Maitland, FL
03.2024 - Current
- Coordinates and files fully executed contracts through the provider processing workflows, including credentialing and configuration setup, as needed.
- Communicate with customers and stakeholders via inbound and outbound calls and/or emails in a timely manner.
- Collects Initial and Re-credentialing applications from network provider representatives, evaluates them for completeness, and submits them to credentialing specialists for processing.
- Updates AdventHealth's Client Relationship Management tool and credentialing software with appropriate updates, and maintains accurate data to support network operations.
- Utilizes knowledge and understanding of provider data management applications used to support provider directories and other externally reported rosters.
Contract Coordinator
AdventHealth
Maitland, FL
- Responsible for all aspects of data management related to PHSO provider contracts and network data. Including securing fully executed contracts, coordinating with the primary health division workflow to ensure copies are sent to providers, filing the electronic copy in the electronic warehouse for contracts, and uploading documents into affiliated payers/plans portals as required.
- Coordinates and files fully executed contracts through the provider processing workflows including credentialing and configuration setup, as needed.
- Monitors current contracts to ensure that contracts and agreements expiration issues are avoided prior to their termination dates.
Contracting Coordinator
AdventHealth
Orlando, FL
- Organized and maintained contract documents, fee schedules, and other related materials.
- Facilitated communication between HealthFirst and AdventHealth regarding contracting inquiries, provider enrollment information, and claim disputes.
- Researched and resolved complex inquiries from internal stakeholders regarding provider data.
- Reviewed provider data submissions to ensure accuracy and completeness of information.
- Interfaced with vendors outside of the organization when necessary in order to obtain additional information about providers.
Provider Solutions
AdventHealth
Maitland, FL
- Researched and resolved complex inquiries from internal stakeholders regarding provider data.
- Collaborated with other departments to ensure accurate representation of provider data in the system.
- Interfaced with vendors outside of the organization when necessary in order to obtain additional information about providers.
- Ensured that all changes made to existing records were properly documented and reflected accurately in the system.
- Responded promptly and professionally to customer inquiries via phone or email pertaining to their specific needs.
- Facilitated dispute resolution between the organization and its contracted providers.
Customer Service Representative
Florida Hospital Health Care System
Orlando, FL
12.2011 - 12.2013
- Answered incoming calls and emails, providing frontline customer support with product and service transactions.
- Assisted with customer inquiries, complaints, and requests for information regarding insurance policies.
- Researched relevant policy information to answer customer questions.
- Assisted claimants, providers and clients with problems or questions regarding claims.
Outbound Representative: Workers Compensation
Access On Time
Lake Mary, FL
08.2010 - 07.2011
- Managed patient transportation requests and provided accurate information to clients.
- Coordinated with medical staff, patients, and families to ensure safe transport of patients.
- Maintained records of all transportation services performed and communicated any changes in service levels or policies to customers.
- Ensured compliance with federal, state, and local regulations regarding the transport of passengers requiring special medical attention or equipment.
- Scheduled trips for multiple patients based on availability of resources such as vehicles, drivers, and other personnel needed for the trip.
Medical Bill Claims Processor/Workers Compensation
Amerysis
Oviedo, FL
01.2008 - 01.2009
- Investigated and evaluated workers' compensation claims to determine eligibility, coverage and appropriate benefits.
- Processed and reviewed documents related to workers' compensation claims such as medical reports, wage statements, job descriptions and incident reports.
- Resolved discrepancies in claim information by obtaining additional documentation or clarifying facts.
- Maintained accurate records of all claims including status updates, payment histories and other pertinent information.
Claims Adjuster
Explorer Insurance Co
Lake Mary, FL
05.2005 - 08.2006
- Investigated and analyzed auto insurance claims to determine validity, accuracy, and coverage.
- Determined liability based on facts gathered from investigations.
- Prepared detailed reports summarizing all aspects of the claims process.
- Managed multiple cases simultaneously while meeting established deadlines.
- Processed payments according to terms outlined in policy contracts.
Claims Assistant
AIG Insurance Co
Lake Mary, FL
10.2000 - 05.2005
- Investigated and analyzed auto insurance claims to determine validity, accuracy, and coverage.
- Managed multiple cases simultaneously while meeting established deadlines.
- Processed payments according to terms outlined in policy contracts.
- Researched and verified insurance policy coverage.
- Provide customer support to members, providers, billing departments and other insurance agency's regarding claims, appeals and eligibility.
- Coordinated benefits while applying applicable deductibles, co-insurance and out-of-pocket costs.
Education
Bachelor of Science - Psychology
Universidad Del Sagrado Corazón
Santurce, Puerto RicoSkills
- Data Entry
- Project Planning
- Customer Service
- Troubleshooting
- Multitasking
- Quality Assurance
- Organization and Time Management
- Teamwork and Collaboration
- Problem Resolution
- Salesforce CRM
- MS Office
Timeline
Network Management Specialist
AdventHealth
03.2024 - Current
Customer Service Representative
Florida Hospital Health Care System
12.2011 - 12.2013
Outbound Representative: Workers Compensation
Access On Time
08.2010 - 07.2011
Medical Bill Claims Processor/Workers Compensation
Amerysis
01.2008 - 01.2009
Claims Adjuster
Explorer Insurance Co
05.2005 - 08.2006
Claims Assistant
AIG Insurance Co
10.2000 - 05.2005
Contract Coordinator
AdventHealth
Contracting Coordinator
AdventHealth
Provider Solutions
AdventHealth
Bachelor of Science - Psychology
Universidad Del Sagrado Corazón
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