ESTELITA MARTINEZ
Amerihealthcaritas
Gloucester City,NJ
1
Language
20
years of professional experience
Analyzed and restructured approval processes to facilitate timely patient care delivery through remote opportunities.
Work History
Quality Assurance Supervisor
8 Years 9 Months- Led quality assurance initiatives to enhance compliance with regulatory standards and improve service delivery.
- Developed and implemented training programs for staff to ensure adherence to quality protocols and best practices.
- Conducted regular audits of operational processes, identifying areas for improvement and implementing corrective actions.
- Collaborated with cross-functional teams to streamline workflows, resulting in increased efficiency and reduced errors.
Insurance Authorization Specialist
9 Months- Initiated and obtained prior authorizations for diagnostic imaging and outpatient surgeries via phone, fax, and payer portals.
- Monitored and managed pending authorization requests to ensure compliance with turnaround time requirements.
- Document all authorization activities, approvals, denials, and reference numbers in EPIC EMR.
- Reviewed medical records and provider notes to support medical necessity for authorization approvals.
- Managed authorization denials by notifying providers, facilitating peer-to-peer discussions with payers, and securing required clinicals to overturn decisions.
- Remote
Customer Service Representative
3 Years 3 Months- Resolved customer inquiries and complaints, ensuring timely and accurate responses to enhance satisfaction.
- Trained new team members on established procedures and best practices for customer service excellence.
- Collaborated with management to develop strategies that improved operational efficiency and reduced wait times.
- Implemented feedback mechanisms to gather insights from customers, driving continuous improvement initiatives.
Credibility Analyst
5 Years 4 Months- Analyzed healthcare data to identify trends and support strategic decision-making processes.
- Developed comprehensive reports utilizing advanced analytical tools to enhance operational efficiency.
- Collaborated with cross-functional teams to streamline workflows and improve service delivery outcomes.
Lockbox Processor
2 Years 7 Months- Process lockbox transactions efficiently, ensuring accurate posting to customer accounts.
- Monitor and reconcile daily processing discrepancies to maintain data integrity.
- Implement workflow improvements that enhance processing speed and reduce errors.
- Train new staff on lockbox procedures, fostering a culture of compliance and accuracy.
Quality Assurance Auditor
3 Years 3 Months- Conducted thorough audits of operational processes to ensure compliance with industry standards.
- Reviewed and analyzed documentation for accuracy and consistency in quality assurance practices.
- Developed and implemented quality control procedures to enhance operational efficiency.
- Assist with new hire training on best practices for quality assurance and regulatory compliance.
Bookkeeper
3 Years 10 Months- 1Managed accounts payable and receivable processes to ensure accuracy and timely payments.
- Reconciled cashier register to accurate balance.
- Generated monthly financial reports for management review, highlighting key trends and variances.
- Before start of shift provider register to each cashier of $100.00. Balance prior night cash register for Garda pickup. Order currency when needed.
Team Leader/Provider Full Service
6 Years 2 Months- Led cross-functional teams to enhance operational efficiency and improve service delivery within healthcare programs.
- Developed training programs for staff, fostering skill advancement and promoting a culture of continuous improvement.
- Implemented best practices in patient care coordination, resulting in improved health outcomes and patient satisfaction.
- Collaborated with stakeholders to identify process gaps and drive strategic initiatives that align with organizational goals.
Education
General Education Development
Skills
Prior Authorizations
Benefit Verification
Medical Terminology
HIPAA Compliance
Payer Portal Navigation
Remote Communication Tools
EMR Systems
CPT
ICD-10
HCPCS
Patient Advocacy
Data Entry
Documentation Accuracy
Time Management
Organization
Multitasking
Prioritization
Microsoft Office Suite Proficiency-Excel
Outlook
PowerPoint
Denial Management
Attention to Detail
Adaptability
Accuracy
Medical Necessity
Electronic Health Records
Languages
Spanish
Elementary
Timeline
Insurance Authorization Specialist
Randstad
04.2025 - 01.2026Read More
Customer Service Representative
Wawa
05.2020 - 08.2023Read More
Quality Assurance Supervisor
Amerihealthcaritas
11.2017 - CurrentRead More
Lockbox Processor
PNC Bank
08.2017 - 03.2020Read More
Credibility Analyst
Amerihealthcaritas
06.2015 - 10.2020Read More
Quality Assurance Auditor
Amerihealthcaritas
06.2012 - 09.2015Read More
Bookkeeper
Home Depot
10.2010 - 08.2014Read More
Team Leader/Provider Full Service
Amerihealthcaritas
04.2006 - 06.2012Read More
William Penn High School
General Education Development
Read More