Jomary Ortiz
Methuen
Summary
To obtain employment at a company where I can expand my knowledge and obtain additional training.
Qualified and hardworking Reimbursement Specialist with expertise in policy research and customers service. Offering experience in analyzing coverage and securing collection for claims. Excellent written and verbal communication skills.
Overview
20
20
years of professional experience
Work History
Reimbursement Specialist II
Novocure
Portsmouth
10.2020 - Current
- Complete insurance benefit verifications to confirm active coverage.
- Secure approvals from assigned payers to establish medical necessity and facilitate timely patient treatment.
- Apply problem-solving and critical thinking to overturn denials and ensure successful reimbursement.
- Monitor the status of submitted claims and conduct follow-up action with insurance companies regarding outstanding claims.
- Actively participate in team training and provide support across all reimbursement processes, ensuring consistency, knowledge sharing, and operational efficiency.
- Submit, monitor, and track the status of claims appeals to resolve payment discrepancies efficiently.
- Investigate and resolve incorrect payments while identifying and escalating patterns of payer behavior that impact reimbursement.
- Identify and communicate challenges and opportunities related to payer contracts and medical policy changes.
- Proactively recognize and communicate opportunities to streamline workflows and enhance operational efficiency.
- Perform additional responsibilities based on team and organizational priorities.
- Processed patient reimbursement claims accurately and efficiently.
- Communicated with healthcare providers regarding claim status and requirements.
- Coordinated with financial teams to resolve billing discrepancies.
- Maintained up-to-date knowledge of reimbursement policies and regulations.
- Collaborated with cross-functional teams to improve workflow efficiency.
- Maintained confidentiality and integrity of patient data.
- Researched rejections, investigating problems to appeal claims.
- Determined medical necessity, using individual insurance carrier regulations.
- Worked with billing department to reduce contract implementation errors.
Patient Admissions Services
Lawrence General Hospital
Lawrence
02.2015 - 10.2020
- Clerical Duties
- Patient Registration
- Insurance Verification
- HIPPA Compliance
- Completed day-to-day duties accurately and efficiently.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Identified needs of customers promptly and efficiently.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Maintained updated knowledge through continuing education and advanced training.
- Worked with cross-functional teams to achieve goals.
Administrative Assistant
Lawrence General Hospital
Lawrence
08.2009 - 02.2015
- Clerical Duties
- Insurance Verification
- Obtain Authorization
- Book Procedures
- Appointment Reminder Calls
- Medical Interpreter
- HIPPA Compliance
- Order Office Supplies
- Specimen Delivery
- Managed patient scheduling and appointment confirmations for efficient department operations.
- Assisted healthcare professionals with administrative tasks and document management.
- Coordinated communication between departments to ensure seamless information flow.
- Organized medical records and maintained compliance with privacy regulations.
- Maintained inventory of office supplies and ordered materials as needed.
- Responded to patient inquiries and provided information about hospital services.
- Answered phone calls and emails to provide information, resulting in effective business correspondence.
- Entered data into spreadsheets using Microsoft Excel or other similar programs.
- Organized and maintained filing systems for physical and electronic documents, ensuring accuracy and confidentiality of records.
- Handled confidential documents in an organized fashion according to established protocol.
- Maintained office supplies inventory by checking stock to determine inventory level.
- Greeted visitors in a professional manner, responding to inquiries and directing them to appropriate personnel.
- Provided administrative support to the executive team, including scheduling meetings and managing calendars.
- Answered questions from customers regarding products and services offered by the company.
- Scheduled appointments between clients and customers and internal staff members.
- Ensured efficient operation of office equipment such as printers, copiers and fax machines.
Front Desk Receptionist
Community Medical Professionals
No. Andover
06.2005 - 08.2009
- Clerical Duties
- Insurance Verification
- Book Appointments
- Check-in Patients
- Appointment Reminder Calls
- HIPPA Compliance
Education
Undergrad/Bachelors -
Southern New Hampshire University
Manchester, NH12-2025
High School Diploma -
Greater Lawrence Vocational Technical High School
Andover, MA06.2005
Skills
- Excellent Customer Service Skills
- Administrative Experience
- Authorization Experience
- Great Organizational Skills
- Insurance Verification Knowledge
- Knowledgeable in Microsoft Office (Outlook, Word, Excel, and PowerPoint)
- Experience with EMR, Emdeon, EClinical Works, Paragon, Evicore, and Nehen
- Insurance verification
- Patient registration
- Customer service
- Problem resolution
- Data entry
- Workflow optimization
- Compliance management
- Team collaboration
- Payment posting
- Client service
- Healthcare industry
- Eligibility verification
- Bookkeeping
- Commercial insurance
- Claims processing
- Microsoft office
- HIPAA compliance
- Process monitoring
- Organizational skills
- Teamwork
- Time management abilities
- Multitasking capacity
- Problem-solving aptitude
- Verify data
- Self motivation
- Professionalism
References
Furnished upon request
Timeline
Reimbursement Specialist II
Novocure
10.2020 - Current
Patient Admissions Services
Lawrence General Hospital
02.2015 - 10.2020
Administrative Assistant
Lawrence General Hospital
08.2009 - 02.2015
Front Desk Receptionist
Community Medical Professionals
06.2005 - 08.2009
Undergrad/Bachelors -
Southern New Hampshire University
High School Diploma -
Greater Lawrence Vocational Technical High School
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