Elida Ortega
Corpus Christi,TX
Summary
Excellent people skills and thrives on helping to solve problems. Superb communication skills, verbal and written. Strong attention to detail. Highly organized with the ability to multi-task and accomplish multiple objectives to further my knowledge in a professional business setting.
Overview
33
33
years of professional experience
Work History
Senior Claims Analyst
Driscoll Health Plan
08.2017 - Current
- Reduced claim processing time by streamlining workflow and implementing efficient case management strategies.
- Enhanced overall team performance by providing mentorship, guidance, and training to junior claims analysts.
- Increased accuracy in claims assessment through thorough investigation and diligent documentation of claim details.
- Improved customer/provider satisfaction by consistently resolving complex claims in a timely and professional manner.
- Lead Departmental projects and improvements
- Identify trends and recommend solutions for errors as identified through pre and post payment claim and recovery review
- Ensure adherence to sate and federal compliance reimbursements and contract policies
Coordinator
Driscoll Health Plan
11.2016 - 08.2017
- Increased efficiency by streamlining coordination processes and implementing new organizational systems.
- Managed project timelines for successful completion, ensuring milestones were met and deadlines were adhered to.
- Improved team productivity with regular communication and progress updates, fostering a collaborative work environment.
- Coordinated cross-functional teams, resulting in seamless project execution and enhanced outcomes.
Customer Service Representative
Valence Health
03.2013 - 10.2016
- Verify Insurance Claims, private insurance, Medicaid
- Submitted refund requests for claims paid in error
- Inform members of their financial responsibilities prior to services being rendered
- Answer phones
- Fax documents to members and providers
- Mail Return
- After Hours Calls
- Test Phone lines.
Medical Office Specialist (Assistant Manager)
Coastal Bend Cancer Center
05.2007 - 11.2013
- Wrote clear and detail clinical phone message for Physicians
- Scheduled surgeries and procedures
- Completed registrations quickly and cordially for new patients
- Scheduled patient appointments and radiology exams
- Pulled/filed medical records
- Answered phones (up to 20 lines)
- Responsible for supervision of a staff
- Training of medical office representatives
- Prepared weekly reports
- Assisted in the development of new policies and procedures
- Referrals and authorization
- Verified insurance
- Check-In/ Check Out
- Ordered office supplies
- Processed monthly physician on-call calendars
- Assisted patients with complaints.
Scan Coordinator
HEB # 2
09.1990 - 03.2006
- Pricing
- Replenish stock
- Supervise and counsel employees
- Created sales.
Education
Medical Office Specialist Diploma -
Certification - Certifier Medical / Billing Coder
Del Mar College
Corpus Christi, TX01.2024
GED Graduate -
01.2006
Skills
- HIPAA certified through Kaplan Higher Education
- Medial Manager Software
- Patient-focused care
- Exercises good judgment
- Quality control
- Money management
- Maintains strict confidentiality
- Knowledge of HMOS,,Medicare and Medicaid
- Self-motivated
- Able to Multi-task
- Bilingual
- ICD-P and CPT coding
- HIPAA Compliance
- CPR
- OSHA trained
- PowerPoint
- Telephone technique
- Dependability
- Professionalism and Integrity
- Adaptability and Flexibility
- Insurance Industry Knowledge
- Critical Thinking Abilities
- Claims Processing Efficiency
- Claims Analysis Expertise
Fax
Fax
Timeline
Senior Claims Analyst
Driscoll Health Plan
08.2017 - Current
Coordinator
Driscoll Health Plan
11.2016 - 08.2017
Customer Service Representative
Valence Health
03.2013 - 10.2016
Medical Office Specialist (Assistant Manager)
Coastal Bend Cancer Center
05.2007 - 11.2013
Scan Coordinator
HEB # 2
09.1990 - 03.2006
Medical Office Specialist Diploma -
Certification - Certifier Medical / Billing Coder
Del Mar College
GED Graduate -
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