Dora Ortiz Lara
Caldwell,ID
Summary
Detail oriented healthcare professional with extensive experience in medical services and stong work ethics. Proven ability to collaborate effectively with teams and adapt to dynamic healthcare environments. Excellent communication skills and empathetic nature support positive patient outcomes.
Overview
2026
2026
years of professional experience
Work History
Patient Access Representative
Full Circle Health
12.2019 - Current
- Assisted patients with registration and appointment scheduling processes.
- Collected and verified patient information to ensure accuracy in records.
- Provided support in navigating insurance verification and eligibility checks.
- Communicated effectively with patients to address inquiries and concerns.
- Ensured compliance with HIPAA regulations to maintain confidentiality of sensitive patient information during all interactions.
- Maintained accurate patient records, contributing to a well-organized database for seamless information access across departments.
- Developed proficiency in various healthcare software programs for accurate documentation of patient encounters and streamlined workflows within the department.
- Collaborated with healthcare providers to ensure timely appointment scheduling and coordinated follow-up care for patients'' needs.
- Trained new hires on department procedures, policies, and software systems, ensuring consistent quality service delivery from all team members.
- Ensured seamless operation of front office, efficiently handling multiple administrative tasks simultaneously.
- Achieved high levels of accuracy in patient data entry, minimizing errors and enhancing record reliability.
Patient Specialist (Pediatrics)
Saltzer Medical Group
2018 - 2019
- Assisted patients with registration processes and insurance verification for seamless access to services.
- Streamlined appointment scheduling, reducing patient wait times and enhancing overall service efficiency.
- Handled sensitive situations involving distressed patients with empathy maintaining professionalism throughout interactions.
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
- Verified insurance coverage and obtained necessary authorizations to ensure timely billing and reimbursement.
- Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.
- Managed high call volume while maintaining a professional demeanor, ensuring accurate communication of information.
- Reduced billing errors by verifying demographic information and updating records as needed.
- Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
- Educated patients on available resources, programs, and financial assistance options to optimize their healthcare experience.
- Processed payments using cash and credit cards, maintaining accurate records of transactions.
- Greeted and assisted patients with check-in procedures.
- Trained new staff on filing, phone etiquette and other office duties.
Patient Specialist (Internal Medicine/ Surgery)
Saltzer Medical Group
2016 - 2018
- Assisted patients with appointment scheduling and registration processes to enhance patient experience.
- Managed patient inquiries and provided accurate information regarding services and procedures.
- Coordinated with healthcare providers to ensure timely follow-up on patient care plans.
- Implemented electronic health record systems to streamline patient data management and access.
- Collaborated with healthcare providers to gather necessary documentation for authorization submissions.
- Processed prior authorization requests accurately and efficiently to ensure timely patient access to medications.
- Maintained up-to-date knowledge of insurance policies and regulations impacting prior authorizations.
- Developed streamlined processes for tracking authorization statuses, improving workflow consistency.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
- Reviewed applications for different aid programs and determined which qualification criteria for individuals.
- Managed sensitive patient data with strict adherence to HIPAA regulations, ensuring privacy and confidentiality at all times.
- Established strong relationships with referring physicians'' offices by maintaining open lines of communication for seamless coordination of care across providers.
- Collected forms, insurance card, and co-pay to facilitate registration process and prepare patient for appointment.
- Collaborated with interdisciplinary healthcare teams to address complex patient needs and coordinate appropriate care plans.
- Offered simple, clear explanations to help clients and families understand clinic policies and procedures.
- Processed payments using cash and credit cards, maintaining accurate records of transactions.
Prior Authorization Coordinator
Saltzer Medical Group
2007 - 2016
- Coordinated prior authorization requests ensuring compliance with insurance guidelines
- Reviewed clinical documentation for accuracy and completeness to facilitate approval processes
- Collaborated with healthcare providers to gather necessary information for timely authorizations
- Utilized electronic health record systems to track and manage authorization statuses efficiently
- Mentored junior coordinators in best practices for handling complex authorization cases
- Reduced errors in documentation by meticulously reviewing medical records and verifying patient information.
- Collected and processed patient liability statements prior to service.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Authorized surgical requests in accordance with applicable plan guidelines.
- Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
- Maintained the confidentiality of sensitive patient information, adhering strictly to HIPAA regulations and safeguarding medical records appropriately.
- Contributed to improved patient outcomes by staying current on industry trends and changes in regulatory standards related to prescription drug coverage policies.
- Provided empathetic support for patients navigating complex medical systems, offering guidance and assistance throughout the prior authorization process.
- Expedited the approval process for vital medications by maintaining a strong working relationship with insurance providers.
- Mitigated risk of denied claims by conducting thorough research on individual policy guidelines before submitting requests.
- Maintained accurate case files, updating relevant information as needed to ensure efficient record-keeping practices.
- Fostered positive relationships with key stakeholders, utilizing exceptional interpersonal skills to address inquiries professionally and promptly.
- Demonstrated exceptional problem-solving skills, addressing challenges related to patient care coordination and insurance requirements with a solutions-oriented mindset.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
Receptionist
Saltzer Medical Group
2001 - 2007
- Facilitated patient check-in and appointment scheduling to enhance operational efficiency.
- Managed patient inquiries via phone and in-person, providing timely and accurate information.
- Coordinated insurance verification processes to ensure eligibility and reduce claim denials.
- Assisted patients in completing necessary documentation, improving overall patient experience.
- Participated in ongoing training programs related to HIPAA compliance, maintaining up-to-date knowledge on regulatory requirements.
- Entered patient demographic and insurance data into electronic medical record system.
- Processed medical records requests efficiently, safeguarding patient privacy while ensuring timely information access for healthcare providers.
- Assisted with insurance verification tasks, ensuring accurate billing and timely reimbursement for services rendered.
- Handled complex insurance pre-authorization processes accurately, enabling timely delivery of necessary medical services.
- Coordinated referrals efficiently between primary care providers and specialists, ensuring a seamless patient experience.
- Provided compassionate support for patients facing financial challenges, assisting them in navigating available resources and payment options.
- Processed payments using cash and credit cards, maintaining accurate records of transactions.
Skills
- Fluent in Spanish and English
- Prior authorization experience
- EPIC proficiency
- Professionalism and ethics
- HIPAA compliance
- Problem-solving
- High School Diploma
- Valid driver's liscence
Timeline
Patient Access Representative
Full Circle Health
12.2019 - Current
Patient Specialist (Pediatrics)
Saltzer Medical Group
2018 - 2019
Patient Specialist (Internal Medicine/ Surgery)
Saltzer Medical Group
2016 - 2018
Prior Authorization Coordinator
Saltzer Medical Group
2007 - 2016
Receptionist
Saltzer Medical Group
2001 - 2007
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